March 31, 2020
By Penelope Strauss & Ashleigh Lin
To support International Transgender Day of Visibility on 31 March, we asked Penelope Strauss & Ashleigh Lin from the Telethon Kids Institute to discuss their research findings from the Trans Pathway survey to highlight the important barriers trans and gender diverse young people experience when trying to access care. These barriers emphasise the importance of greater support and advocacy for trans and gender diverse young people. International Transgender Day of Visibility is honoured every year on the 31 March to celebrate trans and gender diverse people around the world and raise awareness around discrimination.
Trans and gender diverse (TGD) youth are young people whose gender identity does not match the sex marked on their original birth certificate. While the exact number of TGD young people is unknown, recent estimates from the US1 and Australia2 report that 2.3-2.7% of high-school aged young people Identify themselves as TGD, demonstrating that this group make up a significant proportion of the young population.
In 2016, we conducted a national online survey called Trans Pathways that assessed the mental health and care pathways of 859 Australian TGD young people aged 14-25 years. Findings revealed that TGD young people were experiencing high levels of distress and were exposed to negative experiences at alarmingly high rates. 3 Specifically, almost 1 in 2 respondents had ever attempted suicide, and 3 in 4 had ever been diagnosed with depression and/or anxiety.3 Despite this, we found that they experience significant barriers to medical and mental health services, and that feeling isolated from services was associated with increased risk for suicide attempts.3 These findings demonstrate that much work needs to be done to make health services safer and more accessible for this group of young people.
Our research also found a large proportion of respondents had experienced a lack of family support (65.8%), and these young people were twice as likely to have ever attempted suicide.3 Canadian research from the TransPULSE study has demonstrated the impact of parental support on mental health, with respondents (aged 16-24 years) less likely to report depressive symptoms if they had parental support (23% compared with 75%).4 In this study, the reported suicide rate within the prior year was 4% in young people strongly supported by parents compared with 57% in those who were not strongly supported.4
Professional associations for the health of TDG populations such as the Australian Professional Associations for Trans Health (AusPATH) have recently called for increased support for TGD young people. TGD young people may seek medication intervention such as puberty blockers, gender-affirming hormones and/or gender-affirming surgery/ies. Recent negative media and opposition to medical gender affirmation for adolescents in the US and Australia puts access to this vital medical care at risk, despite the substantial evidence that medical gender affirmation improved mental health outcomes for those who desire it.5 6 7
Mental health clinicians have an important role to play in providing a safe environment for TGD young people, particularly because many work within a system that is not always safe, welcoming or affirming.8 Many mental health practitioners require additional training on gender diversity. Trans Pathways participants described seeing clinicians who invalidated their experiences and often relied on the young person educating them about gender diversity in order to get the care they desired and needed.9 Other research has highlighted that mental health clinicians lack knowledgeof gender diversity, referral processes for TGD clients, and the legal processes through which TGD people may seek to change their name and/or gender marker.10
On today’s Transgender Day of Visibility, we encourage you to support TGD young people. The topics discussed in brief here highlight how vital greater support of and advocacy for TGD young people is within families, schools, healthcare settings and broader society. We all have a part to play.
Professional Associations for Trans Health
· World Professional Association for Transgender Health (WPATH)
· Australian Professional Association for Trans Health (AusPATH)
· United States Professional Association for Transgender Health (USPATH)
· Canadian Professional Association for Transgender Health (CPATH)
· European Professional Association for Transgender Health (EPATH)
· Professional Association for Transgender Health Aotearoa (PATHA)
1. Rider GN, McMorris BJ, Gower AL, Coleman E, Eisenberg ME. Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study. Pediatrics 2018;141(3):e20171683.
2. Fisher CM, Waling A, Kerr L, et al. 6th National Survey of Australian Secondary Students and Sexual Health 2018. Bundoora: Australian Research Centre in Sex, Health & Society, La Trobe University 2019.
3. Strauss P, Cook A, Winter S, Watson V, Wright Toussaint D, Lin A. Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: findings from Trans Pathways. Psychological Medicine 2019:1-10.
4. Travers R, Bauer G, Pyne J, Bradley K, Gale L, Papadimitriou M. Impacts of Strong Parental Support for Trans Youth. Toronto: Children’s Aid Society of Toronto & Delisle Youth Services; 2012.
5. Mahfouda S, Moore JK, Siafarikas A, Hewitt T, Ganti U, Lin A, Zepf FD. Gender-affirming hormones and surgery in transgender children and adolescents. The Lancet Diabetes & Endocrinology 2018.
6. Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A. Puberty suppression in transgender children and adolescents. The Lancet Diabetes & Endocrinology 2017.
7. Allen LR, Watson LB, Egan AM, Moser CN. Well-Being and Suicidality Among Transgender Youth After Gender-Affirming Hormones. Clinical Practice in Pediatric Psychology 2019;7(3):302-311.
8. Dolan IJ, Strauss P, Winter S, Lin A. Misgendering and experiences of stigma within healthcare settings for trans individuals in Western Australia: implications of structural policies and impacts on delivery of care. Med J Aust 2020;12(4):150-151.e151.
9. Strauss P, Cook A, Winter S, Watson V, Wright Toussaint D, Lin A. Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute. Perth, Australia 2017.
10. Whitman CN, Han H. Clinician competencies: Strengths and limitations for work with transgender and gender non-conforming (TGNC) clients. International Journal of Transgenderism 2016:1-18.