"Nobody Gives You the Book for This": How Transgender Adolescents and Parents Navigate Stress and Support

Background and Purpose

Throughout adolescent development, transgender adolescents and their parents face minority stressors connected to predominantly cisgender dominant interpersonal, institutional and community norms and expectations. As transgender adolescents are developing self-efficacy to challenge fixed assumptions connected to their gender, parents are experiencing their own confusion, adjustment, and stress. Given the connection between parent-child relationship functioning on adolescent mental health, studying the transgender adolescent-parent system in concert (i.e., dyadic) has a strong potential to inform both research and intervention development. We describe how different types of minority stressors contribute to adolescent-parent distress and parent support processes, while support and inclusion contribute to positive adolescent identity development and mental health outcomes.

This study fills a gap by exploring how stress and support contribute to early gender affirmation and transition processes from the perspectives of transgender adolescents and parents within the same family unit. Our qualitative dyadic Life History approach provided space for families to draw from their unique experiences and perspectives to understand minority stress and contribute to knowledge about how systems can support transgender adolescents.

Methods

Forty qualitative Life-History Calendar interviews were conducted with transgender adolescents and one of their parents separately and simultaneously. A purposive sample of transgender adolescent-parent dyads (N=20 dyads; 40 individuals) were recruited from four sites in California. We captured the perspectives of dyads separately and simultaneously using a Life History Calendar qualitative interview approach. Adolescents in our sample were between the ages of 12 and 17 and within their first 12 months of being prescribed gender affirming hormones and or hormone blockers. More than half in our adolescent sample were transmasculine (40% transgender young men; 20% non-binary and transmasculine; 40% transgender young women) and White (60% White; 10% Latinx; 10% Middle Eastern/North African; 20% multiracial/multiethnic). Parents identified as cisgender and the majority of parents were mothers (80% mothers; 20% fathers). Life History calendar interviews were structured to the lifespan of the adolescent and provided opportunities for dyads to discuss their own gender journey and that of the other dyadic member.

Results

Findings reveal that time between gender identity disclosure and the beginning of puberty was related to transgender-related knowledge gaps and gender affirmation and transition readiness gaps within dyads. Additionally, internalized, interpersonal and institutional minority stress contributed to parent support and adolescent gender affirmation processes. On the other hand, access to trans affirming support and education within schools, mental health care, health care, and community shrank those gaps and contributed to adolescent identity development, adolescent gender affirmation, and hope for the future.

Conclusion and Implications

Findings emphasize the importance of community connection and trans affirming education for parent support and adjustment. As cisgender normativity and heteronormativity remain pervasive across social settings, findings demonstrate that parents along with schools, mental health care and health care institutions are in unique positions to enhance social inclusion and acceptance, address minority stressors, reduce barriers to adolescent gender affirmation and transition, and contribute to positive adolescent mental health outcomes.