Study shows transgender youth have high parental support, but lack access to care

A first-of-its-kind study gives a glimpse into the experiences of 174 transgender youth across Canada over a two-year period, highlighting the importance of parental support and the lack of timely access to care, which had a significant effect on their mental health.

The study, published this month in the peer-reviewed journal Pediatrics, followed the trans youth who had gone through puberty, but were under the age of 16, and were referred to one of 10 children's hospitals across the country over a two-year period between 2017 and 2019. It's also one of the first such studies to include the perspectives of families of trans and non-binary youth.

The study found even though 62 per cent of youth reported strong parental support, many still experienced high rates of anxiety or depression.

You see these youth and they just come into themselves and they become happy again. They begin talking to their family again … and feeling that they're being accepted for who they are.- Dr. Margaret Lawson

"A sizeable number of these youth — too many — had considered suicide," said Dr. Margaret Lawson, an endocrinologist at CHEO, eastern Ontario's children's hospital in Ottawa, and the paper's co-principal investigator.  

Almost 35 per cent had suicidal thoughts at least once in their lives, while nearly 17 per cent had tried to take their own lives the year before, the study showed.

Lawson said classmates, teachers, extended family or society as a whole may not be as understanding as supportive parents, adding to the youth's distress.

"Teenagers want to fit in. They don't want to be different."

Anxiety, depression highest in transmasculine youth

Gender dysphoria is one of the biggest mental health challenges for trans and non-binary youth. This is a clinical diagnosis describing discomfort or distress with the gender a person is assigned at birth versus the gender with which they identify. Youth also feel judged and not accepted for who they are.

Even the fear of being misgendered can increase the fear and anxiety, which leads to difficulty coping, Lawson said.

Even though nearly 80 per cent of the youth in the study were transmasculine — those who were assigned female at birth but identify as male — it doesn't mean there are fewer transfeminine youth.

There were more transmasculine youth partly due to transmisogyny, she explained, and how society views transfemales, with transfemales being more likely to stay in their assigned (male) gender because of a fear of coming out.

But coming out can also have a greater effect on transmales' mental health. They're more likely to go through puberty earlier, have their periods, and come out to their family and classmates earlier, so their gender dysphoria can increase, she said, leading to higher rates of anxiety and depression.

Access to care

Despite nearly two-thirds of the youth in the study being gender-aware before their 12th birthday, Lawson said they often waited an average of almost four years — with some seeing up to eight physicians — before being seen in one of the 10 clinics.

That, she said, highlights the need for faster access to gender-affirming care.

"While they're waiting, these youth are developing more and more distress and if they had been seen sooner, would there be less distress, and mental health issues [less] significant? I would certainly hope so," she said.

But once they receive that care, the improvement is palpable.

"You see these youth and they just come into themselves and they become happy again. They begin talking to their family again … and feeling that they're being accepted for who they are."