Resilience and Transgender Youth

  • The Resilience and Transgender Youth (RTY) Project was a two-phase, qualitative research project designed to better understand protective factors in the lives of transgender adolescents and youth adults.
  • This study provided relevant information how to better support transgender and other gender diverse youth.

Transgender and other gender diverse youth experience stigma and discrimination that put them at increased risk for poor mental health and suicide, substance use, experiencing violence, risky sexual behaviors, and other health risks.

Yet, adolescents are resilient. Quality sexual health education, access to health care services, and safe and supportive environments can help all youth thrive in the face of risk and are critically important for transgender and other gender diverse youth.

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Understanding the experience of transgender youth will help improve school environments, parental relationships, health services, and sexual health education and help to create more supportive environments for transgender youth.

Key Findings

School Environments

  • Transgender youth report feeling isolated and excluded in school environments.
  • Transgender youth express resilience by actively coping with these stressors through advocating for their needs and seeking out (and finding) connection with supportive staff and friends.
Sexual Health Education
  • Transgender youth consider school-based sexual health education unhelpful due to a lack of relevant information, inadequately trained teachers, and a perceived negative tone toward sexuality.
  • Transgender youth rely upon alternate sources of sexual health information, particularly online, where they found relevant information and a sense of community.

Parental Relationships

  • Transgender youth report receiving parental support generally in the form of housing, advice, affirmation, and expressions of love or caring.
  • Transgender youth report parents struggled to provide support specific to their gender identity, such as
    • being emotionally supportive when youth came out to their parents as transgender,
    • chosen name and pronoun usage, and
    • assistance with social, legal, and medical gender affirmation processes.

Health Services

  • Transgender youth report facing challenges to accessing culturally competent and gender affirming health care, such as a lack of provider knowledge of transgender issues and inconsistent use of chosen name and pronouns.

Significance for Schools, Parents, and Healthcare Providers

We all have a role in supporting transgender youth.

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Schools can:

  • Review and implement policies and practices to ensure inclusivity,
  • Take steps to affirm gender identity,
  • Intervene in bullying on campus, and
  • Provide or refer students to comprehensive, affirming, sexual health services.
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Parents can:

  • Seek out resources and programming to assist with understanding, accepting, and gender-affirming behaviors.
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Healthcare providers and office staff can:

  • Take part in transgender cultural competency trainings, and
  • Establish clinic protocols relating to confidentiality and chosen name and pronoun use.

Resilience and Transgender Youth Project Overview

CDC worked with and funded ICF (a research and evaluation firm) to design and implement the Resilience and Transgender Youth Project in order to better understand the lives of transgender adolescents and young adults.

Racially diverse transgender youth and parents of transgender youth participated in interviews and focus groups over a three-year time period. In these conversations, they discussed their definitions of gender and health, as well as protective factors at individual, relationship, school, and community levels.

For a full description of the project methods, please reference the publications below.

Resilience and Transgender Youth Project Publications
  • Andrzejewski J, Pampati S, Steiner RJ, Boyce L, Johns MM. Perspectives of transgender youth on parental support: qualitative findings from the resilience and transgender youth study. Health Educ Behavexternal icon. 2020.
  • Johns MM, Zamantakis A, Andrzejewski J, Boyce L, Rasberry CN, Jayne PE. Minority stress, coping, and transgender youth in schools-Results from the Resilience and Transgender Youth Study. J Sch Healthexternal icon. 2021.
  • Pampati S, Andrzejewski J, Steiner RJ, et al. “We deserve care and we deserve competent care”: Qualitative perspectives on health care from transgender youth in the Southeast United States. J Pediatr Nursexternal icon. 2021;56:54-59.
  1. CDC DASH. Protective Factors for LGBTQ Youth. 2019.
  2. Johns MM, Lowry R, Andrzejewski J, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students — 19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:67–71.
  3. Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52(3):243-256.
  4. Reisner SL, Vetters R, Leclerc M, et al. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health. 2015;56(3):274-279.
  5. Reisner SL, White JM, Bradford JB, Mimiaga MJ. Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center. LGBT Health. 2014;1(3):177-184.