Impacts of Strong Parental Support for Trans Youth

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Building our communities through research
2 October, 2012
Impacts of Strong Parental Support for Trans Youth
A report prepared for Children’s Aid Society of Toronto and Delisle Youth Services
1
Purpose of Report
The aim of this report is to provide preliminary data on the
health impacts of parental support for trans (transgender or
transsexual) youth aged 16 to 24 in Ontario.
Little is known about the ways in which acceptance or
rejection by one’s family is predictive of health or well-
being outcomes among trans youth. However, exposure to
homophobia is now generally regarded as having significant
implications for the health and well-being of lesbian, gay
and bisexual youth. Numerous studies over the last two
decades reveal negative health, mental health, and quality
of life outcomes, including high rates of depression and
anxiety, low self-esteem, problematic alcohol and drug use,
and suicide. Recent studies have demonstrated a strong
effect of parental acceptance during adolescence in
protecting against these outcomes for lesbian, gay, bisexual
and transgender (LGBT) young adults.1,2
partnership between members of the trans community,
community-based organizations, and academic researchers
who are committed to improving the health of trans people.
Trans PULSE is funded by the Canadian Institutes of Health
Research.
Data and Analysis Methods
Survey data were collected from a total of 433 trans
participants (youth and non-youth) by internet or paper
survey. The survey included items on health-related
measures, including social determinants of health, psycho-
social measures, health care experiences, and sexual health.
Participants were trans people aged 16 and over who lived,
worked, or received health care in Ontario. A broad
definition of “trans” was used; participants needed only to
identify themselves as trans. Participation was not limited to
particular trans identities, nor were they required to have
begun or completed a social or medical gender transition.
Figure 1. Proportion of trans youth age 16-24 years in Ontario
experiencing positive health and life conditions, by
level of parental support
72
66
70
64
58
100
92
33
31
15
13
42
45
82
0
10
20
30
40
50
60
70
80
90
100
Satisfied with
life*
VG/excellent
physical
health
VG/excellent
mental
health*
High self
esteem*
Intent to
parent
Adequate
housing*
Adequate
food
Parent(s) very supportive
Parent(s) somewhat to not at all supportive
* = statistically significant difference (p < 0.05)
However, homophobia and transphobia can function
in differing ways, and trans youth have trans-specific
needs and vulnerabilities that may not necessarily be
captured in studies of LGBT youth.
Given the lack of information on impacts of parental
support for trans youth, we assessed the degree to
which parental support for trans youth’s gender
identity and expression had an impact on overall
satisfaction with life, self-assessed physical and mental
health, self-esteem, depression, and suicidality. We
report on these results below.
Trans PULSE Project
This report was produced using data collected during
the second phase of the Trans PULSE Project, a
community-based, mixed-methods research project
aiming to understand and improve the health of trans
people in Ontario. The Trans PULSE team is built on a

2
Social transition can include a change of name, gender
pronoun and gender presentation. Medical transition can
include interventions such as hormone therapy, gender-
affirming surgeries, and in adolescence, the administering of
gonadotropin releasing hormone analogues (GnRHa) to delay
the onset of puberty.
Participants were recruited through respondent-driven
sampling (RDS) over a 12-month period in 2009-2010,
including 123 trans youth, 84 of whom had socially
transitioned gender (or begun to), come out to their parents,
and provided information reporting how supportive their
parents were of their gender identity or expression. This
analysis is based on data from these 84 youth. RDS is a
tracked chain-referral method for recruitment and analysis,
and is designed to limit bias in studies of hidden populations.3
A hidden population is any group or community from which a
random sample cannot be obtained. Data were analysed
using RDSAT 6.0 software.4
In Trans PULSE, each participant could recruit up to three
additional participants. Recruitment patterns were tracked,
individual network sizes (the number of other eligible people
known) were assessed, and these data were used to weight
all statistics based on each participant’s probability of
recruitment. Statistics presented are thus population
estimates for networked trans youth in Ontario (i.e. those
who know at least one other trans person in the province).
Parental Support
We analysed our data for two levels of parental support “not
strongly supportive” and “strongly supportive”. We estimate
that 34% of trans youth in Ontario who are “out” to their
parents and have begun to socially transition have parents
they would describe as “very supportive” of their gender
identity or expression; 25% indicated their parent(s) were
“somewhat supportive” and 42% “not very” or “not at all”,
for a total of 67% in the “not strongly supportive” group.
Life Satisfaction, Physical and Mental Health
Knowing one has social and family supports is very important
in the development of one’s overall sense of health and well-
being. In Trans PULSE, parental support of youth’s gender
identity and expression was directly associated with how
trans youth rated their health and general well-being. Figure
1 shows the proportion of trans youth, aged 16-24 years in
Ontario, experiencing positive health and life conditions, by
level of parental support.
We wanted to know if feeling supported for one’s gender
identity and expression had an impact on trans youth’s
general satisfaction with their lives, which we assessed with
the question “how satisfied are you with your life in
general?” and on their self-reported ratings of mental health
(ranging from poor to excellent).
Figure 1 shows that trans youth who indicated their parents
were strongly supportive of their gender identity and
expression were significantly more likely (72%) to report
being satisfied with their lives than those with parents who
were not strongly supportive (33%). Also statistically
significant, 70% of those with parents strongly supportive of
their gender identity and expression reported positive
mental health compared to 15% of those whose parents
were not strongly supportive.
We also wanted to know if the level of support trans youth
experience from their parents for their gender identity and
expression impacts their evaluation of their overall physical
health. We measured this by asking youth to rate their
health ranging from poor to excellent. While not statistically
significant, of those with strongly supportive parents, 66%
reported very good or excellent overall health compared to
31% of those with parents not strongly supportive of their
gender identity and expression. We note that a lack of a
statistically significant difference does not imply
equivalence, especially given the low statistical power to
detect differences with a small sample size (n=84).
It is also known from many studies of young people’s
psychological well-being, that parental support is a strong
predictor of healthy self-esteem. In Trans PULSE, we
assessed self-esteem using the Rosenberg Self-Esteem Scale
(1965), defining “high self-esteem” as scoring 20 or higher;
having parents strongly supportive of one’s gender identity
and expression indeed had a significant impact on self-
esteem. Of those with strongly supportive parents, 64%
reported high self-esteem compared to only 13% whose
parents were not strongly supportive.
Healthy psychological development in young people is also
generally accompanied by a sense of optimism about the
future. Studies of gay, lesbian and bisexual youth show that
many are anxious about their futures, worrying that they
Figure 2. Proportion of trans youth age 16-24 years in
Ontario experiencing negative health and
life conditions, by level of parental support
23
34
4
75
70
57
0
10
20
30
40
50
60
70
80
90
100
Depressive
symptoms*
Considered
suicide, past yr
Suicide attempt,
past yr*
Parent(s) very supportive
Parent(s) somewhat to not at all supportive
* = statistically significant difference (p < 0.05)

3
won’t have long-term relationships or families. We asked
participants if they intended to parent in the future by asking
"Would you like to have or adopt a child in the future?” While
not statistically significant, among those with parents strongly
supportive of their gender identity or expression, 58%
reported an intent to have children compared to 42% of
those whose parents were not strongly supportive.
Figure 2 shows the proportion of trans youth aged 16-24
years in Ontario experiencing negative health and life
conditions, by level of parental support for their gender
identity and expression. We were particularly concerned
about mental health and suicide risk among trans youth given
the range of studies showing these associations among
lesbian, gay and bisexual youth. We used the 20-item CES-D
scale designed to measure depressive symptomatology in the
general population. The presence of depressive symptoms
(CES-D  16) was significantly related to whether trans youth
had parents supportive of their gender identity and
expression. A clear difference emerged with depressive
symptoms reported by only 23% percent of those with
supportive parents in contrast with 75% of those whose
parents were not strongly supportive.
To attain a recent measure of suicide risk, we asked
participants if they had considered suicide in the past year,
and whether they had attempted it. Consideration of suicide
was common, and was reported by 35% of youth whose
parents were strongly supportive and 60% of those whose
parents were not strongly supportive. Particularly alarming is
that among this latter 60%, nearly all (57%) had actually
attempted suicide in the past year. In contrast, only 4% of
those with strongly supportive parents attempted suicide.
While 4% is still far too high, the impact of strong parental
support can be clearly seen in the 93% reduction in reported
suicide attempts for youth who indicated their parents were
strongly supportive of their gender identity and expression.
Housing and Food Security
Trans youth were classified as inadequately housed if they
indicated they were currently homeless, in precarious
housing situations (e.g. couch-surfing, living in a boarding
house), or had great difficulty making housing payments
while being below the low-income cut-off. Having adequate
housing was reported by 100% of youth with parents strongly
supportive of their gender identity and expression, but only
by 45% of youth whose parents were not strongly supportive.
We also wanted to measure the impact of parental support
on whether trans youth had enough food. Having adequate
food was defined as whether a household had enough to eat
over the past year. While not statistically significant, for those
with parents strongly supportive of their gender identity and
expression, 92% reported having adequate food compared to
82% of those with parents not strongly supportive.
Implications of Our Findings
Trans PULSE data have considerable implications for
parents/caregivers and for those working with trans youth in
schools and services. First and foremost, our findings show
clear associations between the support that trans youth
experience from their parents and numerous health
outcomes. The most significant differences show that trans
youth who have strong parental support for their gender
identity and expression report higher life satisfaction, higher
self-esteem, better mental health including less depression
and fewer suicide attempts, and adequate housing
compared to those without strong parental support. These
findings draw a direct relationship between strong parental
support and the reduction of significant risk factors for trans
youth.
Our findings related to suicide consideration, self-reported
poor physical health, inadequate access to food, and having
a reduced intention to parent should not be ignored or
dismissed because the differences between groups were not
statistically significant, given our low statistical power to
detect differences in this analysis. Indeed, the estimates for
effects are still large and paint a consistent picture that is
worrisome enough to warrant attention from service
providers, parents and other caregivers, and policy-makers.
For parents and caregivers, our data have many
implications. Our earlier results (not shown) revealed that
having a “somewhat supportive” parent did not have a
significantly more positive effect on youth than if their
parents were not at all supportive of their gender expression
and identity. This indicates that anything less than strong
support may have deleterious effects on a child’s well-being.
These results should be viewed in light of recent suggestions
that LGBT youth may rate their families as more supportive
than their behaviours would indicate. Our findings suggest
the need for parents of trans youth to find adequate support
for themselves so that they can provide the strong support
that their children need.
The experience of having a child come out as trans can be
overwhelming for some parents. Parents worry about what
other people will think and how their child will fit into their
cultural or faith communities. Some parents feel shame or
grief because their child is different than they expected and
many worry that their child will be bullied or will lead an
unhappy life. For some families, a non-judgemental
counsellor can help to process these fears. For others, peer
support from other parents of trans youth, either on-line or
in person, where available, is their greatest resource.
Wherever parents seek support, it is important that they
express and process these complex feelings with other
adults and not with their child. While some parents worry
that being trans will cause their child to be unhappy,
ultimately our data indicate that it is parents and caregivers
themselves who provide the foundation for their children’s

4
health and well-being with their support. Therefore, policy-
makers and service providers need to ensure effective
services are available directly for parents and caregivers of
trans youth.
Those working professionally in school settings, child
welfare, residential and other services should be aware of
the risks facing trans youth whose parents are unsupportive
of their gender expression and identity. These youth face
significant and life-threatening risk factors, directly related
to lacking support at home. Teachers, service providers and
administrators may lack the knowledge or skill to intervene
in situations where trans youth are being bullied, and some
may wrongly assume that these youth will find the support
they need at home. This may not be the case. Indeed, our
data suggest that parents, in many cases, are not supportive,
leaving youth to fend for themselves, possibly increasing
their feelings of alienation, abandonment and despair. With
such high rates of suicidal ideation and actual suicide
attempts among trans youth, anything that adversely
impacts their mental health will be detrimental. The
presence of an active Gay-Straight Alliance (GSA) in a school
is an important and crucial resource for trans youth, and
may serve to meet some of their needs. Studies, however,
show that trans youth often feel alienated in GSAs as the
strong focus on gay and lesbian experience may not
adequately address the reality and needs of trans youth.
Service providers may not be aware that trans youth are in
their midst. The erasure and invisibility of trans youth,
coupled with a general lack of knowledge among youth
service providers about their issues, renders their needs
invisible. Trans youth may also be actively ignored in
services, or they may avoid accessing services altogether, for
fear of being stigmatized by service providers for presenting
outside of traditional gender boundaries. Yet, resources for
building trans-inclusive services exist.5-8 Trans-inclusive
youth programs that provide trans youth with a safe and
confidential space to access professional and peer supports
are crucial in helping to decrease feelings of depression and
the despair that precedes suicidal ideation and attempts.
Suicide crisis lines, in particular, must build their capacity to
respond to the needs of trans youth. Like school-based
personnel, service professionals should not assume that
trans youth are receiving supports at home. Indeed, our
data show that parental responses at home may be the root
cause of many adverse health and well-being outcomes.
Finally, our data point to an urgent need for policy-makers
to make themselves familiar with the needs of this very
vulnerable group of youth, and to respond accordingly with
resources that will help to ameliorate a very desperate
situation. For example, providers in a range of settings,
including schools, mental health, child welfare, residential,
and social and health care services, require appropriate
policies, practices, training and resources to ensure that
service provision to trans youth is delivered with dignity and
respect, and is free from any bias or barriers related to
gender identity or gender expression.
We were not able to examine the ways that parental
support for gender may impact trans youth differently in
relation to other parts of their identities, such as race,
culture, language, newcomer status, disability, etc.
However, multiple levels of invisibility, marginalization,
alienation or victimization could alter risks and produce
different outcomes for trans youth with intersecting
identities. Therefore service providers and policy-makers
need to also address the needs, risks and protective factors
that affect those trans youth who may experience unique
challenges due to intersecting identities.
For trans youth, the availability of both on-line and local
supportive resources is increasing. We include information
below about crisis lines and services that are sensitive to the
needs of trans youth. It is also possible that the presence of
other supportive adults can mitigate some of the negative
effects of having unsupportive parents. As such, we
encourage youth to seek out supportive and safe adults in
the community or in counselling services who can offer
guidance and counselling supports through difficult times.
For some parents, their attitude toward their trans child
may improve over time. While we don’t know enough about
this empirically, studies that focus on the families of lesbian,
gay and bisexual individuals show that many parents come
to terms with their child’s sexual orientation over time, and
become more supportive. While many trans youth can and
do find a way to move on with their lives, despite a lack of
parental support, we feel that they should not have to do so
alone. We urge policy makers, service providers,
communities and families to take the necessary steps to
effectively recognize, welcome and support trans youth, and
to eliminate any gender-based bias or barriers.
References
1. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative
health outcomes in white and Latino lesbian, gay, and bisexual young adults.
Pediatrics 2009;123(1):346-352.
2. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence
and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric
Nursing 2010;23(4):205-213.
3. Heckathorn DD. Respondent-driven sampling II: Deriving valid population estimates
from chain-referral samples of hidden populations. Social Problems 2002;49(1):11-34.
4. Volz E, Wejnert C, Degani I, Heckathorn DD. Respondent-Driven Sampling Analysis
Tool (RDSAT) Version 6.0.1. Ithaca, NY: Cornell University.
5. Bauer GR, Hammond R, Travers R, Kaay M, Hohenadel KM, Boyce M. “I don’t think
this is theoretical; this is our lives”: How erasure impacts health care for transgender
people. Journal of the Association of Nurses in AIDS Care 2009;20(5):348-361.
6. Children’s Aid Society of Toronto. Out and Proud Affirmation Guidelines – Practice
Guidelines for Equity in Gender and Sexual Diversity. Toronto, ON, 2011.
7. Mottet L, Tanis J. Opening the door to inclusion of transgender people: The nine keys
to making lesbian, gay, bisexual and transgend er organizations fully transgender-
inclusive. New York: National Gay and Lesbian Task Force Policy Institute and the
National Center for Transgender Equality, 2008.
8. Ryan C. Helping families support their lesbian, gay, bisexual, and transgender (LGBT)
children. Washington, DC: National Center for Cultural Competence, Georgetown
University Center for Child and Human Development, 2009. Available at:
http://nccc.georgetown.edu/documents/LGBT_Brief.pdf.

E-Bulletins, presentations and articles available at:
www.transpulseproject.ca
To contact Trans PULSE:
info@transpulseproject.ca
1-877-547-8573
Report prepared by:
Robb Travers, PhD; Greta Bauer, PhD, MPH; Jake Pyne, MSW;
Kaitlin Bradley, MSc, for the Trans PULSE team; Lorraine
Gale, MSW, for Children’s Aid Society of Toronto; and Maria
Papadimitriou, MSc, MPH, for Delisle Youth Services.
Trans PULSE is funded by Project Partners
5
Resources for Trans Youth
ONTARIO WIDE
The LGBT Youth Line - A hotline staffed by youth, for youth
1-800-268-9688 http://www.youthline.ca/index.php
HALTON
LGBTTTIQQAA Youth Support Group @ Positive Space Halton
905-875-2575 ext 239 http://search.hipinfo.info/record/BTN4873
KITCHENER / WATERLOO
OK2BME - Group for LGBT youth
ok2bme@kwcounselling.com http://www.ok2bme.ca/
LONDON
Open Closet – Social support group for LGBT 14-18 year olds
http://www.hivaidsconnection.ca/open-closet
Trans Youth London - Group for trans youth
https://www.facebook.com/TransYouthLondon?ref=ts
OTTAWA
Pink Triangle Youth Group for LGBT Youth
613-563-4818 or volunteer.coordinator@ptsottawa.org
YSB Spectrum - LGBT Youth Group
613 241 7788 ext 409 or hiv@ysb.on.ca
THUNDER BAY
The Other 10% @ Children's Centre Thunder Bay - Drop-in LBGTTIQ
+ questioning group for 12-25 year olds
807-343-6373
Trans* Support Collective - Youth-friendly group for trans people
and supporters
tbtsc2012@gmail.com https://www.facebook.com/pages/Trans-
Support-Collective/194317560663423
TORONTO
Griffin Centre – Several groups for LGBT Youth including a group for
youth of colour (Spektrum) and LGBT youth labelled with
intellectual disabilities (Compass)
416-222-1153 http://www.griffin-centre.org/spektrum.php
Pride and Prejudice Program @ Central Toronto Youth Services -
Groups and counselling for LGBT Youth
416-924-2100 http://www.ctys.org/
STARS (Strong and Resilient) @ Delisle Youth Services - Group for
queer, trans and questioning youth
416-482-0081 http://delisleyouth.org/pages/stars-y
Supporting Our Youth (SOY) - A program of the Sherbourne Health
Centre - A variety of groups and programs for LGBT youth,
including Trans Fusion Crew, a group for trans youth
416-324-5077 http://www.soytoronto.org/
Trans Youth Toronto @ The 519 Church Street Community Centre -
Drop In group for trans youth.
416-355-6792 mpage@the519.org
http://www.the519.org/programsservices/transprograms/transyo
uthtoronto
Resources for Parents of Trans Youth
Fact Sheet: “Supporting Gender Independent Children”, for health
and social service providers
http://www.rainbowhealthontario.ca/admin/contentEngine/cont
entDocuments/Gender_Independent_Children_final.pdf
Families in Transition – on-line resource for parents of trans youth
Central Toronto Youth Services
http://www.ctys.org/sites/default/files/familiesintransition-
a_resource_guide_for_parents-080608.pdf
Family Acceptance Project (USA) - On line resources for families of
LGBT Youth
http://familyproject.sfsu.edu/
Gender Identity Hotline - PFLAG CANADA - Hotline which parents
and others can call for support
Toll-free: 1-888-822-9494 gender@pflagcanada.ca
http://www.pflagcanada.ca/en/index-e.php
Gender Spectrum (USA) - On-line resources for parents of trans or
gender variant children
http://www.genderspectrum.org/
“If you are concerned about your child’s gender behaviors” – On-
line resource manual for parents of gender variant children.
Children's National Medical Center in Washington DC
http://www.childrensnational.org/files/PDF/DepartmentsandProg
rams/Neuroscience/Psychiatry/GenderVariantOutreachProgram/G
VParentBrochure.pdf
Rainbow Health Ontario - Series of brochures for parents of
gender independent children will launch in 2013
www.rainbowhealthontario.ca
Stephanie A. Brill and Rachel Pepper. (2008). The Transgender
Child: A Handbook for Families and Professionals. Cleis Press.
TransParent Canada
http://www.transparentcanada.ca/?file=kop1.php