Transgender Adolescent-Parent Minority Stress and Support through Adolescence

Background and Purpose. We know little about how transgender adolescents and their parents perceive and experience transgender identity development and expression, minority stress, and parent-support processes. Parent-adolescent stress (hereafter dyadic stress) and parent-support can contribute to emotional health for all adolescents. The extant research primarily focuses on transgender adolescents or their parents, missing important dyadic experiences between them. This study explored dyadic stress and parent-support for transgender adolescents navigating their gender identity development and expression against dominant cultural expectations across social domains including schools, mental healthcare settings, home, and within extended family and social networks.

Methods. We conducted simultaneous and separate semi-structured Life History Calendar interviews with 21 transgender adolescent-parent dyads (42 individual interviews) from 2017- 2018. Interviews focused on navigating transgender identity development and gender expression across specific social domains. Adolescents were ages 12-18 and initiated hormone therapy or hormone blockers within the last 12 months prior to their interview. We recruited participants from transgender-specific healthcare settings and support groups in Southern California.  Through a phenomenological approach, we coded 42 interviews using open and axial coding processes. We identified themes and mapped thematic differences and similarities of individual and dyadic stress and support processes through adolescence.  

Results. Parent-support emerged as an important protective factor against gender non-conformity-related stress during early childhood and across adolescence. Adolescents and parents reported differences and similarities regarding stress and parent-support related to (1) gender non-conformity, puberty and gender affirmation processes; and (2) gender identity disclosures and support received within various social domains.   

The onset of puberty marked a time of extreme stress and confusion for dyads. Dyads with early access to transgender-specific care and knowledge before puberty onset experienced different stressors related to puberty, dysphoria, and gender affirmation processes compared to those without early access. Adolescents and parents discussed their own disclosure and gender affirmation stressors across important social domains.  Adolescents placed importance on gender affirmation and discussed stress related to navigating dysphoria, stigma and validation. Parents often experienced grief, loss, and stress connected to their own adjustment, support and social network disclosures, and their child’s disclosure decisions related to being transgender.  At the same time, parents discussed developing an identity connected to fierce advocacy and support for their child. Evidence emerged suggesting that parents whose identity is tied to parenting a transgender child may have important implications for family dynamics, parent-stress and adolescent development.  Parent-support and social policies promoting gender affirmation processes can mitigate adolescent dysphoria, minority stress and enhance adolescent self-efficacy.  

Conclusion and Implications. Our work fills an important gap in research by underscoring the importance of transgender adolescent and parent perspectives of identity development, stress, and support. Differences and similarities reported by adolescents and their parents highlight the need for our social systems to: 1) address dyadic-stress; 2) promote inclusion, awareness, and support for transgender adolescents and their parents navigating social domains; 3) validate childhood and adolescent gender diversity; and 4) mitigate barriers to gender affirming processes.