Do Transgender Teens Face Greater Risk of Substance Use?

Transgender Teens Face Stressors That Lead to Increased Substance Use

Do Transgender Teens Face Greater Risk of Substance Use?

Teen life is tough enough with all of its peer pressure, social media stressors, academic demands, and propensity for family discord. That's a lot for anyone to handle. Could life possibly get any tougher? Well, yes, it could. Imagine what life must be for a transgender teen.

From Bullying to Violence, No Lack of Trouble for Transgender Teens

In addition to «typical teen traumas,» transgender adolescents face the additional emotional and physical hurdles of bullying, harassment, rejection, threats, victimization, and violence directly resulting from their gender identity.  

In 2020 alone, at least 44 transgender and gender-nonconforming individuals were murdered — the most since Human Rights Campaign (HRC) began tracking this data in 2013.

  There is no data to suggest how many of these murders were designated as hate crimes.

But HRC, which has documented more than 200 deaths over the eight-year period from 2013 to 2020, acknowledges that the victims were killed by a combination of acquaintances, partners, and strangers and that some «involve clear anti-transgender bias.» 

In February, for example, a Pennsylvania mother killed her two children, including a 16-

year-old trans boy and his 22-year-old nonbinary sibling. These are but two of 28 transgender/gender-nonconforming murders committed less than six months into 2021 — a pace projected to easily surpass 2020's record of 44.  

HRC adds that in some cases the victims' transgender status «may have put them at risk in other ways, such as forcing them into unemployment, poverty, homelessness and/or survival sex work.»

As information this filters back to transgender teens, it contributes to their heightened sense of anxiety and fear, and begs the question: How are these individuals able to cope when exposed to so much bias, prejudice, and hate?

Trans Teens Turning to Alcohol to Cope

More than half of transgender teens — or gender minority (GM) adolescents — begin engaging in substance use as a means of enduring the stressors they face during their young lives. This conclusion is data from a study that was published in the open-access journal PLOS ONE.

This isn't to suggest that many teens — transgender or otherwise — don't use or experiment with tobacco, marijuana, or alcohol. Many do. But the report, written by Sabra L.

Katz-Wise of Boston Children's Hospital and Harvard Medicine School and her colleagues, attributes greater emotional distress among GM youth to a higher lihood of alcohol use than that of their cisgender (those who identify with biological birth gender) counterparts. 

Previous research indicated that substance use was 2½ to 4 times higher for GM youth than cisgender youth. 

Meanwhile, the current study examined the longitudinal effects of GM stressors in three areas:

  • Substance use in GM adolescents
  • Related risk factors such as internalized transphobia, depressive symptoms, and anxiety symptoms
  • Protective factors such as resilience, gender-related pride, family functioning, social support, and gender-related community connectedness

Participants in the study included 33 GM adolescents, ages 13-17, from the community-based longitudinal Trans Teen and Family Narratives Project. Each participant completed an online survey every six months — five in all — over a two-year period, staggered from 2015 to 2019.

At the outset of the study, 17% of the participants reported any kind of substance use: tobacco, marijuana, or alcohol. Two years later, at the conclusion of the study, the number of participants reporting any kind of substance use had more than tripled to 56%. 

Interestingly, higher exposure to GM stressors significantly increased the lihood of trans teens engaging in alcohol use — but not tobacco or marijuana use. The study including no data regarding drug or opioid use. 

Support from Family and Friends Can Help

Fortunately, there are factors that can mitigate the stressors that might otherwise lead to increased alcohol use.

One is family functioning, which includes supportive structural, relational, and social properties associated with the family unit. The other is social support.

However, these protective factors — as they relate to alcohol use — were found to be effective at lower levels of GM stress, but not at higher levels.

Researchers concluded that future interventions with GM adolescents should focus on addressing internalized transphobia while strengthening resilience, gender-related pride, and family functioning as measures to combat substance use.

«A study conducted by our team found better family functioning was associated with less self-harm and depressive/anxious symptoms, and greater self-esteem and resiliency among GM adolescents,» the study's authors wrote.

Internalized transphobia, resilience, and gender-related pride were found to be the most significant mediators of associations between GM stressors and substance use. 

«Since GM adolescents appear to be using substances to cope with exposure to gender minority stressors, programs could assist adolescents in identifying adaptive coping strategies in response to such stressors,» the report states.

«GM adolescents should also be connected to resources where they can connect with other GM adolescents.

Efforts on a macro-level to increase anti-discrimination policies and laws and decrease stigma toward GM individuals may ultimately improve the lives of GM adolescents by reducing exposure to gender minority stressors.»

InSync EHR Software Relieves Stress for Mental Health Practices

The secret to relieving anxiety is to first identify stressors and pain points that are the source of the anxiety. Only then — after identifying the cause — can you begin to find solutions.

That approach certainly applies to practices with EHR systems that are less than efficient and with spotty support from their vendors. At InSync Healthcare Solutions, our software is fully supported and specialized for behavioral health practices. Providers can watch a stress-free demonstration below. The 5-minute snapshot of our software has easy-to-read callouts highlighting features. 

Mental Health EHR System Snapshot

For a closer look at how our configurable, mobile-friendly software system can streamline workflows for your mental health practice, schedule a demo now with one of our experts. We're happy to answer questions and explain how our system can save you time and money. 


Human Rights Campaign: Fatal Violence Against the Transgender and Gender Non-Conforming Community is 2021

PLOS ONE: Longitudinal effects of minority stressors on substance use and related risk and protective factors among gender minority adolescents

Advocate: Trans and Nonbinary Siblings Shot to Death; Mother Charged


Why LGBTQ+ Youth Are at Increased Risk for Substance Use & How You Can Help

Do Transgender Teens Face Greater Risk of Substance Use?

LGBTQ+ individuals are about twice as ly to suffer from a mental health disorder as those who identify as heterosexual.[1] A 2019 national survey of mental health among LGBTQ+ youth found they continue to face numerous mental health challenges despite societal progress.[2]

The fact that LGBTQ+ youth are at increased risk of experiencing mental health problems helps explain their increased risk of substance use and addiction.

Youth who identify as a sexual minority (LGBTQ+) are about twice as ly to use substances as youth identifying as heterosexual.

[3] Sexual minority youth are also at increased risk of using multiple substances (polysubstance use), which exacerbates the harms.[4]

Mental health and substance use disorders are linked. Youth who suffer from one are more ly to experience the other. Approximately 60-75% or adolescents with mental illness have a co-occurring substance use disorder.[5]

Note that being LGBTQ+ is not inherently a risk factor for experiencing a mental health or substance use disorder. The heightened risk comes from the stigma and discrimination they face as a result of their sexual orientation and/or gender identity. Being LGBTQ+ is not a mental illness, nor is it a choice, and should not be referred to as such.

Special considerations for transgender youth

Transgender youth face even higher levels of stigmatization and discrimination, corresponding to higher rates of mental health challenges and suicidality[6]. One research study shows that transgender youth have a 2.

5 to 4 times higher risk of substance use relative to their cisgender peers.

[7] Research conducted by the Human Rights Campaign explores the greater challenges faced by transgender youth and the consequences of growing up in unsupportive home, school or social environment.

Additional risk factors

LGBTQ+ youth often encounter additional circumstances – wise stemming from stigma and a lack of acceptance – that increase their risk for substance use.

Lack of family connection

Parents and caregivers are the biggest influence on their children’s decisions to use nicotine, alcohol or other drugs.

A poor relationship can interfere with the type of open and honest communication that protects against substance use.

Research from the Family Acceptance Project found that sexual minority young adults who experience family rejection during adolescence are more than three times as ly to use illicit drugs[8] as those who are accepted by their family.

Social anxiety

Anxiety among LGBTQ+ youth in social situations, such as when they first begin socializing within the community or when they are around others who may not be accepting of their identity, can fuel substance use.


LGBTQ+ youth are at heightened risk of experiencing homelessness due to family rejection, which puts them at significant risk for using substances.[9] Up to 40% of the homeless youth population identify as LGBTQ+[10], and this population uses substances at a higher rate and more frequently than other homeless youth.[9]


Physical and verbal harassment toward LGBTQ+ youth – often in school settings – takes a significant toll on mental health. Research has found an association between victimization against LGBTQ+ students in schools and increased lihood of substance misuse.[11]

Protecting your LGBTQ+ child

Because your child may face additional pressures and challenges, demonstrating your love, acceptance and support is essential to reducing their substance use and addiction risk.

Research shows that family support and acceptance can help significantly decrease an LGBTQ+ adolescent’s lihood of substance use and improve their mental health.

[12] This means actively affirming their identity rather than merely tolerating it.

Ways to actively support your LGBTQ+ child and minimize their risk of substance use include:

Learn about and get involved with the LGBTQ+ community

You can demonstrate support by encouraging your child to get involved in LGBTQ+ community activities, and by getting involved yourself. Helping your child find community social activities to overcome isolation and stigma that don’t involve substances can help prevent or stop their substance use.

Explore the unique issues faced by LGBTQ+ youth and communicate openly with your child about these topics. Learn and use affirming, respectful language when referring to your child and other members of the LGBTQ+ community, and help to normalize this show of support in your larger family and community.

Help your child access additional support

Many behavioral health care providers specialize in or have professional experience with issues unique to LGBTQ+ youth. It can benefit your child to receive support from these providers.

Affirmation-based therapy, which consists of supporting LGBTQ+ individuals and increasing their confidence, can improve mental health.

Engaging in community and school programs that address specific LGBTQ+ risk factors can also help prevent substance use.

Get support for you and your family

Personal support can better equip you to care for your child and keep them safe. Working with a support group specifically for parents of LGBTQ+ youth or seeking family or individual therapy can be helpful for you and your child’s mental health.

You can learn more about the community, how your behaviors can affect your child and talk about your thoughts and feelings.

For many parents, this may include concerns about how they will be treated in society and how best to support them with other family members, friends and the community at large.

Use and share correct pronouns

It has become more common for people to introduce themselves with their personal gender pronouns (e.g., she/her, he/him, they/them) – for example, in group settings or in their email signature. Not everyone has a gender identity that we perceive to match their gender appearance.

Many individuals do not fall within the gender binary at all. Making a conscious effort to express your pronouns to others – and not assume another’s pronouns – is a simple way to normalize the full range of gender identity.

It also helps ensure that all individuals feel included and affirmed regardless of gender.

Have open and on-going conversations

On-going conversations will help you recognize when they need support and how best to help. Consider asking these questions:

  • What name/pronouns would you me to use?
  • What safety concerns do you have? What can I do to help?
  • If someone asks me about your gender identity, expression or sexual orientation, how would you me to respond?
  • How do you feel that your friends and others are supporting you? What can I do to help?

Overall, you want the message to be that they are loved for who they are and they can come to you at any time to discuss their concerns.


Lesbian, Gay, Bisexual, Trans & Queer identified People and Mental Health

Do Transgender Teens Face Greater Risk of Substance Use?

Although lesbian, gay, bisexual, trans and queer identified (LGBTQ) people are as diverse as the general Canadian population in their experiences of mental health and well-being, they face higher risks for some mental health issues due to the effects of discrimination and the social determinants of health.

This information was compiled by Rainbow Health Ontario and CMHA Ontario.

What factors impact on mental health?

Socio-economic factors (or determinants) play a key role in mental health and wellbeing for all of us, and are particularly important for marginalized populations. Three significant determinants of positive mental health and wellbeing are: social inclusion; freedom from discrimination and violence; and access to economic resourcesi.

All three factors impact LGBTQ individuals and communities in Ontario:

  • Bisexual and trans people are over-represented among low-income Canadians
    • An Ontario-based study found that half of trans people were living on less than $15,000 a yearii

LGBTQ people experience stigma and discrimination across their life spans, and are targets of sexual and physical assault, harassment and hate crimesiii

  • Hates crimes motivated by sexual orientation more than doubled in Canada from 2007 to 2008, and were the most violent of all hate crimesiv
  • An Ontario-based study of trans people found that 20 per cent had experienced physical or sexual assault due to their identity, and that 34 per cent were subjected to verbal threats or harassmentv
  • Trans people in both Canada and the US report high levels of violence, harassment, and discrimination when seeking stable housing, employment, health or social servicesv

Additional factors that may impact on mental health and well-being for LGBTQ people include the process of “coming out” (sharing one’s LGBTQ identity with others), gender transition, internalized oppression, isolation and alienation, loss of family or social support, and the impact of HIV and AIDS.vii


LGBTQ individuals may experience multiple forms of marginalization or disadvantage at the same time. For example, an individual’s experience may be shaped at the same time by their sexual orientation, racialization, gender, disability and income (e.g. a bisexual South Asian woman may have an anxiety disorder and be living in poverty).

Intersectionality refers to an approach by which intersecting experiences of marginalization and the needs of the whole person are considered.

There are multiple ways that intersectionality impacts the mental health of LGBTQ people.

For example, LGBTQ people may experience other forms of marginalization – such as racism, sexism, poverty or other factors – alongside homophobia or transphobia that negatively impact on mental health.

Additionally, an individual with a mental health condition who is also an LGBTQ person may face added challenges in accessing mental health services that are appropriate and inclusive and may face discrimination on the basis of both disability and sexual orientation.

LGBT people and the DSM

Due to homophobia and transphobia, LGBTQ identities have been included in the Diagnostic and Statistical Manual of Mental Disorders (the DSM).

The DSM is a classification of mental health conditions (termed mental disorders) published by the American Psychiatric Association (APA) .

The first edition of the DSM was published in 1952, and multiple revised editions have been released since.

In 1973 and 1974, due to growing evidence and protest, a majority of APA membership agreed to remove homosexuality from the manual.

Although homosexuality was delisted in the 1980 edition (the DSM-III), variations of the listing remained until 1986. Since 1980, Gender Identity Disorder, or trans identity, has been listed as a disorder.

 The fifth edition of the DSM, released in 2013, introduces the term ”Gender Dysphoria” to replace previous terms.

Facts and figures

LGBTQ people face:

  • Higher rates of depression, anxiety, obsessive-compulsive and phobic disorders, suicidality, self-harm, and substance use among LGBT peoplex
  • Double the risk for post-traumatic stress disorder (PTSD) than heterosexual peoplexi

LGBTQyouth and trans people face increased risk. For example:

  • LGBTQ youth face approximately 14 times the risk of suicide and substance abuse than heterosexual peersxii
  • 77% of trans respondents in an Ontario-based survey had seriously considered suicide and 45% had attempted suicide
    • Trans youth and those who had experienced physical or sexual assault were found to be at greatest riskxiii

There is also evidence that LGBTQ people are at higher risk for substance use issues than the general populationxiv:

  • Some research suggests that use of alcohol, tobacco and other substances may be 2 to 4 times higher among LGBT people than heterosexual peoplexv
  • A Toronto-based study found significantly higher rates of smoking among LGBT adults (36%) than other adults (17%) xvi
  • American studies report higher rates of alcohol-related problems among lesbian and bisexual women than other women xvii

Promoting positive mental health and wellbeing

Key factors for positive mental health and wellbeing for LGBTQ individuals include:

  • Support from family and friends, particularly for youthxvii
  • Supportive workplaces and neighbourhoodsxix
  • Low levels of internalized homophobia (homophobia adopted by the LGBT person themself)xx, which can be fostered and supported through identification or community building with other LGBT individualsxxi
  • Experiencing positive responses to coming outxxii
  • Addressing the social determinants of health

Information for health providers

Rainbow Health Ontario, a provincial organization which seeks to promote the health of Ontario’s LGBTQ communities, recommends the following steps be taken by providers working with LGBTQ individuals:

  • Increase awareness of the broader social and legal context in which LGBTQ clients live
  • Become familiar with the degree to which internalized discrimination can impact on health
  • Develop understanding of the social determinants of both physical and mental health
  • Promote family acceptance of LGBTQ adolescents and encourage them to connect with LGBTQ communities
  • Provide appropriate equity training to ensure that suicide response and crisis intervention staff approach LGBTQ clients without stereotypes or discrimination, and that gender of trans clients is not misidentified
  • Improve recognition that individuals who belong to multiple marginalized communities may face additional barriers to maintaining good mental health
  • Increase familiarity with resources to support LGBT people at greatest risk for suicide, including youth and trans people (see below)

Additional Resources

Rainbow Health Ontario has developed a fact sheet about LGBTQ Mental Health.

It Gets Better Campaign – In response to publicized suicides by LGBT youth, author Dan Savage initiated the It Gets Better campaign ( through which supportive LGBT people and allies share supportive messages through online videos.

Kids Help Phone – Children and youth ages 5 to 20 can speak with trained cousellors at Kids Health Phone (1-800-668-6868).

Lesbian, Gay, Bi & Trans Youthline – The Lesbian, Gay, Bi & Trans Youthline offers free peer support for youth aged 26 and under (1-800-268-9688).

Parents, Friends of Lesbians and Gays (PFLAG) – PFLAG ( is a resource for LGBT people and their families.

iCentre for Addiction and Mental Health, Canadian Mental Health Association Ontario, Centre for Health Promotion – University of Toronto, Health Nexus, Ontario Public Health Association. Mental Health Promotion in Ontario: A Call to Action, 2008.
iiM. Tjepkema. Health care use among gay, lesbian and bisexual Canadians. Statistics Canada. Canada: Statistics Canada,2008; G. Bauer, Boyce M, Coleman T, Kaay M, Scanlon K, Travers R. Who are trans people in Ontario? Toronto: Trans PULSE E-Bulletin; 2010. Report No.: 1(1).
iiiI.H. Meyer. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin. 2003; 129(5):674-697.
ivM. Dauvergne. Police reported hate crime in Canada, 2008. Juristat [Internet]. 2010; 30(2). Available from:
vBauer et al. Suicidality among trans people in Ontario: Implications for social work and social justice. Service social, 2013; 59 (1): 35-62.
viSee: S. Gapka and R. Raj. Trans health project: A position paper and resolution adopted by the Ontario public health association. Toronto: OPHA; 2003; EL Lombardi, G. Van Servellen. Building culturally sensitive substance use prevention and treatment programs for transgendered populations. Journal of Substance Abuse Treatment. 2000; 19:291-296; JSI Research & Training Institute, Inc. Access to health care for transgendered persons in greater Boston. Boston: Report for GLBT Health Access Project; 2000; LJ Moran, AN Sharpe. Violence, identity and policing. Criminal Justice. 2004; 4(4):395-417; V. Namaste. Invisible lives: The erasure of transsexual and transgendered people. Chicago: University of Chicago Press; 2000.
viiCentre for Addiction and Mental Health. “ARQ2: Asking the Right Questions 2”. Toronto: Centre for Addiction and Mental Health: 2007.
viiiSee American Psychiatric Association website:
ixKE Bryant. The Politics of Pathology and the Making of Gender Identity Disorder. University of California, Santa Barbara: 2008
xAL Diamant, C. Wold. Sexual orientation and variation in physical and mental health status among women. Journal of Womens’ Health. 2003; 12(1):41-49; SD Cochran, VM Mays. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: Results from the California quality of life survey. American Journal of Public Health. 2007; 91(11):2048-2055; S. McCabe, WB Bostwick, TL Hughes, BT West, CJBoyd. The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States American Journal of Public Health. 2010; 100(10):1946-1952.
xiRoberts AL, Austin SB, Corliss HL, Vendermorris AK, Koenen KC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health. 2010; 100(12):2433-2441.
xiiGibson P. Gay and lesbian youth suicide. In: Fenleib MR, editor. The Secretary’s Task Force on Youth Suicide, United States Government Printing Report of the Secretary’s Task Force on Youth Suicide, United States Government Printing Office, 1989; Benibgui M. Mental health challenges and resilience in lesbian, gay and bisexual young adults: Biological and psychological internalization of minority stress and victimization. 2011.
xiiiBauer et al.
xivCanadian Centre for Substance Abuse. Lesbian, Gay, Bisexual, Transsexual, Transgender, Two-Spirit, Intersex and Queer (LGBTTTIQ).
xvQueensland Association for Healthy Communities. “Alcohol, Tobacco & Other Drug Use in Lesbian, Gay, Bisexual and Transgender (LGBT) Communities.” Available at:
xviClarke, M et al. The Toronto Rainbow Tobacco Survey: A report on Tobacco Use in Toronto’s LGBTTQ Communities, 2007. Available from:
xviiEliason, M. Best Practices for Lesbian/Bisexual Women with Substance Use Disorders. 2009. Available at:
xviiiBenibgui M. Mental health challenges and resilience in lesbian, gay and bisexual young adults: Biological and psychological internalization of minority stress and victimization. 2011; Ryan C, Russell ST, Huebner D, Sanchez DR. Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing. 2010; 23(4):205-213; Ryan C, Hueber D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009; 1:346-352.
xixGoldberg E, Smith JZ. Stigma, social context, and mental health: Lesbian and gay couples across the transition to adoptive parenthood. Journal of Counselling Psychology. 2011; 58(1):139-150.
xxGoldberg et al.
xxiCox N, Berghe WV, Dewaele A, Vincke J. Acculturation strategies and mental health in gay, lesbian, and bisexual youth. Journal of Youth and Adolescence. 2009; 39(10):1199-1210.
xxiiRosario M, Schrimshaw EW, Hunter J. Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviour. 2009; 23(1):175-184.


Transgender Children & Youth: Understanding the Basics

Do Transgender Teens Face Greater Risk of Substance Use?

Children are not born knowing what it means to be a boy or a girl; they learn it from their parents, older children and others around them. This learning process begins early.

As soon as a doctor or other healthcare provider declares – observing the newborn’s external sex organs – “it’s a boy” or “it’s a girl,” the world around a child begins to teach these lessons.

Whether it’s the sorting of blue clothes and pink clothes, “boys’ toys” and “girls’ toys” or telling young girls they’re “pretty” and boys they’re “strong.” It continues into puberty and adulthood as social expectations of masculine and feminine expression and behavior often become more rigid.

But gender does not simply exist in those binary terms; gender is more of a spectrum, with all individuals expressing and identifying with varying degrees of both masculinity and femininity. Transgender people identify along this spectrum, but also identify as a gender that is different than the one they were assigned at birth.

Gender identity and expression are central to the way we see ourselves and engage in the world around us. This is certainly true of transgender and gender-expansive children and teens, for whom family support is absolutely critical.

In fact, an increasing body of social science research reflects that gender-affirming behavior on the part of parents and other adults (teachers, grandparents, etc.) greatly improves mental health and well-being.

The opposite is true—transgender children are more ly to experience anxiety, depression, and at greater risk of substance abuse and homelessness when their immediate caregivers are rejecting or hostile.

It is important to know—and quite alarming, that research finds that transgender youth are at greatest risk of suicide (compared to their non-transgender peers) as a result of rejection, bullying, and other victimization.

In other words, for some transgender youth, family support can be the difference between life and death. Parents and caregivers can find resources, peer support, and professional guidance to help along the journey, and to insure that your child can not just survive, but thrive.

Is My Child Transgender….

At some point, nearly all children will engage in behavior associated with different genders – girls will play with trucks, boys will play with dolls, girls will hate wearing dresses and boys will insist on wearing them – and gender nonconforming behavior does not necessarily mean that a child is transgender. That said, sometimes these behaviors can clue us in to what a child may be feeling about their gender – with some children identifying as another gender than the one they were assigned by the time they are toddlers.

The general rule for determining whether a child is transgender or non-binary (rather than gender nonconforming or gender variant) is if the child is consistent, insistent, and persistent about their transgender identity.

In other words, if your 4-year-old son wants to wear a dress or says he wants to be a girl once or twice, he probably is not transgender; but if your child who was assigned male at birth repeatedly insists over the course of several months—or years, that she is a girl, then she is probably transgender. Children who are gender non-binary—in other words, they do not feel that they are a boy or a girl, but perhaps a bit of both, or neither, may not have the words at a very young age to capture that feeling, but over time it may become more clear to them, and ultimately to you, that they are non-binary, versus a trans girl or a trans boy.

Naturally, there are endless variations in the ways that children express themselves, so the best option if you think your child might be transgender is to consult a gender therapist. You can find our map of gender clinics here.

…or is my child gay or lesbian?

Gender identity and sexual orientation are two different things. Being transgender is about an individual’s gender identity—whether they feel male, female, a little of both, or neither.

Being gay, lesbian or bisexual is about an individual’s sexual orientation, which is our sexual or romantic attraction to people of the same gender, different genders, both or neither.

While many children who go on to identify as lesbian, gay or bisexual express gender-expansive behaviors, whether they are transgender is about identity rather than attraction. Everyone possesses both a gender identity and a sexual orientation; in other words, a transgender person can also identify as gay, lesbian or bisexual.

What is “gender dysphoria”?

Gender dysphoria is the diagnosis typically given to a person whose assigned birth gender is not the same as the one with which they identify.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the term – which recently replaced Gender Identity Disorder – “is intended to better characterize the experiences of affected children, adolescents, and adults.” To be clear, transgender identity is not a mental illness.

The “disconnect” transgender people often experience is a persistent and authentic disconnect between the sex assigned to them at birth and their internal sense of who they are.

This disconnect is referred to by medical professionals as “gender dysphoria” because it can cause undue pain and distress in the lives of transgender people. The diagnosis of gender dysphoria is often the gateway to having insurance coverage for gender-affirming care and to allowing trans people to live as their most authentic selves.

It isn’t just a phase and it’s not something you can change.

Sure, most children and teens go through “phases” – only wearing all black, dying their hair, being obsessed with a certain band or asking to go by a nickname – but being transgender or non-binary is not a phase—it is a journey, and trying to dismiss it can be harmful during a time when your child most needs support and validation.

Trying to change your child’s gender identity – either by denial, punishment, reparative therapy or any other tactic – is not only ineffective; it is dangerous and can do permanent damage to your child’s mental health.

So-called “reparative” or “conversion” therapies, which are typically faith-based, have been uniformly condemned as psychologically harmful by the American Psychological Association, the American Medical Association, the American Psychiatric Association, and numerous similar professional organizations.

The most recent survey of high school students by the Centers for Disease Control finds that roughly 3% of adolescents and teens identify as transgender or non-binary.

My teenager just came out as transgender, shouldn’t they have known sooner?

While many transgender people say that they knew they were transgender as soon as they knew what “boys” and “girls” were—as young as age 3, for many others, the journey to living openly as their affirmed gender is longer one. For some, understanding their gender identity—whether transgender or non-binary, is a more complex process that lasts into their teens or adulthood.

Stigma, lack of knowledge and fear of rejection by family and peers often keep transgender people from coming out as children or teens. Sometimes a transgender person will come out as gay, lesbian, or bisexual before recognizing their gender identity or coming out as their true gender. No matter when your child comes out, knowing they have your support is critically important.

Simple Ways to Start Supporting Your Transgender Child

  • Always use the name and pronouns that align with your child’s gender identity.
  • Be your child’s advocate – call out transphobia when you see it and ask that others respect your child’s identity.
  • Educate yourself about the concerns facing transgender youth and adults.
  • Learn what schools can and should do to support and affirm your child.
  • Encourage your child to stand up for themselves when it is safe to do so, and to set boundaries when necessary.
  • Assure your child that they have your unconditional love and support.

More information about transgender children and youth:

  • The Human Rights Campaign’s Transgender Children and Youth page includes resources for families, community members, school officials and more.
  • Our Parents for Transgender Equality Council members share their stories and provide educational resources for parent.
  • Co-published with the American Academy of Pediatrics and the American College of Osteopathic Pediatricians, the Human Rights Campaign Foundation’s “Supporting & Caring for Transgender Children” is a groundbreaking resource that explains how families and healthcare professionals can help transgender and gender-expansive children thrive.
  • HRC Foundation's Welcoming Schools is the nation's premier professional development program providing training and resources to elementary school educators on a range of issues, including how to support transgender and non-binary students.
  • Trans Families provides online support groups, resource directories, and educational resources for parents of transgender children

More support for families, caregivers and communities:

  • PFLAG is one of the oldest organizations in the country that supports the families, friends and allies of LGBTQ people. PFLAG has local chapters across the United States, including groups specifically for families with transgender children.

Gender Spectrum has adapted Family Acceptance Project research for parents and family members of transgender children.


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