Transgender youth are strong: Resilience among gender expansive youth worldwide

We are thrilled to present a special collection of empirical papers, critical commentaries/reviews, and a book review in the International Journal of Transgenderism. We called for cutting-edge research that explored the experiences of transgender young populations as it relates to health, well-being, and/or school achievement and experiences. We were particularly interested in scholarship focused on opportunities for resilience and reducing stigma among the trans youth population. We selected works that focused on resiliency among transgender and gender expansive young people. This special issue is published by the International Journal of Transgenderism with support from the Public Discourse Project at the University of Connecticut in Storrs, Connecticut, USA. Included in this special issue are 10 exciting contributions that advance the scholarship regarding the health and well-being of gender expansive young people.

The impetus for this special issue was the plethora of recent troubling legislation that have limited and removed sundry rights of transgender individuals. As a result of divisive rhetoric, transgender youth often face particular challenges related to acceptance by their families, at school, and in the larger community. Our own previous scholarship (Veale et al., 2016; Watson, Veale, & Saewyc, 2017) identified disparities among transgender youth, yet we also identified particular contexts for resilience that mitigated negative mental health and disordered eating. By way of this special issue, we sought to collect contemporary scholarship that extended this emerging body of literature.

Among 10 contributions, 6 are empirical papers. The collection of these papers approached resiliency from multiple lenses – from school-based clubs as tools for engagement in advocacy, to proactivity and self-care as strategies to mitigate struggles. These empirical articles focused on diverse contexts, including school, the media, and religious contexts.

We begin with the U.S. context, where an emerging body of research focused on the lived experiences of transgender young people (e.g., Katz-Wise et al., 2017; Reisner et al., 2015). The first paper included in this collection analyzed responses from 295 gay-straight alliance (GSA) members from across 33 U.S. high schools and found significant variations in gender diversity discussions across GSAs and among youth within each GSA (Poteat et al., 2018). Poteat and colleagues found that higher levels of advocacy within GSAs was associated with having more transgender friends and perceiving respectful climates in GSAs. This paper makes a valuable contribution given emerging evidence finds increasing school-based disparities for transgender youth across the U.S. (Kosciw, Greytak, Giga, Villenas, & Danischewski, 2016).

Moving from the institution of school to that of families, Aramburu Alegría (2018) explored the characteristics of supportive families, in particularly related to the well-being of transgender youth. As part of the first wave of a longitudinal study, Aramburu Alegría interviewed 14 parents of 12 transgender youth aged 6 to 17; she found that among socially transitioned youth, parents tended to grant independence and facilitated selective disclosure of trans identities to best support their trans youth. Established supportive networks, such as counselors, were leveraged to provide camaraderie and promote resilience among the youth in the sample. While Aramburu Alegría consistently heard about struggles parents endured—notably dealing with uncertainty surrounding the child's future and safety—she concluded that when parents were able to work with their child to socially transition, she in turn found the youth to be happier and more engaged. These findings corroborate previous scholarship that has found parents and family to be essential in the well-being of transgender youth as they transition through adolescence (Klein & Golub, 2016; Watson et al., 2017).

Of course, many transgender young people do not have access to supports in schools or from family members—a significant number of homeless young people are transgender (Whitbeck, Lazoritz, Crawford, & Hautala, 2014). Shelton, Wagaman, Small, and Abramovich (2018) explored resilience strategies among 27 transgender and gender expansive youth who had histories with homelessness. Though participants were well aware of negative societal views related to trans identities, these youth also reported that exercising choice (e.g., intentionally choosing what they did or where they would live), self-definition (e.g., rejecting a ‘homeless’ label), and envisioning positive futures in light of their challenges (e.g., homelessness contributing to growth) were key in the resilience of these young people.

Turning to the Canadian context, Clark, Veale, Townsend, Frohard-Dourlent, and Saewyc (2018) explored whether non-binary (n = 344) trans youth differed in health care access and health outcomes compared to their binary (n = 495) transgender counterparts. In recent times, more transgender youth are identifying as non-binary (see Richards et al., 2016), and so comparing health care experiences based on (non-) binary status is timely. The authors found that the majority of non-binary youth in their sample were assigned female at birth (82%) and 19–25 year old non-binary youth were more likely to forego health care that they needed and less likely to seek hormone therapy than their binary-identified counterparts. With this knowledge, we are better attuned to how those youth who identify outside the “man/woman” binary might experience health care, which has important implications for medical professionals and therapists.

Another Canadian study analyzed news articles focused on the issue of the compatibility of the transgender lived experience with the doctrine that guides the Catholic school system. By way of a critical discourse analysis, Herriot and Callaghan (2018) reported two theological arguments used to thwart transgender inclusion in Canadian schools – (1) that gender cannot be changed because it is God-given, and (2) a divine gender plan does not make room for transgressive bodies. Herriot and Callaghan took a unique approach to investigating an opportune topic – the issue of trans bodies in traditionally unwelcoming spaces, and how this tension may be changing as social contexts become more progressive, is certainly timely.

The final empirical study in this issue also focused on youth in Canada. Pullen Sansfaçon et al. (2018) used community-based participatory action research to produce a rich set of qualitative data examining the barriers that transgender youth experience when attempting to access gender-affirming care. This work provides a useful addition to quantitative research that has provided evidence for these barriers, such as Clark et al. (2018) in this issue. Pullen Sansfaçon and colleagues are able to provide richer and more in-depth data about these experiences. This study serves as a call-to-action for healthcare professionals working with transgender youth to work to reduce and address these negative experiences.

From the Australian context, Riley (2017) provides an in-depth critical review of the important issues affecting transgender youth. Bullies, blades, and barricades describe the threats to physical safety as well as the barriers to authentic gender expression that impact the lives of transgender youth across many contexts, including school, home, friendship circles, and professional circles. While Riley provides a very thorough critical review of the research literature on these topics, in our opinion the most important contribution of her review is the application of this knowledge to clinical practice. Riley emphasizes the need for clinicians to be advocates for transgender youth that they see. Clinicians working with transgender youth can draw upon this article as a valuable resource for practical applications for clinical work with this population.

Three papers part of this collection are critical reviews focused on engaging with and critiquing the extant body of transgender scholarship—oftentimes suggesting areas for future development. Three additional responses to the first critical review are included in the spirit of soliciting open dialogue. These contributions in particular are advantageous in moving the field forward during a unique period when transgender bodies are being legislated in troubling ways.

Temple Newhook et al. (2018) provide a critical review of the methods and interpretations of four studies that they refer to as the desistance studies. These studies have had a significant impact on clinical practice for transgender youth (Coleman et al., 2012). Temple Newhook and colleagues suggest that in the future we should focus on the best way to support gender expansive youth, rather than on whether their gender identity will persist or desist. Their commentary provides a source of ideas for the ways to move research on this topic forward. In the interests of open academic dialogue, we invited the authors of the studies in question to respond to Temple Newhook and colleagues’ commentary. Zucker (2018) and Steensma and Cohen-Kettenis (2018), responded separately. Zucker problematizes the rigor of the systematic inclusion of historical scholarly literature and suggested Temple Newhook and colleagues should have included other works in their critical review. Zucker also suggests that persistence of trans youth might be higher than reported in the follow-up studies to date. In their response, Steensma and Cohen-Kettenis disagree that their own previous work did not taken into consideration the needs of children and recommend that studies on trans and gender diverse children's development should be not abandoned. Steensma and Cohen-Kettenis also point out alternatives in estimating persistence rates of gender dysphoria and outline the limitations in the choices of works used to present the prevalence in the Temple Newhook and colleagues’ article. We invited Winters et al. (2018) to provide a final response; in this, they clarify some of the points raised by Zucker and Steensma and Cohen-Kettenis. They remind the readers they produced a “critical commentary” and not an exhaustive literature review and acknowledge the contributions of all three responding authors and agree with their sentiments regarding the changing historical context for care. Winters and colleagues reiterate that their review was in the spirit of moving away from the disproportionate focus on using these studies to predict children's identities as they grow up.

In their critical review, Ehrensaft, Giammattei, Storck, Tishelman, and Keo-Meier (2018) also focus on the ways that we can progress healthcare for transgender youth for the future. As well as providing an excellent summary of the literature on prepubertal social transitions and emerging evidence of the benefits of a gender-affirmative approach, Ehrensaft and colleagues synthesize this with clinical practice knowledge regarding prepubertal social transitions. The result of this is a useful guide for healthcare professionals to practice from a gender-affirmative framework. Many of the practical issues discussed by the authors will be useful for professionals to justify gender-affirmative practice at a time when much opposition remains worldwide to allowing youth to affirm their own genders.

Accompanying the empirical and review papers is a book review of Elijah Nealy's “Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition.” Drs. Pleak and Shadianloo (2017) begin their book review by situating Nealy's contribution in the broader literature, which has been focused primarily toward therapists. Nealy's book is uniquely targeted to two distinct, but similarly important, stakeholders: parents and therapists. Pleak and Shadianloo (2017) point out the superb use of evidence-based data presented in the spirit of best supporting transgender youth, complimented with Nealy's own experience growing up transgender. The book review carefully summarizes the three distinct parts of Nealy's book and concludes that the book comes at a crucial time in the fight for bettering the experiences of transgender youth.

In summary, we are proud to introduce this wonderful collection of papers that we hope will contribute to moving forward the field of transgender youth health, well-being, and opportunities for resilience in a meaningful way. We hope you enjoy this collection.