Family building desires among transgender and gender expansive adolescents: A longitudinal family-level analysis

Abstract

Introduction

Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how these preferences are developed in a larger ecological context.

Aim

The current study used Ecological Systems Theory as a framework to describe the family building attitudes of TGE adolescents, their caregivers, and their siblings.

Methods

Participants were recruited from community-based venues in the New England region of the U.S. to participate in the TTFN Project, a longitudinal community-based mixed methods study. The sample for the current study included 84 family members from 30 families (30 TGE adolescents, 11 siblings, 44 caregivers). All participants completed a semi-structured qualitative interview about family building attitudes and desires for TGE and cisgender adolescents at two waves across 6-8 months. Interview transcripts were analyzed using a combination of immersion/crystallization, thematic analysis, and template organizing style approaches. The Transgender Youth Fertility Attitudes Questionnaire (TYFAQ) was employed to quantitatively describe the family building attitudes of TGE adolescents and their families.

Results

Eight themes corresponding to the levels of the ecological systems model – individual-level (perceived reproductive potential, reproductive identity), family-level (communication about family building, familial experiences and expectations), community-level (community support and role models; community expectations and norms), and societal/institutional-level (medicalization of family building, external sociopolitical factors) – were developed from the interviews. Results from the TYFAQ indicated that compared to cisgender adolescents, TGE adolescents were less likely to value having biological children and more likely to consider adoption in comparison to their cisgender siblings.

Discussion

Findings emphasize the importance of using Ecological Systems Theory to understand the family building attitudes and desires of TGE adolescents and their families.

Keywords:

• Adolescents
• ecological systems
• longitudinal
• family building
• fertility
• transgender

Conflict of interest

The authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The authors are willing to allow the journal to review their data if requested. Raw data were generated at Boston Children’s Hospital. Derived data supporting the findings of this study are available from the corresponding author SKW on request.

Additional information

Funding

The TTFN Project was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K99R00HD082340) and the Boston Children’s Hospital Aerosmith Endowment Fund, both awarded to Dr. Katz-Wise. Dr. Katz-Wise was also funded by the Maternal and Child Health Bureau, Health Resources and Services Administration (Leadership Education in Adolescent Health project 6T71-MC00009).

Funding

The TTFN Project was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K99R00HD082340) and the Boston Children’s Hospital Aerosmith Endowment Fund, both awarded to Dr. Katz-Wise. Dr. Katz-Wise was also funded by the Maternal and Child Health Bureau, Health Resources and Services Administration (Leadership Education in Adolescent Health project 6T71-MC00009).