Baseline Psychological Functioning of Transgender and Gender Expansive Adolescents in a Gender Affirming Outpatient Clinic

Abstract

Objective

The purpose of this study is to understand baseline psychological functioning and protective factors for transmasculine, transfeminine, and gender expansive youth seeking services at a gender affirming outpatient clinic. This study also examines differences between these groups.

Method

137 TGE youth aged 12–21 completed the Behavior Assessment Scale for Children, Third Edition. Of the 137 participants, 82 (59.4%) identified as transmasculine, 26 (18.8%) identified as transfeminine, and 29 (21.0%) identified as non-binary/gender expansive. Additionally, a majority (79.6%) identified as White. Several analyses were conducted to explore baseline psychological functioning across different groups and look at the impact of psychotherapy and the current political climate.

Results

Results showed no significant differences between gender identity groups for depression, anxiety, hyperactivity, attention problems, relations with parents, interpersonal relationships, self-esteem, self-reliance, external locus of control, and ego strength. For all variables except anxiety and self-esteem, participants scored in the average range. There was not a significant difference by identity in access to psychotherapy or treatment access on psychological functioning psychological functioning. We also found no significant differences between psychological functioning and sociopolitical events. However, gender identity moderated the relationship between self-esteem and attention problems.

Conclusions

These results suggest that there are few differences found between groups of TGE youth regarding mental health symptoms in this sample. The results suggest additional research is needed to understand what screening measures are appropriate for use with TGE youth and provides evidence that not all clinical samples of TGE youth are experiencing clinically significant mental health symptoms.

Keywords

transgender and gender expansive youth BASC-3 mental health symptoms protective factors

Get full access to this article

View all access options for this article.

References

American Civil Liberties

Union.

(2024). Mapping attacks on LGBTQ rights in U.S. state legislatures in 2024 . https://www.aclu.org/legislative-attacks-on-lgbtq-rights-2024

Austin

Craig

S. L.

(2015). Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21–29. https://doi.org/10.1037/a0038642

Becerra-Culqui

T. A.

Liu

Nash

Cromwell

Flanders

W. D.

Getahun

Giammattei

S. V.

Hunkeler

E. M.

Lash

T. L.

Millman

Quinn

V. P.

Robinson

Roblin

Silverberg

M. J.

Tangpricha

Goodman

(2018). Mental health of transgender and gender nonconfrming youth compared with their peers. Pediatrics, 141(5), e20173845. https://doi.org/10.1542/peds.2017-3845

Bloom

T. M.

Nguyen

T. P.

Lami

Pace

C. C.

Poulakis

Telfer

Tollit

M. A.

Pang

K. C.

(2021). Measurement tools for gender identity, gender expression, and gender dysphoria in transgender and gender-diverse children and adolescents: A systematic review. The Lancet Child & Adolescent Health, 5(8), 582–588. https://doi.org/10.1016/S2352-4642(21)00098-5

Brooks

V. R.

(1981). Minority stress and Lesbian women. Free Press.

Connolly

M. D.

Zervos

M. J.

Barone

C. J.

Johnson

C. C.

Joseph

C. L. M.

(2016). The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health, 59(5), 489–495. https://doi.org/10.1016/j.jadohealth.2016.06.012

Coyne

C. A.

Poquiz

J. L.

Janssen

Chen

(2020). Evidence-based psychological practice for transgender and non-binary youth: Defining the need, framework for treatment adaptation, and future directions. Evidence-Based Practice in Child and Adolescent Mental Health, 5(3), 340–353. https://doi.org/10.1080/23794925.2020.1765433

Durwood

Eisner

Fladeboe

C. (G.)

Barney

McLaughlin

K. A.

Olson

K. R.

(2021). Social support and internalizing psychopathology in transgender youth. Journal of Youth and Adolescence, 50(5), 841–854. https://doi.org/10.1007/s10964-020-01391-y

Faul

Erdfelder

Buchner

Lang

A.-G.

(2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149

10.

Faul

Erdfelder

Lang

A.-G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146

11.

Goldbach

J. T.

Schrager

S. M.

Wood

J. K.

O’Brien

R. P.

Dunlap

S. L.

Rhoades

(2024). Development and validation of the transgender adolescent stress survey–minority stress (TASS-MS). Frontiers in Psychology, 15(1), 1448693. https://doi.org/10.3389/fpsyg.2024.1448693

12.

Grossman

A. H.

D’augelli

A. R.

Frank

J. A.

(2011). Aspects of psychological resilience among transgender youth. Journal of LGBT youth, 8(2), 103–115. https://doi.org/10.1080/19361653.2011.541347

13.

Grossman

A. H.

Park

J. Y.

Frank

J. A.

Russell

S. T.

(2021). Parental responses to transgender and gender nonconforming youth: Associations with parent support, parental abuse, and youths’ psychological adjustment. Journal of Homosexuality, 68(8), 1260–1277. https://doi.org/10.1080/00918369.2019.1696103

14.

Hayes

A. F.

(2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd edition). The Guilford Press.

15.

Hendricks

M. L.

Testa

R. J.

(2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research & Practice, 43(5), 460–467. https://doi.org/10.1037/a0029597

16.

Herman

J. L.

Flores

A. R.

O’Neill

K. K.

(2022). How many adults and youth identify as transgender in the United States? The Williams Institute, UCLA School of Law.

17.

Hidalgo

M. A.

Petras

Chen

Chodzen

(2019). The gender minority stress and resilience measure: Psychometric validity of an adolescent extension. Clinical Practice in Pediatric Psychology, 7(3), 278–290. https://doi.org/10.1037/cpp0000297

18.

Howell

Maguire

(2019). Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland. International Journal of Transgenderism, 20(4), 421–433. https://doi.org/10.1080/15532739.2019.1658145

19.

Hughto

J. M. W.

Reisner

S. L.

Pachankis

J. E.

(2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147(1), 222–231. https://doi.org/10.1016/j.socscimed.2015.11.010

20.

Jain

Singh

(2015). Locus of control and its relationship with mental health and adjustment among adolescent females. Journal of Mental Health and Human Behaviour, 20(1), 16. https://doi.org/10.4103/0971-8990.164803

21.

Johns

M. M.

Lowry

Andrzejewski

Barrios

L. C.

Demissie

McManus

Rasberry

C. N.

Robin

Underwood

J. M.

(2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report, 68(3), 67–71. https://doi.org/10.15585/mmwr.mm6803a3

22.

Kia

MacKinnon

K. R.

Abramovich

Bonato

(2021). Peer support as a protective factor against suicide in trans populations: A scoping review. Social Science & Medicine, 279(1), 114026. https://doi.org/10.1016/j.socscimed.2021.114026

23.

Klinger

Oehlke

S. M.

Riedl

Eschbaum

Zesch

H. E.

Karwautz

Kothgassner

O. D.

(2024). Mental health of non-binary youth: A systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health, 18(1), 126. https://doi.org/10.1186/s13034-024-00822-z

24.

Kuper

L. E.

Cooper

M. B.

Mooney

M. A.

(2022). Supporting and advocating for transgender and gender diverse youth and their families within the sociopolitical context of widespread discriminatory legislation and policies. Clinical Practice in Pediatric Psychology, 10(3), 336–345. https://doi.org/10.1037/cpp0000456

25.

Lee

J. Y.

Rosenthal

S. M.

(2023). Gender-affirming care of transgender and gender-diverse youth: Current concepts. Annual Review of Medicine, 74(74), 107–116. https://doi.org/10.1146/annurev-med-043021-032007

26.

Lenkens

Rodenburg

Schenk

Nagelhout

G. E.

Van Lenthe

F. J.

Engbersen

Sentse

Severiens

Van De Mheen

(2020). “I Need to Do This on My Own” resilience and self-reliance in urban At-Risk youths. Deviant Behavior, 41(10), 1330–1345. https://doi.org/10.1080/01639625.2019.1614140

27.

Matsuno

Israel

(2018). Psychological interventions promoting resilience among transgender individuals: Transgender Resilience Intervention Model (TRIM). The Counseling Psychologist, 46(5), 632–655. https://doi.org/10.1177/0011000018787261

28.

McAdaragh

M. O.

Parchem

Duval

Baccam

Z. G.

Caso

T. J.

Arenella

Berg

D. R.

Rider

G. N.

(2024). Gender-inclusive clinical screeners: Using CBCLs and YSRs in a clinic-based sample of transgender/gender-diverse youth. Psychological Assessment, 36(2), 89–101. https://doi.org/10.1037/pas0001290

29.

Meyer

I. H.

(2003). Prejudice, social stress, and mental health in Lesbian, Gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

30.

Olezeski

C. L.

Meade

N. G.

Ralston

A. L.

(2025). Advocacy in practice: The role of mental health providers in creating systems of support for transgender and gender expansive youth. Evidence-Based Practice in Child and Adolescent Mental Health, 11(2), 298–308. https://doi.org/10.1080/23794925.2025.2491062

31.

Pachankis

J. E.

McConocha

E. M.

Clark

K. A.

Wang

Behari

Fetzner

B. K.

Brisbin

C. D.

Scheer

J. R.

Lehavot

(2020). A transdiagnostic minority stress intervention for gender diverse sexual minority women’s depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(7), 613–630. https://doi.org/10.1037/ccp0000508

32.

Poquiz

J. L.

Coyne

C. A.

Garofalo

Chen

(2021). Comparison of gender minority stress and resilience among transmasculine, transfeminine, and non-binary adolescents and young adults. Journal of Adolescent Health, 68(3), 615–618. https://doi.org/10.1016/j.jadohealth.2020.06.014

33.

Price-Feeney

Green

A. E.

Dorison

(2020). Understanding the mental health of transgender and non-binary youth. Journal of Adolescent Health, 66(6), 684–690. https://doi.org/10.1016/j.jadohealth.2019.11.314

34.

Reisner

S. L.

Vetters

Leclerc

Zaslow

Wolfrum

Shumer

Mimiaga

M. J.

(2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health, 56(3), 274–279. https://doi.org/10.1016/j.jadohealth.2014.10.264

35.

Rider

G. N.

Berg

Pardo

S. T.

Olson-Kennedy

Sharp

Tran

K. M.

Calvetti

Keo-Meier

C. L.

(2019). Using the Child Behavior Checklist (CBCL) with transgender/gender nonconforming children and adolescents. Clinical Practice in Pediatric Psychology, 7(3), 291–301. https://doi.org/10.1037/cpp0000296

36.

Rimes

K. A.

Goodship

Ussher

Baker

West

(2017). Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. The International Journal of Transgenderism, 20(2–3), 230–240. https://doi.org/10.1080/15532739.2017.1370627

37.

Simons

Schrager

S. M.

Clark

L. F.

Belzer

Olson

(2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019

38.

Toomey

R. B.

Syvertsen

A. K.

Shramko

(2018). Transgender adolescent suicide behavior. Pediatrics, 142(4), e20174218. https://doi.org/10.1542/peds.2017-4218