Estimating Population Size and Demographic Characteristics of Lesbian, Gay, Bisexual, and Transgender Youth in Middle School

doi:10.1016/j.jadohealth.2012.06.016

Journal of Adolescent Health

Volume 52, Issue 2, February 2013, Pages 248-250

https://doi.org/10.1016/j.jadohealth.2012.06.016 Get rights and content

Abstract

Purpose

To estimate the size and demographic characteristics of the lesbian, gay, bisexual, and transgender youth populations using data from the 2011 Youth Risk Behavior Survey (YRBS) administered in San Francisco Unified School District middle schools.

Methods

The YRBS was administered to a stratified random sample of 2,730 youth (grades 6–8) across all 22 public middle schools in San Francisco. Cross-tabulations using complex samples analyses were used to derive population estimates and confidence intervals.

Results and conclusions

Results show that 3.8% of middle school students identify as lesbian, gay, or bisexual, and 1.3% of middle school students identify as transgender. To improve our understanding of the size of these populations across the nation, researchers conclude it is imperative that all YRBS administration sites include items on sexual orientation and gender identity as they would any other demographic item, such as race/ethnicity, sex, or age. The current lack of reliable data on the size and characteristics of the lesbian, gay, bisexual, and transgender youth population limits the capacity of policy makers, administrators, and practitioners to address their needs.

Section snippets

Methods

Using a stratified random sampling design, the 2011 YRBS was administered to 2,730 youth (grades 6–8) across all 22 public middle schools in San Francisco in compliance with the CDC's administration guidelines and state regulations on parent consent/notification. The process yielded a 74% survey completion rate, surpassing the CDC's 60% criteria for the generation of weighted data. CDC statisticians calculated sampling weights, strata, and primary sampling unit statistics. Cross-tabs using

Measures

Following the CDC guidelines, standard YRBS demographic items (e.g., sex, race/ethnicity, age, and grade) were included in the analyses if no fewer than 100 respondents were represented [8]. Sexual orientation was measured using the item, “Which of the following best describes you?” and the response set “heterosexual (straight); gay or lesbian; bisexual; and not sure.” Transgender-inclusive gender was measured with the item, “What is your gender?” and the response set “female; male; and

Results

Population estimates show 3.8% of students in SFUSD middle schools identify as LGB (Table 1). Within the 3.8% of LGB students, 1.7% identify as gay or lesbian and 2.1% as bisexual. Another 12.1% of students responded they were “not sure” about their sexual orientation. Results also show 1.3% of students identify as transgender, resulting in a weighted population estimate of 137 transgender youth. Across available demographic variables, the proportion of LGB and transgender youth appeared to

Discussion and Conclusions

The population estimates derived in this study clearly demonstrate the presence of LGBT students at the middle school level. The large proportion of students (12.1%) who report being “unsure” of their sexual orientation is likely owing to a combination of factors, including the variability of developmental trajectories across youth; their social, cultural, and familial contexts; and differences in youths' understanding and interpretation of the survey item. Additional research is needed on the

Acknowledgments

The authors gratefully acknowledge the San Francisco Unified School District's School Health Programs staff; its director Kim Coates; and program managers Kevin Gogin and Kim Levine for their invaluable contributions to and support of this study. Points of view or opinions expressed in this document are those of the authors and do not necessarily represent the official position or policies of the San Francisco Unified School District.

References (10)

The health of lesbian, gay, bisexual and transgender people; conducting research on the health status of LGBT populations; Chapter Three: Childhood/Adolescence
(2011)
Young adolescents' developmental characteristics
K. Miller et al.
Design, development and testing of the NHIS sexual identity question
(2011)
S.B. Austin et al.
Making sense of sexual orientation measures: Findings from a cognitive processing study with adolescents on health survey questions
J LGBT Health Res
(2007)
C. Regan et al.
Understanding sexual minority youth. 2008. University of Florida IFAS Extension

There are more references available in the full text version of this article.

Cited by (93)

Clinical profiles and care of transgender children and adolescents in a specialized consultation in Île-de-France
2023, Neuropsychiatrie de l'Enfance et de l'Adolescence
Il existe très peu de données cliniques françaises sur les modalités de prise en charge médicale des enfants et adolescents transgenres alors que le sujet vient très régulièrement sur le devant de la scène médiatique.
Nous proposons dans cet article de décrire de manière rétrospective l’ensemble des enfants et adolescents reçus depuis 2012 dans la plus importante consultation spécialisée identité de genre enfants et adolescents d’Île-de-France. Outre leurs caractéristiques sociodémographiques, nous étudions la présence ou non d’une incongruence de genre selon les critères de la CIM 11, les vulnérabilités psychiatriques et sociales des sujets et décrivons les principales modalités de prise en charge proposées : la transition sociale, le blocage pubertaire, les transitions hormonales et/ou les rares transitions chirurgicales. Ces trois dernières propositions sont discutées en réunion de concertation pluridisciplinaire (RCP).
Nous avons colligé 239 jeunes âgés de 3 à 20 ans. L’âge moyen auquel les jeunes et leur famille sont vus au premier rendez-vous est de 14,5 ans (± 3,16). Au total, 91 % de l’échantillon présentent une incongruence de genre, 32 % ayant exprimé cette incongruence avant la puberté. Deux-tiers sont des jeunes assignés de sexe féminin à la naissance (p < 0,05). En termes de psychopathologie, les troubles dépressifs et anxieux, ainsi que la suicidalité arrivent largement avant les autres cooccurrences psychiatriques. L’ostracisme et le rejet scolaire sont fréquents. Par rapport à la population adolescente générale, les jeunes de la consultation spécialisée sont beaucoup plus exposés aux discriminations et aux insultes, voire aux agressions sexuelles dans l’espace public, que leurs pairs et l’internalisation de la transphobie par ces jeunes est particulièrement importante. Au total, 40 % des jeunes ont effectué une transition sociale avant le premier rendez-vous et 74 % et 61 % d’entre elles/eux l’on fait au sein de la famille et à l’école (l’âge moyen de la transition sociale à l’école = 15,13 ans). Au total, 35 % des jeunes ont officialisé en mairie le changement de prénom (l’âge moyen = 16,26 ans). La prise de bloqueurs de puberté concerne 11 % des jeunes qui ont atteint la puberté (âge moyen = 13,9 ans, délai moyen avant instauration du traitement = 10 mois). Au total, moins de la moitié des jeunes (44 %) ont reçu un traitement hormonal masculinisant ou féminisant par hormones sexuelles (âge moyen = 16,9 ans, délai moyen avant l’instauration = 14 mois). Au total, 8,7 % des jeunes ayant reçu un traitement hormonal par hormones sexuelles ont réalisé une préservation de fertilité. Les demandes de chirurgie avant 18 ans restent très rares. Les plus fréquentes sont les torsoplasties (20 %) réalisées à l’âge moyen de 18,44 ans et jamais avant 16 ans.
Les résultats de cette cohorte sont proches de ceux rapportés par d’autres centres européens pour ce qui concerne la proportion plus élevée de jeunes assignés de genre féminin à la naissance. En revanche, ils diffèrent avec des chiffres plus bas en termes de recours à des traitements hormonaux. La transition sociale est dans notre centre la demande la plus fréquente mais elle n’est pas systématique. Nous discuterons la place de la parole dans notre accompagnement pour expliquer ces différences.
French clinical data on the medical management of transgender children and adolescents are scarce. Yet, the topic regularly comes to the forefront of the media.
In this article, we propose to retrospectively describe all the children and adolescents received since 2012 in the largest specialized gender identity consultation for children and adolescents in Île-de-France. In addition to their sociodemographic characteristics, we study the presence or not of gender incongruence according to the ICD 11 criteria, the psychiatric and social vulnerabilities, and describe the main management modalities proposed: social transition, puberty blockage, hormonal transitions and/or rare surgical transitions. These last three proposals were discussed in multidisciplinary concertation meetings.
We collected 239 youths aged 3 to 20 years. The mean age at which youth and their families were seen at the first appointment was 14.5 years (± 3.16). In all, 91% of the sample had gender incongruence, with 32% expressing gender incongruence before puberty. Two-thirds were youth assigned female at birth (P < 0.05). In terms of psychopathology, depressive and anxiety disorders, as well as suicidality, came well ahead of other psychiatric co-occurrences. School ostracism and rejection were common. Compared to the general adolescent population, the young people in the specialized consultation are much more exposed to discrimination and insults, and even sexual aggression in the public space, than their peers, and the internalization of transphobia by these young people is particularly important. In all, 40% of the young people made a social transition before the first consultation and 74% and 61% of them did so within the family and at school (the average age of social transition at school = 15.13 years). In all, 35% of the young people made the name change official at the town hall (the average age = 16.26 years). Puberty blockers were used by 11% of the youths who had reached puberty (mean age = 13.9 years, mean time to initiation = 10 months). In total, fewer than half of the youths (44%) received masculinizing or feminizing sex hormone treatment (mean age = 16.9 years, mean time to initiation = 14 months). In all, 8.7% of the young people who received sex hormone treatment underwent fertility preservation. Requests for surgery before the age of 18 remain very rare. The most frequent are torsoplasties (20%) performed at a mean age of 18.44 years and never before 16 years.
The results of this cohort are close to those reported by other European centers in terms of the higher proportion of young people assigned female at birth. However, they differ with a lower proportion of hormonal treatment. Social transition is the most frequent request in our center, but it is not systematic. We wonder whether the place of narration while in our care may explain these differences.
Gender care
2023, Encyclopedia of Child and Adolescent Health, First Edition
Although gender was once thought to be synonymous with sex, it is now recognized to be a complex entity, independent of hormones, genitalia, and the chromosomes and genes which define sex. As recognition and acceptance of the transgender population increases, more individuals have begun to take steps at a younger age to facilitate alignment of their role in society with their gender identity. Caring for a gender diverse youth involves a multidisciplinary approach with mental health providers and medical providers as well as social workers, family involvement if relevant, and community engagement. A key feature of gender care is its highly individualized nature. Although two people may have a similar gender identity on paper, they may have dramatically different goals and they may seek different combinations of social transition, medical transition, and surgical transition.
The care of transgender children and adolescents in France: Recent controversies and ethical issues
2022, Neuropsychiatrie de l'Enfance et de l'Adolescence
Ces dernières années, la communauté médicale est traversée par les débats sociétaux autour du genre, du sexe, de la procréation et des droits humains. Aussi les questions autour de la prise en charge médicale des enfants et adolescents transgenres viennent elles très régulièrement sur le devant de la scène médiatique suscitant la mobilisation de collègues à l’origine de prise de positions réclamant entre autres l’interdiction de prescrire des traitements hormonaux jusqu’à 25 ans. Nous proposons dans cet article de reprendre point par point les principaux sujets de controverses autour de la prise en charge médicale contemporaine des transidentités de l’enfant et de l’adolescent, à savoir la transition sociale, le blocage pubertaire, les transitions hormonales, et les transitions chirurgicales, et de les mettre en perspective de la situation contemporaine en France. Si la plupart des études cliniques menées depuis plus de 25 ans montrent les impacts positifs des prises en charge médicales des adolescents transgenres sur leur devenir psychologique soulignant l’innocuité relative des traitements, l’accompagnement psychodynamique n’en demeure pas moins essentiel, prenant en compte la singularité de chaque patient au fil des rencontres. Le temps long est parfois requis, parfois contre-indiqué en fonction de chaque situation clinique. Rappelons qu’il n’y a aucune prescription médicamenteuse avant la puberté, et pour les adolescents la durée moyenne entre la première consultation (pour laquelle ils ont attendu souvent un an) et une éventuelle prescription est d’une année. Dans le contexte où la population des enfants et adolescents transgenres est particulièrement vulnérable, ne pas nuire n’est pas systématiquement s’abstenir de prescrire, chaque situation clinique devant être évaluée dans sa singularité avec précaution et discernement. Ces décisions de transition médicale sont discutées et validées si pertinentes, en France depuis 2015, dans le cadre de Réunions de Concertation Pluridisciplinaire. Par-delà les opinions et les débats sociétaux, de réels enjeux éthiques sont à considérer, en particulier autour de la notion de consentement libre et éclairé chez l’enfant et l’adolescent, et les recherches doivent se poursuivre.
In recent years the medical community has been crossed by societal debates around gender, sex, procreation, and human rights. Also, questions around the medical care of transgender children and adolescents very regularly come to the fore in the media leading colleagues to seek prohibiting hormonal treatment until the age of 25 years. In the current report, we propose to explore all controversial proposals in the field of contemporary transgender care, i.e. : social transition, puberty suppression with GnRH, hormonal transition, and surgical transition. In addition, we expose the way such a practice is ongoing in France. If most of the clinical studies carried out internationally for more than 25 years have shown considerable positive impacts of the medical care of adolescents on their psychological future and emphasizing the relative safety of the treatments, the psychodynamic support remains essential considering the uniqueness of each patient over the course of the meetings. A long period of time is sometimes required, while sometimes it is contraindicated depending on each clinical situation. Drug prescriptions before puberty are not permitted, and for adolescents the average time between the first consultation (for which they often waited a year) and a possible prescription is one year. As transgender children and adolescents are a particularly vulnerable population, doing no harm does not always mean refraining from prescribing, and each clinical situation has to be assessed in its uniqueness with care and discernment. Since 2015 in France these decisions are taken after assessment during multidisciplinary concertation meetings. Beyond societal opinions and debates, real ethical issues must be considered, especially around the notion of free and informed consent in children and adolescents, and research must continue.
The co-occurrence of neurodevelopmental disorders in gender dysphoria: Characteristics within a paediatric treatment-seeking cohort and factors that predict distress pertaining to gender
2022, Journal of Psychiatric Research
Gender dysphoria, characterised by distress associated with an incongruence between an individual's assigned and experienced gender, is encountered in 1%–2% of children and adolescents. Recent findings suggest neurodevelopmental disorders (NDDs), including Autism, are frequently reported among youth with Gender Dysphoria. This study aims to explore the frequency of NDDs in children and adolescents presenting to a hospital-based gender service, and to investigate the contribution of autistic traits and general psychological distress to distress pertaining to gender. Sixty-four participants (mean age = 12.91 years) with Gender Dysphoria were recruited to this study. Self- and caregiver-report questionnaires were used to evaluate psychological distress, autistic traits, and distress pertaining to gender. Relative to the rest of the participants, the 13 (20.31%) with a co-occurring NDD diagnosis reported elevated autistic traits (p < .001). They did not differ in terms of psychological distress or distress pertaining to gender. A hierarchical linear regression revealed autistic traits alone did not contribute to the variability in distress pertaining to gender, whereas general psychological distress accounted for 9.9% of the variability in distress pertaining to gender (p = .012). The current findings indicate that NDD diagnoses are common in children and adolescents with Gender Dysphoria who attend hospital-based services. Psychological distress, rather than autistic traits, contributes more variability in distress pertaining to gender. Taken together, these findings indicate the need to consider NDDs in treatment plans but also to focus on the important relationship between psychological distress and Gender Dysphoria.
Overview of residency doctors’ training in Île-de-France on care of children and adolescents with a trans-identity status
2021, Neuropsychiatrie de l'Enfance et de l'Adolescence
Cette enquête réalisée auprès des médecins internes d’Île-de-France a pour but d’effectuer un état des lieux de la formation actuelle et des connaissances des internes en médecine concernant l’accompagnement de la transidentité chez l’adolescent et l’enfant. Cette enquête a été effectuée au cours du mois de juin 2020, par le biais d’un questionnaire en ligne anonyme composé de 16 questions.
Les résultats, collectés auprès de 143 internes, montrent un manque de connaissances aussi bien théorique que pratique pour l’ensemble des spécialités ayant répondu. Cela inclut les spécialités de pédiatrie et pédopsychiatrie pourtant directement concernées. Cette situation est principalement due à : un manque de formation et d’enseignement mis en place en amont au sein des universités de médecine et des hôpitaux ; un sujet encore considéré comme tabou au sein même du corps médical. Il semble important de noter ici, que suite à ce constat, les internes interrogés sont ainsi dans la très grande majorité en demande d’un enseignement plus complet, et cela intégré à leur cursus de formation médicale.
Il semble plus qu’important de considérer ce sujet, véritable enjeu de santé publique qui prend une place de plus en plus importante en consultation de l’enfant et de l’adolescent, afin de permettre un meilleur accompagnement des patients et un meilleur accès aux soins au sein d’une population fragilisée par des années de discriminations et d’inégalités face au droit fondamental que constitue la santé.
Gender dysphoria, non-binarity, trans-identity, neutrality, gender fluid. faced with the emergence of a redefinition and reaffirmation of gender, what place and training are there for the doctors of tomorrow? A public health issue is coming to the fore as the suicide rate among these adolescents is seven times higher than among so-called “cisgender” adolescents. So how do you take care of these patients and their families, for whom access to care is so difficult? Several doctors have found themselves confronted with this real tidal wave of requests for gender consultations without any training or clear recommendations.
This survey, carried out among resident doctors in the Île-de-France region, aims to assess the current practical and theoretical training concerning the care of children and adolescents with a trans-identity status. This survey was carried out during the month of June 2020, using an anonymous online questionnaire consisting of 16 questions including multiple choices as well as open-ended ones. The questions concerned a self-assessment of practical and theoretical knowledge according to the year and specialty of the residency. It also addressed the issue of training programs implemented by medical faculties and university hospitals as well as the confrontation to trans-identity in clinical practice and the reflections emerging from it.
The findings, collected from the answers of 143 resident doctors, show an overall lack of knowledge, theoretical and practical, without medical specialization distinction. It includes pediatric and child psychiatric specialties that are all the more directly concerned. This gap is mostly attributed to the lack of training and teaching in medical universities and hospitals, as well as to a subject still considered taboo within the medical profession itself. The overwhelming majority of doctors are thus in demand for more comprehensive education on the issue as part of their general medical training curriculum.
It appears more than important to consider trans-identity status a real public health issue. This matter is taking on an increasingly crucial role in child and adolescent medical counselling. In the coming years, this will enable better patient support and better access to care within a population weakened by years of discrimination and inequality in relation to the fundamental right to health.
Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment
2021, Journal of Sexual Medicine
Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care.
This retrospective cohort study used military healthcare data from 2010–2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents.
3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.45, 95% CI [4.77–6.24]), use more mental healthcare services (IRR 2.22; 95% CI [2.00–2.46]), and be prescribed more psychotropic medications (IRR = 2.57; 95% CI [2.36–2.80]) compared to siblings. The most pronounced increases in mental healthcare were for adjustment, anxiety, mood, personality, psychotic disorders, and suicidal ideation/attempted suicide. The most pronounced increased in psychotropic medication were in SNRIs, sleep medications, anti-psychotics and lithium. Among 963 TGD youth (M_age: 18.2) using gender-affirming pharmaceuticals, mental healthcare did not significantly change (IRR = 1.09, 95% CI [0.95–1.25]) and psychotropic medications increased (IRR = 1.67, 95% CI [1.46–1.91]) following gender-affirming pharmaceutical initiation; older age was associated with decreased care and prescriptions.
Results support clinical mental health screening recommendations for TGD youth. Further research is needed to elucidate the longer-term impact of medical affirmation on mental health, including family and social factors associated with the persistence and discontinuation of mental healthcare needs among TGD youth.
Hisle-Gorman E, Schvey NA, Adirim TA, et al. Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment. J Sex Med 2021;18:1444–1454.

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Adolescent health briefEstimating Population Size and Demographic Characteristics of Lesbian, Gay, Bisexual, and Transgender Youth in Middle School

Abstract

Purpose

Methods

Results and conclusions

Section snippets

Methods

Measures

Results

Discussion and Conclusions

Acknowledgments

The health of lesbian, gay, bisexual and transgender people; conducting research on the health status of LGBT populations; Chapter Three: Childhood/Adolescence

Young adolescents' developmental characteristics

Design, development and testing of the NHIS sexual identity question

Making sense of sexual orientation measures: Findings from a cognitive processing study with adolescents on health survey questions

J LGBT Health Res

Understanding sexual minority youth. 2008. University of Florida IFAS Extension

Adolescent health brief
Estimating Population Size and Demographic Characteristics of Lesbian, Gay, Bisexual, and Transgender Youth in Middle School