How you can help reduce trans teens' high-risk behaviors

August 17, 2017

Pediatricians may be the first or only resource for some trans or gender nonconforming youths, and it’s important to offer them support and resources, particularly when it comes to navigating all-too-common high-risk behaviors.

Transgender or gender nonconforming teenagers are more likely to engage in a variety of high-risk behaviors, from unsafe sex to drug use, according to a new study that encourages pediatricians to reach out and offer support to this vulnerable population.

In “Risk and Protective Factors in the Lives of Transgender/Gender Nonconforming Adolescents,” published in the Journal of Adolescent Health, lead author Marla Eisenberg, ScD, MPH, associate professor and director of research in the division of General Pediatrics and Adolescent Health Department of Pediatrics at the University of Minnesota in Minneapolis reveals that transgender and gender nonconforming adolescents are at a greater risk of engaging in high-risk behavior than other teenagers. For some of these teenagers, contact with a healthcare provider may serve as a lifeline.

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“Healthcare providers and others who work with and on behalf of adolescents are advised to recognize the unique needs of this population and act as allies by working to create safe spaces for young people,” the study authors note. “In addition, families,

school personnel, and community members can provide crucial protections to buffer challenges and support the healthy development of these adolescents.”

The study questioned more than 81,000 ninth through eleventh graders in Minnesota about gender issues, and 2.7% of those polled identified as either transgender or gender nonconforming. Prevalence of transgender or gender nonconforming teenagers was higher among those assigned female at birth (3.6%) compared to those assigned male at birth (1.7%). Prevalence was also high among Hawaiian/Pacific Islanders, American Indians, multi-racial students, and those experiencing severe economic hardship. There was no significant difference in the prevalence of trans adolescents in metropolitan versus suburban or rural areas.

What was significant was the level of involvement of transgender and gender nonconforming teenagers in a host of high-risk behaviors, the report reveals. More than 60% of trans respondents endorsed suicidal ideation-a rate that is 3 times that of cisgender participants. Another third of trans adolescents reported having made a suicide attempt, the study notes and significantly more trans teenagers were depressed or bullied than their cisgender peers.

In regard to participation in other high-risk behaviors, transgender and gender nonconforming teenagers were significantly more likely than cisgender teenagers to engage in binge drinking, cigarette smoking, marijuana use, alcohol consumption, sexual activity, sexual activity without protection, and sexual activity while intoxicated.

Across the transgender and gender nonconforming spectrum, assigned males were more likely to engage in binge drinking, marijuana use, high-risk sexual behaviors, and bullying than assigned females, but assigned females were more likely to endorse emotional distress and suicide attempts or ideation.

Levels of 4 protective factors that may help protect adolescents from engaging in high-risk behaviors were also assessed, including family connect and student-teacher relationships, and were found to be low among transgender and gender nonconforming adolescents in comparison with cisgender adolescents.

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Henry Ng, MD, MPH, FAAP, FACP, associate professor, assistant dean for admissions, and chair of the department of internal medicine and pediatrics at Case Western Reserve University School of Medicine; immediate past president of GLMA: Health Professionals Advancing LGBT Equality; associate editor of LGBT Health; and clinical director of the PRIDE Clinic at MetroHealth Medical Center in Cleveland, Ohio, discussed the findings presented in the study with Contemporary Pediatrics and says pediatricians, in some cases, may be a critical resource for these adolescents.
“The pediatrician should be aware that trans teenagers may participate in high risk behaviors in part from family rejection. As a pediatrician obtains the information that a patient is transgender, it is import to assess who they have disclosed to and how they were received,” Ng says. “Parents and guardians who are unable to affirm a transgender teenager's identity may be placing them into the arms of others who will be affirming, but also more likely to be involved in a high risk behavior.

“The pediatrician may be first and only point of disclosure,” Ng continues. “Other times, the patient has socially transitioned and is out to the universe. In that case, it is important to determine the degree of peer and family support a young person has and their involvement in transgender community.”

Local programs through lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) or trans support groups focused on teenagers or young adults may be helpful in providing support and affirmation, Ng recommends. These resources can often be found through local LGBTQ community centers.

Ng says he hopes pediatricians will be open to communicating with young trans patients in a non-judgmental way.

“Create a safe space to talk about gender and sexuality. After the pediatrician has assessed that the teenager is transgender or gender non-binary and has assessed their overall wellness, it would behoove the provider to be familiar with mental health, sexual health, and LGBT health resources to support the patient,” Ng says. “Familiarity with the American Academy of Pediatrics' office guidelines for caring for LGBT youth, the World Professional Association for Transgender Health (WPATH) Standards of Care regarding transgender teenagers and a network of health resources and referrals is paramount in helping a young trans teenager be their best self.”