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Pediatrics. 2018 May;141(5). pii: e20173845. doi: 10.1542/peds.2017-3845. Epub 2018 Apr 16.

Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers.

Author information

Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Departments of Biostatistics and Bioinformatics and.
Epidemiology, Rollins School of Public Health, and.
Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia.
Rockway Institute, Alliant International University, San Francisco, California.
Division of Research, Kaiser Permanente, Northern California, Oakland, California.
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland.
Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan; and.
Emory School of Medicine, Emory University, Atlanta, Georgia.
Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.
Epidemiology, Rollins School of Public Health, and



Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions.


Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date.


Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14-45) to 54 (95% CI 18-218).


TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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