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J Adolesc Health. 2017 Oct;61(4):521-526. doi: 10.1016/j.jadohealth.2017.04.014. Epub 2017 Jul 21.

Risk and Protective Factors in the Lives of Transgender/Gender Nonconforming Adolescents.

Author information

Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. Electronic address:
Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
Center for Adolescent Nursing, School of Nursing, University of Minnesota, Minneapolis, Minnesota.
Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.



Research suggests that transgender and gender nonconforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex.


This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N = 81,885). Students who were transgender, genderqueer, genderfluid, or unsure about their gender identity (TGNC) were compared with those who were not, using χ2 and t-tests. Outcome measures included four domains of high-risk behaviors and experiences and four protective factors.


The prevalence of TGNC identity was 2.7% (n = 2,168) and varied significantly across gender, race/ethnicity, and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, χ2 = 1959.9, p < .001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males.


This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the United States, highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development.


Gender identity; Health behaviors; Protective factors; Transgender

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