Timing of Social Transition for Transgender and Gender Diverse Youth, K-12 Harassment, and Adult Mental Health Outcomes

Purpose: Many transgender and gender diverse (TGD) youth undergo a social transition in which they change their gender expression to align with their gender identity. Our objective was to examine associations between timing of social transition (during the prepubertal childhood period, adolescence, or adulthood) and adult mental health outcomes.

Methods: We conducted a secondary analysis of the 2015 U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Based on self-reports, participants were categorized as having undergone social transition during childhood (ages 3-9 years), adolescence (ages 10-17 years), or adulthood (ages ≥18 years). Using multivariable logistic regression, we examined associations between timing of social transition and adult mental health outcomes.

Results: After adjusting for demographic and potential confounding variables, childhood social transition was associated with lower odds of lifetime marijuana use (adjusted odds ratio .7, 95% confidence interval = .5-.8, p < .0001) when compared with adult social transition. Before adjusting for K-12 harassment based on gender identity, adolescent social transition was associated with adverse mental health outcomes, including greater odds of lifetime suicide attempts when compared with adult social transition (adjusted odds ratio 1.3, 95% confidence interval = 1.1-1.7, p = .004). These associations were no longer significant after further adjusting for K-12 harassment.

Conclusions: Although past research has shown TGD youth who undergo social transition have favorable mental health outcomes in the short term, they may have worse mental health in adulthood if not protected from K-12 harassment based on gender identity. It is the responsibility of clinicians to emphasize the importance of adolescents having safe and affirming social environments.