A retrospective analysis of the gender trajectories of youth who have discontinued a transition.

Background: Detransition is frequently covered in the media as a return to a cis identity after transition. Detransition is often studied in isolation and fails to examine it in context of various stages leading to detransition. Aim: To present the perspectives and reflections of youth who have detransitioned on their journey from early transition to discontinuation, focusing on three key dimensions: gender modalities, sexual modalities, and dysphoria experiences, and their evolution during this journey. Method: We drew from 20 in-depth interviews with young people aged 16 to 25 who have discontinued a transition and examined various stages of the gender journey from early transition to detransition. Youth narratives were analyzed thematically and longitudinally. Results: We developed three main themes related to the gender journey: nonlinear gender modalities, navigating sexual modalities along with gender modalities, and coping with dysphoria and body discomfort. We found a great diversity of experiences with regard to these within each participant and across the sample. Discussion: Transition and detransition trajectories are nonlinear and heterogeneous, without any identified commonalities that enable the prediction of outcomes after transitions. However, transnormativity may influence how people who detransition are expected to conform to a certain narrative despite the diversity of experiences present in this community.

Social Support and Mental Health Among Transgender and Nonbinary Youth in Quebec.

Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths' mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths' health and may constitute key areas for intervention for those supporting them.

Experiences of discrimination or violence and health outcomes among Black, Indigenous and People of Colour trans and/or nonbinary youth.

AIMS: Identify the relationship between experiences of discrimination or violence and health outcomes for transgender and nonbinary Black, Indigenous and People of Colour (BIPOC) compared to their white trans and nonbinary peers. DESIGN: A national online survey, the 2019 Canadian Trans and Nonbinary Youth Health Survey, was conducted among youth ages 14-25, in English and French. METHODS: Participants were recruited from November 2018 to May 2019 (N = 1519). BIPOC youth comprised 25.7% of the sample (n = 390). Questions about six types of discrimination (e.g. racism and sexism) and violence (physically threatened or injured), plus foregone health care, self-harm and suicidality were drawn from existing validated measures. Analyses involved cross-tabulations with chi-square tests and logistic regressions. RESULTS: Trans and non-binary BIPOC reported significantly higher prevalence of suicide attempts (24.9% vs. 19.5%) and violence victimization compared to white youth. They had significantly higher odds of self-harm and foregone health care when experiencing discrimination by ethnicity or culture. All types of violence were significantly associated with higher odds of foregone physical health care, self-harm, suicide ideation and suicide attempt. CONCLUSION: In Canada, trans and nonbinary youth who are BIPOC face disparities in health outcomes and experiences of violence and discrimination compared to white trans and nonbinary youth. IMPACT: Nurses should assess for violence exposure and discrimination among trans and/or nonbinary youth of colour, and promote health equity by advocating for policies to reduce violence and discrimination, including racism, for trans and nonbinary young people.

School Factors Strongly Impact Transgender and Non-Binary Youths' Well-Being.

BACKGROUND: School plays an important role in transgender and non-binary (TNB) youths' life and well-being. The aim of this study was to gain a better understanding of how the lived experiences, gender affirmation and challenges encountered by TNB youths in the school setting affect their well-being. METHOD: Our study was a qualitative secondary data analysis, based on the interviews of 12 Canadian TNB youths aged 15-17 years old. RESULTS: We found that TNB students' well-being was closely related to the acknowledgment of gender identity at school. Several factors, including school socio-cultural environment, teachers' and peers' attitudes and behaviours, school physical environments and the respect of confidentiality of gender identity were all found to impact TNB students' well-being. To face adversity related to some of these factors, TNB youths used several contextually driven strategies such as compromising, educating, and sensitizing others about gender diversity and avoiding certain people or situations. CONCLUSION: Our results highlight the important influence of school climate and culture, as well as teachers', school personnel's and peers' behaviours and attitudes on TNB youths' well-being. Our findings can guide future interventions to help schools become more inclusive and supportive of gender diversity.

En Réponse Au Projet De Loi 2 : Associations Entre Les Démarches Légales D'affirmation Du Genre et Deux Indicateurs De Bien-être Chez Des Personnes Trans et Non-Binaires Du Québec.

Mots-clés bien-être, détresse psychologique, satisfaction devie, transition légale, identité de genre, trans, non-binaire.

Experiences and Stressors of Parents of Trans and Gender-Diverse Youth in Clinical Care from Trans Youth CAN!

Parents of trans and gender-diverse youth can experience challenges navigating gender-affirming (GA) care such as stigma, transphobia, and lack of support. There is little information available about stressors, worries, and positive feelings of parents as they try to support their youth accessing GA care. This article presents baseline survey data on experiences and stressors of 160 parents/caregivers in the Trans Youth CAN! cohort study, which examined medical, social, and family outcomes in youth age 16 years or younger considering puberty blockers or GA hormones. Data were collected at 10 Canadian gender clinics. Authors report on participating parents' characteristics, levels of support toward youth, stressors, worries, concerns, and positive feelings related to youth's gender. Most parent participants were White (85.1 percent), female (85.1 percent), birth or adoptive parents (96.1 percent), and reported strong support for youth's gender. Participants' concerns included their youth facing rejection (81.9 percent), generalized transphobia (74.6 percent), or encountering violence (76.4 percent). Parents also reported positive feelings about seeing their youth grow more confident. Most parental worries and stressors were situated outside the family, reflecting the systemic discrimination faced by youth and their families. Social workers could address these by developing systems-focused interventions and by further taking into account intersectional health disparities.

[+Proud: A Mobile Application to Empower LGBTQ+ Youth and their Family]. / +Fièr : une application mobile pour aider les jeunes issus de la communauté LGBTQ+ et leur famille.

LGBTQ+ people are anywhere from 1.5 to 4 times more likely than heterosexual people to report depression, anxiety, suicidal behaviors, substance abuse, eating disorders, risky sexual behaviors, homelessness, and victimization. Objective The purpose is to describe the development of a mobile application for LGBTQ youth and their family. This article is part of a research program intended to equip LGBTQ+ youth and their families with technological tools to help them foster adaptive strategies in the face of stigma. LGBTQ+ youth face unique stressors both publicly (e.g. victimization) as well as personally (e.g. identity development and "coming out" process). Method We build upon Isabelle Ouellet-Morin's team +Fort: Stronger than Bullying © mobile application designed to reduce victimization among youth. We will create a new app called +Fièr/+Proud, to be designed and piloted in collaboration with LGBTQ+ participants ages 13-25 and their families. Impact Our hope is to bring LGBTQ+ youth together nationally and internationally to explore health promoting coping strategies, learn from custom training modules, share their unique experiences, and help inform parents of the experiences that LGBTQ+ people often face and fight in silence.

Pathways to gender affirmation in trans youth: A qualitative and participative study with youth and their parents.

How trans youth realize about their gender identity and come out to their significant others is under-researched and very few studies include both youth and parental perspectives. This study was developed in Switzerland, a country where families with trans youth are just beginning to break invisibility. The research protocol draws on grounded theory methodology, is participative and developed in collaboration with a local trans NGO and a pan Canadian project. We conducted 20 semi-structured interviews with 10 trans youth and their caregivers/parents (10 interview). At least three developmental pathways seem to emerge: a) the affirmed children who affirm themselves very early, (b) the silent children who spend their childhood in a state of internal tension without being able to position themselves and (c) the neutral children who become aware of their gender difference at puberty following a childhood in which gender was not problematic. In all cases puberty is a crossroads, lived painfully with significant manifestations of both social and body dysphoria. A better understanding of the process of gender development in trans children and youth will help improve our interventions to better serve young people and their families, and help them overcome the different levels of oppressions they face.

"I knew that I wasn't cis, I knew that, but I didn't know exactly": Gender identity development, expression and affirmation in youth who access gender affirming medical care.

Background: Research about gender identity development is still in its infancy, especially among youth who experience gender dysphoria and are accessing gender-affirming medical care. Aims: This article contributes to the literature on how gender identity and gender dysphoria is experienced, expressed and addressed by youth who have started, or are just about to start, a gender-affirming medical intervention. Methods: The project draws from qualitative interviews with 36 trans children and youth of different ages and stages of puberty. The data were collected in three specialized Canadian clinics that offer gender-affirming care and they were analyzed through inductive thematic analysis. Results: Two interlinked dimensions of the youth's lives allow meaning-making of their gender identity: 1) internal or personal and 2) interactional or social processes. Careful analysis reveals three gender identity development pathways that may be taken by youth, from early questioning to the affirmation of their gender identity. A discussion of current models of gender identity development and their limitations concludes the article.

The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics.

Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate. Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions. Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery. Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions. Discussion : The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.

[Trans Youth and their Parents: an exploration of experiences and interventions in a trans-affirming perspective]. / Parentalité et jeunes transgenres : un survol des enjeux vécus et des interventions à privilégier pour le développement de pratiques transaffirmatives.

This article explores the most recent knowledge on the experiences of trans youth and their parents. The article also explores best practices for professional who work with those families. Finally the article proposes two main principles of intervention to work with those populations, highlighting the importance of a transaffirmative perspective. In particular, it is proposed to challenge the current way of understanding gender and to appreciate the complexity of the various trajectories young people may take. Furthermore, we suggest focusing the intervention on promoting self-determination of the young person as well as to support families so they can better meet their child's needs.Objectives To provide comprehensive review of current knowledge on the experience of parenting a transgender youth, and to propose some reflections on directions for working with those families.Method Written as a theoretical paper, this article employs a systematic literature review to identify promising interventions with families who support a transgender youth.Results Because families of transgender children and youth experience difficulties both on personal and social levels, many of which are coming from social stigmatization and lack of knowledge about their experience, it is proposed that practitioners work toward interventions that not only facilitate families support, but also works toward a more just and inclusive society by broadening access to services and by challenging oppressive structures that contribute to the difficulties experiences by children, youth and their families.Conclusion The paper proposes that practitioners working with families of transgender children must be guided by an reviewed conception of gender and an understanding of the multiplicity of contexts that may affect the person's trajectory, as well as promoting self-determination and supporting families in meeting their needs.