How do transgender teens cope with stress?

  • A 2-year survey of transgender or gender minority (GM) adolescents, who have a different gender identity than the one they were assigned at birth, suggests that many use alcohol to cope with GM-related stress.
  • Internalized cissexism had associations with an increased risk of substance use in response to stress, whereas resilience and gender-related pride had associations with a lower risk.
  • Family and social support protected against alcohol use at low levels of stress, but not at high levels.
  • The researchers conclude that future interventions with GM youth should aim to reduce internalized cissexism and strengthen resilience, gender-related pride, and family functioning.

Transgender people have a different gender identity to the sex they were assigned at birth, in contrast to cisgender individuals, who are comfortable with their assigned gender.

A recent study found that transgender and nonbinary adolescents face more emotional distress and bullying and have fewer protective factors, such as family connectedness, compared with their cisgender peers.

Another study found that the prevalence of substance use among these GM youth can be up to 4 times higher than in cisgender youth.

These findings suggest that GM adolescents use drugs, such as alcohol, to cope with the additional stressors they encounter in their everyday lives.

However, the research to date has been cross-sectional (focused on a single moment in time), making it harder to establish the root causes of substance use.

A newly published study, which surveyed the substance use of 30 GM adolescents every 6 months over a period of 2 years, supports the view that they used alcohol, in particular, to cope with GM-related stresses.

Scientists at Boston Children’s Hospital, Harvard Medical School, and the Harvard T. H. Chan School of Public Health, all in Boston, MA, conducted the research. The results appear in PLOS ONE.

Risk factors and protective factors

Their study examined how stressors, such as victimization, and related risk factors, namely internalized cissexism, depressive symptoms, and anxiety affected substance use.

It also investigated potentially protective factors, such as resilience, gender-related pride, family functioning, and social support.

All the subjects, who were aged 13–17 years, were part of a community-based research project called the Trans Teen and Family Narratives Project.

Participants identified as:

  • transfeminine (11)
  • transmasculine (15)
  • nonbinary (4)

At the start of the study, 17% reported using substances, including tobacco, alcohol, and marijuana. But by the end, 56% of participants claimed that they were using one of these.

Higher exposure to GM-related stress significantly increased the likelihood that these adolescents would use alcohol, but not tobacco or marijuana.

Internalized cissexism

The survey asked participants to rate how strongly they agreed or disagreed with a list of statements, such as:

  • “When I think of my gender identity or expression, I feel depressed” — to gauge internalized cissexism.
  • “I reach my goals if I work hard” — to gauge resilience.
  • “My gender identity or expression makes me feel special and unique” — to gauge gender-related pride.
  • “I feel part of a community of people who share my gender identity” — to gauge community connectedness.

Internalized cissexism mediated the association between stress and substance use. In other words, the more internalized cissexism teens felt, the more likely they appeared to deal with GM-related stress through substance use.

Conversely, resilience and gender-related pride appeared to protect against substance use in response to GM-related stress.

Participants who reported having supportive friends and family seemed significantly less likely to turn to alcohol in response to low levels of stress, but the same was not true at higher levels.

By the end of the study, 40% of participants reported having used alcohol recently. In contrast, a survey in 2019 found that 29% of high school students in the United States had recently drunk alcohol.

Possible underestimate

Sabra L. Katz-Wize, Ph.D., who led the study, told Medical News Today that the figures for substance use among GM teens suggested by her research were likely to be an underestimate.

Teens enrolled in the Trans Teen and Family Narratives Project are likely to have a greater degree of self-acceptance, resilience, and family or peer support than trans teens who have yet to share their true identities.

“The teens in this sample were all part of families that agreed to participate in research together, indicating a baseline level of support that is likely higher than the general population of gender minority teens,” she said.

“However, it is important to note that even among the families in this study, there were differences in levels of support across different family members and across time (e.g., some family members were initially unsupportive, but now are more supportive).”

The authors conclude that future interventions with GM youth should focus on addressing internalized cissexism and strengthening resilience, gender-related pride, and family functioning.

They write:

“Since GM adolescents appear to be using substances to cope with exposure to gender minority stressors, programs could assist adolescents in identifying adaptive coping strategies in response to such stressors. GM adolescents should also be connected to resources where they can connect with other GM adolescents.”

Limitations of the research

The researchers note some limitations of their survey. For example, the sample was small, while participants were predominantly white and non-Hispanic.

In addition, they tended to come from a higher socioeconomic background than the wider population.

The findings may therefore not generalize to GM teens who were underrepresented in this sample.

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