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Psychology of Sexual Orientation and Gender
Diversity
“I Am Afraid for Those Kids Who Might Find Death Preferable”: Parental
Figures’ Reactions and Coping Strategies to Bans on Gender Affirming Care
for Transgender and Gender Diverse Youth
Roberto L. Abreu, Jules P. Sostre, Kirsten A. Gonzalez, Gabriel M. Lockett, and Em Matsuno
Online First Publication, July 29, 2021. http://dx.doi.org/10.1037/sgd0000495
CITATION
Abreu, R. L., Sostre, J. P., Gonzalez, K. A., Lockett, G. M., & Matsuno, E. (2021, July 29). “I Am Afraid for Those Kids Who
Might Find Death Preferable”: Parental Figures’ Reactions and Coping Strategies to Bans on Gender Affirming Care for
Transgender and Gender Diverse Youth. Psychology of Sexual Orientation and Gender Diversity. Advance online
publication. http://dx.doi.org/10.1037/sgd0000495
“I Am Afraid for Those Kids Who Might Find Death Preferable”: Parental
Figures’Reactions and Coping Strategies to Bans on Gender Affirming
Care for Transgender and Gender Diverse Youth
Roberto L. Abreu
1
, Jules P. Sostre
1
, Kirsten A. Gonzalez
2
, Gabriel M. Lockett
1
, and Em Matsuno
3
1
Department of Psychology, University of Florida
2
Department of Psychology, University of Tennessee, Knoxville
3
Counseling and Counseling Psychology, Arizona State University
Research has documented that parental figures of trans and gender diverse (TGD) youth often struggle
with fear, grief, and stress as a result of antitransgender oppression. However, there is a dearth of
research about how parental figures of TGD youth are impacted by antitransgender state and federal
laws and bills. The present study aimed to explore parental figures’reactions and coping strategies with
recent proposed and enacted laws and bills in the United States restricting access to gender-affirming
healthcare for TGD youth. A sample of 138 parental figures of TGD youth who currently or previously
lived in the United States participated in an online survey where they shared their reactions and coping
strategies as a result of current antitransgender laws and bills. Thematic analysis revealed four themes
depicting participants' cognitive reactions, including: (a) violation of rights, (b) increased stigma, (c)
decreased quality of healthcare, and (d) support for child’s journey. Also, three themes emerged about
participants’emotional reactions, including: (a) fear and anxiety, (b) anger, and (c) relief. Additionally,
participants shared narratives about how they are coping with these antitransgender laws and bills,
including: (a) activism and advocacy, (b) educating others, (c) seeking support from communities/
groups, and (d) relocation and avoidance. Recommendations for practitioners such as debunking incor-
rect information about trans healthcare when working with parental figures are discussed.
Public Significance Statement
No research to date has explored how parental figures of trans and gender diverse (TGD) youth are
impacted by current antitransgender policies. The current study found that parental figures of TGD
youth are experiencing intense cognitive and emotional reactions and also actively using coping
skills to navigate the effects of these oppressive laws and bills.
Keywords: parents, mental health, transgender youth, transgender health, legislation
Parental figures of transgender and gender diverse (TGD) youth
are influential in the well-being of their children. Specifically, pa-
rental rejection contributes to negative mental health outcomes for
TGD youth (Abreu et al., 2019;Kosciw et al., 2018), while paren-
tal acceptance serves as a protective factor against experiences of
discrimination and oppression (e.g., Simons et al., 2013). How-
ever, research shows that parental figures of TGD youth engage in
a nondichotomous (i.e., acceptance, rejection), multilayered pro-
cess after learning about their child’s TGD identity. For example,
in a systematic literature review of 32 studies that explored the
experiences and reactions of parental figures of TGD youth, Abreu
et al. (2019) noted that the process of coming to terms and inter-
acting with one’s TGD child include: (a) initial experiences (the
initial observation of gender atypical behavior and emotional reac-
tions accompanying); (b) transformation processes (parental
figures begin to seek knowledge and develop awareness of dis-
crimination); (c) positive outcomes (parental figures building a
better relationship with their child and engaging in activism); and
(d) influences on parental figures’process (such as time since
learning of their child’s identity and the gender of the parental fig-
ure and the child).
Parental figures’initial reactions include first noticing their
child’s atypical gender expressions, experiencing intense emo-
tional responses such as grief and traumatic shock (e.g., Di Ceglie
& Thummel, 2006), and struggling to reconcile beliefs and preju-
dices about TGD people (e.g., Alegría, 2018). Some parental
Roberto L. Abreu https://orcid.org/0000-0003-1305-2152
Jules P. Sostre https://orcid.org/0000-0003-0089-1379
Kirsten A. Gonzalez https://orcid.org/0000-0002-5499-6152
Gabriel M. Lockett https://orcid.org/0000-0001-6268-2498
Em Matsuno https://orcid.org/0000-0002-6333-7984
Correspondence concerning this article should be addressed to Roberto
L. Abreu, Department of Psychology, University of Florida, 945 Center
Drive, Gainesville, FL 32603, United States. Email: rabreu26@ufl.edu
1
Psychology of Sexual Orientation and Gender Diversity
©2021 American Psychological Association
ISSN: 2329-0382 https://doi.org/10.1037/sgd0000495
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
figures feel overwhelmed at their lack of knowledge and difficulty
finding information about the TGD community (e.g., Di Ceglie &
Thummel, 2006). In addition, parental figures of TGD youth seek
out resources/support and modify their initial negative beliefs
about their child (e.g., Bull & D’Arrigo-Patrick, 2018). Also,
research shows that parental figures face their own coming-out
process and experience stigma and rejection from social groups,
healthcare providers, and educational institutions (e.g., Barron &
Capous-Desyllas, 2017). Furthermore, parental figures of TGD
youth face other barriers such as fearing their child’s safety and
lack of proper training of healthcare professionals to interact with
TGD youth (e.g., Gray et al., 2016). These experiences lead paren-
tal figures to develop awareness of the discrimination their child
faces and develop empathy toward their child and, by extension,
the TGD community (e.g., Gray et al., 2016).
Research has also documented positive outcomes of having a
TGD child. For example, parental figures report improved rela-
tionships with their TGD child, more open communication, and a
closer, more supportive relationship with their child (e.g., Alegría,
2018). Studies show that as parental figures begin to accept and
develop their relationship with their TGD child and start to under-
stand how their child is oppressed, they begin engaging in activism
and advocacy (e.g., Alegría, 2018).
Mental Health Impact on Parental Figures of
Transgender and Gender Diverse Youth
As parental figures learn about and navigate different institu-
tions with their TGD child, they experience negative mental health
symptoms. For example, research has documented that parental
figures of TGD children experience increased feelings of anxiety,
stress, depression, and hypervigilance due to a variety of added
stressors associated with navigating oppressive institutions (e.g.,
schools, healthcare) with their TGD child (e.g., Barron & Capous-
Desyllas, 2017;Bull & D’Arrigo-Patrick, 2018). Additionally,
when in public places, parental figures often feel hypervigilant
for fear of being questioned about their child’s identity (Bull &
D’Arrigo-Patrick, 2018).
Antitransgender Legislation Under Trump’s
Administration
Prior to the Trump administration, legal protections surrounding
gender identity and expression was on the rise. Under the Obama
administration (2009–2016), federal trans-supportive policies were
launched such as protection against discrimination (U.S. Depart-
ment of Labor, 2015), being allowed to openly serve in the mili-
tary (United States Department of Defense, 2016), and making the
process of changing sex markers on passports easier (Jones, 2019).
In addition, during this time, United States officials worked toward
the inclusions and protections of TGD students by taking actions
such as funding the Global Network Against Homophobic and
Transphobic Bullying in schools (Jones, 2019). It should be noted,
however, that while the federal government was working toward
the implementation of transgender affirming laws and bills, simul-
taneously, the backlash and antitransgender legislative push began
to appear in several states. For example, the United States saw sev-
eral states that pushed antitransgender legislation, including North
Carolina's HB2 (Lopez, 2017) and “religious freedom”acts in
states such as Indiana and Tennessee (e.g., Human Rights Cam-
paign, 2015).
Marking the time of Trump’s campaign and election in 2016,
there was intense backlash against the progress toward TGD
rights. Despite promises of protecting TGD people, under the
Trump administration, the White House’s LGBTQ webpages were
removed in conjunction with the dismissal of LGBTQ liaison offi-
cers and the hiring of explicitly anti-LGBTQ officials (Johnson,
2017). In 2018, the Human Rights Campaign tracked a total of
129 anti-LGBTQ state legislations that were introduced within the
year prior. The Trump administration also attempted to roll back
TGD protections by defining gender as someone’s assigned sex at
birth (Salam, 2018). Federal agencies have continued to withdraw
Obama-era policies protecting and recognizing gender identity in
prisons, homeless shelters, and schools (Salam, 2018). The current
political actions and legislation are attempting to erase and legally
invalidate the TGD population in America. This has resulted in
TGD individuals experiencing heightened antitransgender vio-
lence that further exacerbates mental health struggles (Lee, 2017).
For example, research shows that TGD people have experienced
increased harassment, violence, policing, and negative mental
health outcomes, to name a few, under the Trump administration
(see review in Abreu, Gonzalez, Capielo Rosario, Pulice-Farrow,
et al., 2020). However, little is known about how this antitransgen-
der hostile political environment has affected TGD people and
their family members.
Current State Legislation Criminalizing Affirming Care
for Transgender and Gender Diverse Youth
Since early 2020, state legislators in multiple states (e.g., Ala-
bama, Tennessee, South Dakota) introduced or passed state bills
and laws that would criminalize providing gender-affirming medi-
cal care to TGD youth. For example, in Alabama a bill passed that
would put physicians in prison for prescribing puberty blockers
(Bollinger, 2020). In Tennessee, the proposed bill would require a
parental figure to have written recommendations from at least
three physicians, including a psychiatrist, and written consent
from a parent/guardian before hormone replacement, puberty
blockers, or any other gender-affirming medical interventions can
take place (Allison, 2020). Failure to provide these recommenda-
tions would result in a designation of child abuse and healthcare
professionals would face professional misconduct (Allison, 2020).
The punishments from the proposed bills for providing these life-
saving services to TGD youth vary state by state, ranging from a
misdemeanor with up to a year in jail, to a felony with life in
prison (Wax-Thibodeaux & Schmidt, 2020). Given that the pro-
cess of getting the recommendations for any type of gender-affirm-
ing care is already restrictive and lengthy (e.g., having to drive
over 300 miles away, going through a year of doctors’appoint-
ments to get a prescription for puberty blockers; Wax-Thibodeaux
& Schmidt, 2020), these new laws and bills are not only unneces-
sary but violent toward TGD youth.
As it has been described by medical providers, these bills and
laws are a product of misinformation as TGD minors rarely
undergo permanent alterations; specifically regarding the belief
that puberty blockers are irreversible (Wax-Thibodeaux &
Schmidt, 2020). While a few of the bills have passed partially, it is
important that these bills and laws do not continue to be
2ABREU, SOSTRE, GONZALEZ, LOCKETT, AND MATSUNO
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introduced or passed as they further harm an already vulnerable
population by forcing them to endure more gender dysphoria,
depression, and suicidality instead of allowing implementation of
evidence-based treatments documented to reduce these negative
mental health outcomes (Gerson, 2020).
Minority Stress and Anti-LGBTQ Laws and Bills
Minority stress posits that LGBTQ people experience increased
identity-based stress compared with their heterosexual and cisgen-
der counterparts (V. Brooks, 1981;W. Brooks, 1992;Meyer,
2003;Meyer & Frost, 2013). This stress can lead to decreased
physical and mental health for LGBTQ people and their families
and allies (e.g., Meyer & Frost, 2013;Rostosky & Riggle, 2011).
Minority stress theory conceptualizes stress as proximal and/or
distal stressors. Proximal stressors refer to internal stress experi-
enced by individuals as a result of negative perception about their
identity and exposure to oppressive events, leading to internalized
heterosexism and fear of rejection among other negative internal
outcomes for LGBTQ people (V. Brooks, 1981;W. Brooks, 1992;
Meyer, 2003). Distal stressors refer to stressors that happen out-
side of the individual’s sphere, including but not limited to harass-
ment, violence, and structural stigma. Structural stigma refers to
cultural norms, laws, and policies that decrease the well-being of
LGBTQ people and their allies and families (see Hatzenbuehler &
Link, 2014; see Szymanski & Sung, 2010).
Recent sources of distal stressors that TGD youth and their fam-
ilies have been exposed to are antitransgender political administra-
tions (i.e., Trump’s presidential administration) and the passing of
antitransgender laws and bills at the state and federal level (e.g.,
Staples et al., 2018). Current research shows that distal stressors
such as navigating oppressive education and healthcare systems
has a negative impact on parental figures of TGD youth (e.g.,
increased anxiety and hypervigilance; see review in Abreu et al.,
2019). While the negative impact of Donald Trump’s administra-
tion on the well-being of LGBTQ people has been well-docu-
mented (see Lannutti & Galupo, 2018), there is paucity of
research about how current antitransgender laws and bills affect
TGD youth and their parental figures.
Coping and Finding Strength Under Oppressive
Political Climates
As laws and bills at the federal and state level seek to oppress
and invalidate LGBTQ people, it is important to note that these
individuals are finding ways to cope, be resilient, and thrive. For
example, research shows that LGBTQ people under the Trump
administration coped and were resilient by engaging in activism,
advocacy, self-care, positive self-affirmations, self-preservation
activities, and relational disengagement, among others (Gonzalez
et al., 2020;Riggle et al., 2018). Specific to TGD individuals, a
recent study found that immigrant Latinx transgender individuals
(N= 15) find sources of coping during oppressive political cli-
mates by feeling pride in their identity, imagining a better future,
engaging in religious and spiritual practices, and connecting with
family and friends, among others (Abreu, Gonzalez, Capielo
Rosario, Pulice-Farrow, et al., 2020).
Research shows that antioppressive actions taken by allies to
affirm LGBTQ individuals serve as a source of empowerment and
resilience (Riggle et al., 2018;Russell & Richards, 2003). Specifi-
cally, when LGBTQ people witness others engage in activism and
advocacy efforts, they feel hopeful, inspired, and driven to engage
in political activism themselves (Riggle et al., 2018). Research
shows that parental figures of TGD youth often engage in advo-
cacy and activism in order to help their child navigate oppressive
systems (see a review in Abreu et al., 2019). However, little is
known about how parental figures’engagement in advocacy and
activism on behalf of their TGD child impacts their well-being.
Specifically, to our (the authors) knowledge no study has explored
the toll that current antitransgender healthcare laws and bills have
on parental figures of TGD people and ways in which they engage
in coping strategies. Because these laws and bills affect TGD
youth who are underage and rely on the support of their parental
figures for advocacy and healthcare, additional research is needed
to understand how these antitransgender laws and bills affect pa-
rental figures of TGD individuals.
Current Study
Past research has explored the impact of having a TGD child on
the well-being of parental figures as a result of systemic oppres-
sion. Since the Trump administration, antitransgender violence has
increased (see review in Abreu, Gonzalez, Capielo Rosario,
Pulice-Farrow, et al., 2020;Lee, 2017) and approximately 129
anti-LGBTQ state legislations were introduced in 2017 alone
(Human Rights Campaign, 2018). Recently, different states have
introduced and passed antitransgender healthcare legislation
restricting parental figures of TGD youth from granting access to
gender-affirming care for their child, as well as penalizing medical
providers for engaging in gender affirming care to TGD children.
These legislatures have resulted in an increase in mental health
struggles for TGD individuals. In addition, research shows that
LGBTQ individuals find ways of coping and thriving under
oppressive political climates, including finding support from allies.
Given previous research that documents mental health consequen-
ces for parental figures of TGD people as a result of systemic
oppression, we pose that these legislations might also impact the
mental health of parental figures of TGD youth. Similarly, it is
plausible to believe that these parental figures are engaging in cop-
ing strategies in order to resist these oppressive laws and bills and
support their TGD child. The aim of this study was to explore pa-
rental figures’reactions and coping strategies to current bans on
gender affirming care for TGD youth. Specifically, the following
research questions guided the focus of this study: What are the
reactions of parental figures of TGD youth to current antitrans-
gender laws and bills? What strategies do parental figures of TGD
youth employ in order to cope with the current antitransgender
laws?
Method
The current study focused on antitransgender laws and bills sur-
rounding restricted healthcare for TGD children and the effect of these
policies on the parental figures of TGD youth and the youth them-
selves. Given the depth of the responses provided by the participants
in this study and the documented research about the impact of having
a TGD child on the mental health of parental figures, the authors felt it
was important to write one article specifically focused on parental
PARENTAL FIGURES’REACTIONS AND COPING STRATEGIES 3
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figures’reactions and coping strategies associated with the proposed
and already-in-effect antitransgender laws and bills.
The current study utilized an online free-response survey with
138 parental figures of TGD youth who current or who have previ-
ously resided in the United States to explore the impact of these
laws and bills on their well-being. Given that the impact of anti-
transgender laws and bills on parental figures of TGD youth have
not been studied to date, a qualitative approach was most appropri-
ate (see Morrow, 2007). The authors were specifically interested
in using an inductive, semantic, and critical reflexive thematic
analysis approach (Braun & Clarke, 2006,2013) to make meaning
of participants’narratives about their experiences.
Participants
Self-identified parental figures of TGD youth (N= 138) partici-
pated in this study. The age range for participants was 28–68, with
an average age of 46.75 years old (SD = 7.92). The majority of
participants lived within the United States (n= 134, 97.10%),
while four participants (2.90%) resided outside of the United
States. Among the participants who resided outside the United
States, one participant (.72%) lived in Queensland, Australia, one
participant (.72%) lived in Brazil, and two participants (1.45%)
lived in Canada. Participants represented 37 states of the United
States, with most participants residing in Kentucky (n= 12), Flor-
ida (n= 9), and California (n= 9) and representing all four regions
of the United States such as the South (n= 50, 36.23%), Northeast
(n= 21, 15.22%), Midwest (n= 27, 19.56%), and West (n= 36,
26.10%). Participants identified their relationship to their child as
mother (n= 124, 89.86%), father (n= 7, 5.07%), parent (n=2,
1.45%), step-mother (n= 3, 2.17%), guardian (n= 1, .72%), and
foster parent (n= 1, .72%). The participants identified their race
and ethnicity as European American/Caucasian/White (n= 127,
92.03%), Latinx/Latina/o/Hispanic (n= 6, 4.35%), Asian Ameri-
can/Pacific Islander (n= 1, .72%), and multiracial (n= 4, 2.90%).
See Table 1 for a complete description of the participants and their
child’s demographics.
Recruitment and Procedure
Participants were eligible to participate in the study if they iden-
tified as a parental figure of a transgender child, were at least 18
years old, and previously or currently lived within the United
States. Participants were recruited from social media platforms
such as Twitter, Facebook, and Tumblr. Specifically, we targeted
35 social media groups (e.g., discussion groups, support groups)
for parental figures of TGD people. The research team created a
recruitment flyer providing information about the purpose of the
study, eligibility criteria for participating, the principal investiga-
tor’s contact information, and the link to the online survey. Data
collection took place from February 27, 2020 to March 20, 2020.
After receiving IRB approval, eligible and interested partici-
pants were invited to fill out a survey online. At the start of the sur-
vey, participants were asked a series of demographics questions,
such as their age, race and ethnicity, and state of residency, among
others. Participants were then presented with the following contex-
tual information:
In the last few weeks, state legislators in multiple states (for example:
Alabama, Tennessee, South Dakota) have introduced or passed state
bills or laws that would criminalize providing gender-affirming medi-
cal care to transgender youth. For example, in Alabama a bill passed
that would put physicians in prison for prescribing puberty blockers to
transgender youth under the age of 19. In Tennessee, the proposed bill
would require a parent to have written recommendations from at least
three physicians before hormone replacement, puberty blockers, or
other medical interventions can take place. Failure to provide these
recommendations will result in a designation of child abuse, and
healthcare professionals would face professional misconduct.
Table 1
Participant Demographics
n%
Race/ethnicity
European American/Caucasian/White 127 92.03
Latinx/Latina/o/Hispanic 6 4.35
Asian American/Pacific Islander 1 0.72
Multiracial 4 2.90
Relationship to child
Mother 124 89.86
Father 7 5.07
Stepmother 3 2.17
Nonbinary parent 2 1.45
Foster parent 1 0.72
Guardian 1 0.72
Parental figure gender identity
Woman 126 91.30
Man 7 5.07
Gender nonconforming/nonbinary 5 2.17
Parental figure sexual identity
Heterosexual 103 74.64
Bisexual 19 13.77
Pansexual 9 6.52
Lesbian/gay 6 4.35
Queer 4 2.90
Fluid 2 1.45
Asexual 2 1.45
Education level
Attended high school 3 2.17
High school diploma or GED 5 3.62
Some college or technical school (or currently enrolled) 25 18.12
College degree (BA, BS, or equivalent) 36 26.09
Some postbaccalaureate or graduate program (or currently
enrolled) 8 5.80
Advanced college degree (MA, MS, PhD, JD, MD, or
equivalent) 61 44.20
Child’s gender identity
Man/boy 77 55.80
Woman/girl 38 27.54
Gender nonconforming/nonbinary/genderfluid 23 16.67
Bigender 1 0.72
Mostly female 1 0.72
Child’s disclosure age
24 12 8.70
510 22 15.94
1115 77 55.80
1620 22 15.94
21 and older 5 3.62
Child’s current age
510 19 13.77
1115 45 32.61
1620 52 37.68
21 and older 23 16.67
Note. Some participants listed more than one identity (e.g., sexual orien-
tation, number of children), resulting in the percentages adding up to be
over 100.
4ABREU, SOSTRE, GONZALEZ, LOCKETT, AND MATSUNO
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Afterward, participants were prompted to answer open-ended
questions regarding their reactions, the impact of these laws and
bills on themselves and their child, their coping surrounding anti-
transgender laws and bills, and advice for legislators. Participants
were encouraged to provide as much detail as they considered nec-
essary. The following open-ended questions were analyzed for the
current study: (a) What are your reactions to these bills/laws being
proposed and/or passed?; (b) How have you coped and been resil-
ient in response to these bills/laws?
Researchers’Positionality and Self-Reflection
The research team had a range of identities across race, ethnicity,
generational status, nationality, sexual orientation, and gender iden-
tity that allowed for meaningful dialogues during data analysis. The
first author (Abreu) is an assistant professor of counseling psychol-
ogy who identifies as a first generation Latinx, queer, cisgender
man. The second author (Sostre) is a counseling psychology doc-
toral-level student who identifies as Latinx (Puerto Rican descent),
pansexual, and genderfluid. The third author (Gonzalez) is an assist-
ant professor of counseling psychology who identifies as a Latinx
(Mexican descent) heterosexual, cisgender woman. The fourth
author (Lockett) is doctoral-level student who identifies as African
American, queer, trans man. The fifth author (Matsuno) is an assist-
ant professor of counseling psychology who identifies as a multira-
cial (Asian and White), queer, nonbinary person. Several members
of the research team have expertise in qualitative research and have
published multiple peer-reviewed qualitative research papers in
counseling psychology and LGBTQ journals. The primary coders
on this project, Sostre and Lockett, identify as trans and kept coding
journals to document their reactions, feelings, and thoughts through
the coding process (Gilbert, 2001). In order to account for bias and
facilitate objectivity in the coding process, Abreu and Gonzalez,
who are cisgender, served as auditors during the coding process and
engaged in discussions with Sostre and Lockett during data analysis
(see LeCompte & Goetz, 1982).
Data Analysis
Thematic analysis (Braun & Clarke, 2006,2013) was used to
explore the reactions to antitransgender laws and bills and coping
strategies of parental figures of TGD youth. Data analysis began
with Sostre and Lockett coding the data by independently reading
through the participant interviews. They began by breaking down
and grouping together words and clauses with similar meaning
units and ideas (Giorgi, 1985). The grouped together words and
clauses formed the preliminary themes. Sostre and Lockett shared
their independent preliminary themes with Abreu and Gonzalez to
review and provide feedback. After minor adjustments were made
to the preliminary themes structure (e.g., addressing redundant
word choices), both coders and auditors met to discuss, revise, and
finalize thematic structure. Next, independently, Sostre and Lock-
ett coded each participants’response into the thematic structure.
Sostre quantitatively calculated an 86.38% interrater reliability
across the two coders. Coders and auditors met throughout the
coding process to discuss and reconcile coding discrepancies and
edit the initial themes by eliminating themes and identifying new
themes until a thematic structure was finalized. Sostre and Lockett
selected quotes from the transcripts that best reflected each theme
to include in the results. Specifically, quotes that best captured the
main ideas of each theme and subtheme were chosen in order to
provide a voice to the participants in our study. Finally, once the
Results section of the article was drafted, Matsuno provided fur-
ther feedback about the finalized thematic structure, resulting in
the merging of two themes.
We used Nowell et al.’s (2017) approach for establishing trust-
worthiness when using thematic analysis. During Phase 1, we
gathered thoughts about potential codes and kept records of field
notes and transcripts. In Phase 2, the coders established a coding
framework and engaged in peer debriefing. Next, in Phase 3, the
coders made connections in the data and developed themes. In
Phase 4, the coders went back to the data as needed and solicited
feedback from two auditors. During Phase 5, coders and auditors
met to debrief and reach a final consensus. Finally, in Phase 6, rich
and thick descriptions of the coding and analysis process were
documented and quotes from participants to include in the final
written article were selected.
Results
Results yielded three themes and 12 subthemes (see Table 2)
illustrating the reactions of 138 parental figures of TGD youth as a
result of antitransgender laws and their coping strategies. The
three themes consisted of: (a) parental figures’cognitive reactions
to laws and bills, (b) parental figures’emotional reactions to laws
and bills, and (c) parental figures coping strategies.
Parental Figures’Cognitive Reactions to Laws and Bills
One-hundred and ten (79.71%) parental figures described their
thoughts about to the proposed and/or passing of antitransgender
laws and bills, including: (a) violation of rights, (b) increased
stigma, (c) decreased quality of healthcare, and (d) support for
child’s journey.
Violation of Rights
Ninety-two (66.67%) parental figures indicated that these laws
and bills were a violation of both their own rights as a parental fig-
ure as well as a violation of their child’s rights. Participants la-
beled these laws and bills as unethical, unjust, and unfair. For
example, A 48-year-old, White, mother of a 21-year-old, nonbi-
nary youth from Colorado shared about the impact of removing
parental rights to make healthcare decisions for their trans child:
These bills undermine my right as a parent to seek out clinically and
culturally competent care for my child. Where are parents supposed
to turn when their children are suffering? Access to affirming pro-
viders is lifesaving. Requiring recommendations from three providers
is excessive and punitive. Many folks struggle to access just one
provider.
Other parental figures described these laws as inhumane, hate-
ful, and intolerant. For example, a 49-year-old, White, mother of a
9-year-old trans child from Oklahoma described, “It makes me
sick to my stomach. These laws take away all rights of both the
parent and child. It’s horrible and mean.”
PARENTAL FIGURES’REACTIONS AND COPING STRATEGIES 5
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Increased Stigma
Thirty-one (22.46%) parental figures stated that these laws and
bills would increase stigma faced by both their TGD child, them-
selves, and the TGD community. A 55-year-old, White, father of a
20-year-old trans child from California stated how these laws
would have dire consequences for the trans community: “They will
validate discrimination and provide justification for violence
against the [TGD] community. People will die because of the justi-
fication for discrimination and hate these bills give... I would be
more hesitant to reveal my child’s gender identity.”Additionally,
a 33-year-old, White, mother of an 11-year-old trans child from
Nebraska described how the passing of these laws would validate
individuals’transphobic views and increase stigma toward them-
selves as parental figures:
When you pass these laws, you are telling people they are right that
transgender isn’t real and that the parents are incompetent and negli-
gent. This in turn lets people be rude to us and hateful toward us
because we are so clearly “wrong”if the government says so.
Decreased Quality of Healthcare
Thirteen (9.42%) parental figures described how these laws and
bills would negatively impact the healthcare TGD youth are able
to receive. A 43-year-old, White, mother of a 13-year-old trans
child from Tennessee reported that her child’s“doctor is now cau-
tious to treat him just as a general practitioner”due to fear of
being imprisoned. Similarly, a 43-year-old, White, mother of a 13-
year-old trans girl from Nebraska described how not being able to
access puberty blockers would result in more dangerous, inaccessi-
ble healthcare for their child:
They could prevent me from making life saving and life affirming
choices for my child. They could force my child to go through
male puberty which would then require extensive, invasive, and ex-
pensive surgeries to allow her to affirm her gender as an adult
(assuming she survives the psychological turmoil of going through
the wrong puberty). They could prevent me from getting my child
the proper care!
Support for Child’s Journey
One-hundred and five (76.10%) parental figures indicated
increased support for their child and their journey through navigat-
ing the healthcare system as a result of these oppressive laws and
bills. This support took the form of guidance, researching, and pro-
viding financial and emotional support to their TGD child. For
example, a 34-year-old, White, nonbinary parent of a 7-year-old
child from Massachusetts described their unwavering support for
Table 2
Frequency of Participants Endorsing Themes With Theme Definitions
Theme Frequency % (n)
Parental figures’cognitive reactions to laws and bills
Violation of rights 66.67 (92)
Participants described how these laws/bills infringe on their, their children, and their doctors’rights to make the best
decision for trans youth’health
Increased stigma 22.46 (31)
Participants described how these laws/bills will increase the stigma and discrimination faced by trans youth
Decreased quality of healthcare 9.42 (13)
Participants described how the passing of these laws/bills will force trans youth to seek out unsafe and dangerous means
of healthcare
Support for child’s journey 76.10 (105)
Participants described providing emotional and financial support and advocacy for their trans child’s healthcare journey
Parental figures’emotional reactions to laws and bills
Fear and anxiety 31.16 (43)
Participants described experiencing fear and anxiety about their trans child’s healthcare, transitioning, life, and wellbeing
Anger 23.91 (33)
Participants described experiencing anger about the unfair treatment and threat to their trans child’s well-being
Relief 26.10 (36)
Participants described relief about their trans child being over 18, had already transitioned, and/or living in a state where
the bill/law has not been introduced or passed
Parental figure’s coping
Activism/advocacy
Participants described engaging in activism/advocacy groups in order to prevent the passing of these laws/bills 38.41 (53)
Educating others
Participants described educating people, family, and politicians on trans issues in order to reduce stigma 7.97 (11)
Seeking support from communities/groups
Participants described getting involved with and confiding in family, groups, and communities who offer support as a
parent of a trans child
15.22 (21)
Relocation and avoidance
Participants described willingness to move states or countries and avoid traveling to areas with antitransgender legislation
to distance and shield themselves and their TGD child from the antitransgender political climate
26.10 (36)
Note. Chi squares analyses were used to determine differences between participants whose children were minors and participants whose children were
adults. We found no significant differences across these two groups regarding parental figures’cognitive reactions to laws and bills, parental figures’emo-
tional reactions to laws and bills, and parental figures’coping strategies.
6ABREU, SOSTRE, GONZALEZ, LOCKETT, AND MATSUNO
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their child’s medical journey and decisions made by her daughter
and doctor:
It's my job to be a liaison between my child and her healthcare pro-
viders: acknowledge needs, set up appointments, advocate if she wants
that and feels stuck. If she and her provider agree, as a tween or teen
that she needs blockers or HRT, I respect their collective decision. I
might weigh in with suggestions (comparing methods of administra-
tion, for example), but I don't get to tell the person who lives in that
body, or the person with a decade of schooling and a couple decades
of professional experience, that they're wrong.
Similarly, a 48-year-old, White, gender-nonconforming mother
of a 16-year-old child from Pennsylvania emphasized the impor-
tance of educating themselves in order to be able to best support
their child:
My role is to learn as much as I can from researching scientific evi-
dence and medical best practices, talking to trans adults about their
experiences and talking to other parents. [Most important] are listen-
ing to my child and their care providers. I question and challenge my
child at times because I want them to really examine where they are
coming from and verbalize that. When I feel I have enough informa-
tion, I proceed with the actions that seem most likely to support my
child's physical and mental health.
Parental Figures’Emotional Reactions to Laws and Bills
Seventy (50.72)%) parental figures shared varying emotional
reactions to these antitransgender laws and bills, including: (a)
fear and anxiety, (b) anger, and (c) relief.
Fear and Anxiety
Forty-three (31.16%) parental figures experienced fear and anxi-
ety as a result of these laws and bills. These parental figures were
concerned about their own safety, their TGD child and other TGD
youth’s well-being and life, and increased TGD-specific violence
and discrimination. A 49-year-old, White, mother of a 12-year-old
child from Texas expressed fear about increased suicidality from
TGD youth, “I am afraid for those kids who might find death pref-
erable to being forced to go through the bodily changes of puberty
for the wrong gender.”Regarding fear of legal TGD protection
being rolled back, a 43-year-old, White, mother of a 15-year-old
trans child from Missouri stated, “These laws are terrifying. To
think they can reverse all the work and protection we have fought
so hard for is absolutely heartbreaking. What kind of world tells
my daughter she cannot exist?”Additionally, parents expressed
fear regarding their own child’s life. For example, a 33-year-old,
White, mother of a 11-year-old trans child from Nebraska stated:
I am afraid every day for my son. I’m afraid for him to go to the public
restroom or to go to some friends’houses. My other children have
been bullied because they have a trans brother. No one would choose
a life for their child that is hard and full of strife.
Other parental figures described how heightened anxiety has
personally affected her life and mental health. For example, a 44-
year-old, White, mother of a 14-year-old child from Tennessee
shared:
The anxiety [of these laws and bills] caused me to have trouble con-
centrating and relaxing. I cried and fretted about it a lot. I also spent
a lot of my personal time reaching out to other moms and trying to
think about how we can get these bills thrown out.
Anger
Thirty-three (23.91%) parental figures expressed anger over the
proposed laws and bills. Participants indicated that these laws
were unethical and unjust. These parental figures shared that the
persistent discrimination and ignorance surrounding their child’s
TGD identity is frustrating and upsetting. For example, a 32-year-
old, White, mother of a 7-year-old trans child from Oregon
expressed anger about the targeting of TGD children through these
laws and bills, “I am angry and frustrated and upset. I hurt
because people making these laws that are designed to hurt our
children have not met my child, or any child, that this will actually
affect.”Additionally, a 55-year-old, White, mother of a 19-year-
old nonbinary child from Oklahoma expressed anger regarding
people who promote hateful, religion-based agendas stating, “Peo-
ple who ignore these facts in order to push forward a hateful, reli-
gion-based agenda are hypocrites, evil, and fill me with rage.”
Relief
Thirty-six (26.10%) parental figures expressed relief as a result
of living in a state where these antitransgender laws and bills have
not passed, that their child was over 18, and/or that their child has
already transitioned. For example, a 36-year-old, White, mother of
a 9-year-old trans child from Iowa expressed relief because she
lives in a state where these laws do not pose a threat at the
moment, emphasizing that politics should not have a place in TGD
issues:
I have been fortunate to live in a state that recognizes that the law
does not belong in the doctor's office and recognizes that mental
health and medical professionals in coordination with the family are
the ones who should be making medical decisions regarding transgen-
der care; not politicians.
Parental Figures’Coping
Eighty-seven (63.04%) parental figures described how they
coped with the proposed and/or passing of these antitransgender
laws and bills, including: (a) activism and advocacy, (b) educating
others, (c) seeking support from communities/groups, and (d) relo-
cation and avoidance.
Activism and Advocacy
Fifty-three (23.91%) parental figures shared engaging in activ-
ism and advocacy as a way to cope with the proposed and/or pass-
ing of these antitransgender laws. Although activism looked
different for every participant, the majority of parental figures in
our study contacted political figures, attended rallies, joined activ-
ist groups, and/or got involved with LGBTQþcommunity centers.
Some participants shared taking an active role in advocacy and ac-
tivism since the proposal and/or passing of these laws and bills.
For example, a 45-year-old, White, mother of a 15-year-old trans
child from New York described:
PARENTAL FIGURES’REACTIONS AND COPING STRATEGIES 7
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We are, as a family, contacting law makers and working with LGBTþ
advocacy groups to attempt to ensure support for the LGBTQþcom-
munity. I am working with LGBTQþcommunity groups to support
young people who cannot return to homes in states that are dangerous
to their physical or mental health.
Educating Others
Eleven (7.97%) participants engaged in educating others as a
way of coping with the proposed and/or passing of these antitrans-
gender laws. Parental figures took the chance to educate policy-
makers, family members, and others on TGD matters in order to
reduce prejudice and misinformation about these laws and bills
and other issues that affect TGD people. For example, a 39-year-
old, White, mother of a 19-year-old trans man from Indiana dis-
closed, “I've tried to learn as much as I can and educate those
around me when I have the opportunity.”Additionally, a 57-year-
old, White, mother of a 16-year-old trans boy from Tennessee
emphasized engaging in conversations with others about their own
experiences with having a TGD child, “I have become an educa-
tor—very few people who I meet for the first time leave without
knowing that I have a trans kid ... people want to become edu-
cated and I am happy to answer questions.”
Seeking Support From Communities and Groups
Twenty-one (15.22%) parental figures sought support from
communities and groups in order to cope with how these oppres-
sive antitransgender laws and bills affect their TGD child. These
communities and groups included family, activist groups, and
other parental figures of TGD youth both online and in person. For
example, a 55-year-old, White, mother of a 19-year-old nonbinary
child from Oklahoma indicated their involvement with LGBTQ
organizations and support groups:
I have been active in my local PFLAG chapter for several years. I
have also started attending a separate support group specifically for
parents/caregivers of transgender children (of any age) ...our group
provides a safe space for parents to work through their feelings and
come to a place where they can be affirming of their child.
Parental figures not only found support but offered support to
other parental figures by initiating support groups to facilitate
community-building. For example, a 47-year-old, White, mother
of a 16-year-old trans child from Iowa share their experience in
running a support group for other parental figures:
I run a parent group in my town and provide support for any parent or
child who needs it. I actually held a meeting back in the winter and
had six families come to talk about a proposed law where we live.
Relocation and Avoidance
Thirty-six (26.10%) parental figures created plans of relocation
to new states if these laws and bills were to pass in their current
state of residency. Some parents emphasized that they would even
move out of the country if these laws and bills were to pass within
their state or across the United States. For example, a 43-year-old,
White, mother/nonbinary parent of a 5-year-old bigender child
from Missouri emphasized how they have become preoccupied
with having to potentially leave their state or send their child out-
of-state:
I have spent way too much time running scenarios in my head where
we flee the state in the middle of the night packing just what we can in
our car, or having to send our child off to live with other people.
These parental figures also indicated that they have distanced
themselves from news of these antitransgender laws and bills, as
well as shielding their child from news of these laws and bills. For
example, a 43-year-old, White, mother of a 18-year-old trans man
from Iowa made the decision to not focus on these laws for her
and her child's mental health, “They’re terrible but for my own
mental health, and that of my child, we haven’t focused on them.”
Discussion
The purpose of the current study with 138 parental figures of
TGD youth was to uncover how the current proposed and passed
antitransgender laws and bills in the United States restricting
access to medical care for TGD youth have impacted these paren-
tal figures and how they are coping. Given the unprecedented
number of antitransgender laws and bills passed against the trans
community in America under the Trump Administration (Human
Rights Campaign, 2018), recent research has begun documenting
the impact that these oppressive policies have had on the trans
community (e.g., Abreu, Gonzalez, Capielo Rosario, Pulice-Far-
row, et al., 2020;Lee, 2017). While previous studies have docu-
mented how parental figures of trans children are impacted as a
result of systemic oppression (see a review in Abreu et al., 2019),
to the authors’knowledge this is the first study to examine the
impact of current antitransgender laws and bills on parental figures
of trans youth.
Participants viewed these oppressive antitransgender laws and
bills as a violation of their and their child’s rights, a source of
increased stigma toward their TGD child and the TGD community
overall, and as having a negative impact on the quality of health-
care for TGD people. While a small amount of literature has
explored the impact of antitransgender laws and bills of TGD peo-
ple such as increased violence (Lee, 2017) and fear-mongering
and invasion of privacy (Human Rights Campaign, 2016), this
study adds to that small area of research by documenting the
impact of more recent legislative attacks on the families of TGD
youth. In addition, while earlier antitransgender laws focused on
restricting bathrooms access to trans individuals (e.g., Kralik,
2019), these newer laws and bills are shifting to intrude specifi-
cally on the physical and emotional well-being of TGD youth and
their families. This study provides insight about how these new
attacks on TGD youth are affecting their caregivers. Furthermore,
participants expressed intense emotional reactions such as fear,
anxiety, anger, and relief. Although some studies have looked at
the emotional impact on parental figures of TGD youth as they try
to navigate different environments (e.g., healthcare system,
schools; see review Abreu et al., 2019), this study adds to this
body of research by specifically uncovering how oppressive politi-
cal environments are yet another system that negatively affects pa-
rental figures of TGD youth. Although research has documented
how antitransgender laws affect the mental health of TGD individ-
uals (e.g., Abreu, Gonzalez, Capielo Rosario, Pulice-Farrow, et
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al., 2020), to our knowledge no studies have documented how
these newer laws and bills affect the caregivers of TGD
individuals.
There is scant research on how parental figures and family
members of TGD people can cope with navigating different
oppressive systems with their TGD child or family member while
remaining resilient and supportive (e.g., Alegría, 2018). Similarly,
although research shows how TGD people cope under oppressive
political climates (see review in Abreu, Gonzalez, Capielo
Rosario, Pulice-Farrow, et al., 2020), to our knowledge no study
has explored ways in which parental figures of TGD youth cope
with antitransgender legislation that affects their child. Our study
makes a contribution to this body of research by exploring how
the participants in this study have coped through activism and ad-
vocacy, educating others, seeking support from communities and
groups, and relocation and avoidance in order to keep their child
and themselves safe. These unique findings highlight the ways that
gender-related minority stressors have an impact on parental fig-
ures as well as TGD youth themselves.
Strengths, Limitations, and Recommendations for
Future Research
This study is among the first ones to have looked at real-time
antitransgender policies and their impact on the parental figures of
TGD children. The results of this study are even more salient for
parental figures of TGD youth who are currently under 18 years
old, as they are ultimately the ones responsible for facilitating their
child’s healthcare needs (e.g., trips to the doctors, asking for clari-
fying information from medical providers about the healthcare
needs of their child). Researchers should continue to expand on
this research by exploring how these stressors are exacerbating
negative mental health outcomes among parental figures, as well
as their coping strategies over time. Further research could explore
whether the minority stress model framework helps explain the
emotional reactions experienced by parental figures of TGD youth.
This will allow for a better understanding of the long-term effects
on the well-being of TGD people and their caregivers and can help
target effective interventions to support this population.
It is important to acknowledge several limitations of this study.
This study was conducted using a qualitative methods approach
and, therefore, results cannot be generalized to other parental fig-
ures of TGD youth. Also, the majority of our participants identi-
fied as White mothers who are accepting and affirming of their
TGD child. Therefore, our findings do not capture the experiences
of parental figures of color of TGD youth, fathers, and parental fig-
ures who are not accepting of their TGD child and who might
even agree with the passing of such antitransgender laws and bills.
Future research should center the experiences of participants who
identify as people of color, and specifically explore how cultural
values and beliefs impact the effects of these laws and bills on pa-
rental figures of color, including unique coping strategies they
might draw from their own communities. For example, research
shows that people of color use different, culture-specific strategies
(e.g., convivencia and familismo for Latinx immigrant transgender
people; Abreu, Gonzalez, Capielo Rosario, Pulice-Farrow, et al.,
2020;Abreu, Gonzalez, Capielo Rosario, Lockett, et al., 2020;
Abreu, Gonzalez, Mosley, et al., 2020) to cope with systemic
oppression. Recent research shows that parental figures of color
use culturally-driven strategies to navigate the relationship with
their child (e.g., Abreu, Gonzalez, Capielo Rosario, Pulice-Farrow,
et al., 2020;Abreu, Riggle, et al., 2020). Therefore, we pose that
current antitransgender laws and bills affect parental figures of
color and their TGD child differently. To accomplish this, it would
be helpful to use targeted recruitment strategies by building rap-
port and partnerships with communities of color. In addition,
future research should seek narratives from parental figures who
identify as fathers and parental figures who might support anti-
transgender laws and bills. This will allow for a comprehensive
understanding of how these laws and bills impact the family unit.
Using quantitative methods in future studies will help further
validate current findings of the reported impact that these laws and
bills have on parental figures of TGD youth such as increased lev-
els of anxiety. Furthermore, some participants in the study lived in
locations that have not been directly affected by these proposed or
passed laws and bills. Future research should assess differences in
outcomes (e.g., stress, anxiety) for parental figures who live in
states where these laws and bills are in effect versus those who
live in states where these laws and bills have not been introduced
or passed. Finally, while research supports the importance of using
online surveys to inquire about issues that affect sexual and gender
diverse people (e.g., safe space; Riggle et al., 2005), a limitation
of open-ended questions in online surveys (vs. in-person inter-
views) is the inability to ask important follow-up questions. Future
research should conduct in-depth semistructured interviews so that
clarifying questions are able to be explored.
Recommendations for Practitioners and Other Service
Providers
It is essential for mental health practitioners to stay informed
about current legal protections and legal attacks on the TGD com-
munity in order to best serve TGD clients and their families. Men-
tal health practitioners can use this knowledge to help educate
their clients about such legislation and help them process their
emotional reactions. The results of this study indicate that parents
and TGD youth alike have increased anxiety, fear, and anger
related to the recent attacks on TGD youth and increased gate-
keeping practices. Mental health practitioners should be prepared
to validate these emotional reactions and support parental figures’
coping strategies when antitransgender legislation is proposed
and/or passed. Additionally, parents may be more confused about
the potential risks and benefits of gender-affirming medical inter-
ventions with the increased rhetoric against allowing minors to
engage in gender-affirming care. This is an opportunity for pro-
viders to debunk antitransgender messaging and provide scientific
evidence on the actual benefits and risks of engaging in hormone
replacement therapy or surgery (e.g., Ashley, 2019).
Supporting parental figures of TGD youth can help them advo-
cate for their children. Parental figures often take on the responsi-
bility of educating others and advocating in various systems such
as schools and healthcare systems (e.g., Abreu et al., 2019), which
can take this burden off TGD youth. For youth who are minors,
parents hold more power to advocate against such oppressive prac-
tices. Therefore, it is important to increase advocacy among
parents. Additionally, our findings show that engaging in advocacy
and education helps some parents cope by giving them a sense of
agency to protect their child. It is important for practitioners to
PARENTAL FIGURES’REACTIONS AND COPING STRATEGIES 9
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also increase healthy coping through connecting parental figures to
support groups either online or in person and helping parents navi-
gate difficult decisions about what to do if antitransgender bills are
passed in their state. Furthermore, practitioners can use this knowl-
edge to support the TGD community and their parental figures by
advocating for passing TGD-affirming policies or dismantling
TGD-oppressive policies. Mental health practitioners may achieve
this through different methods, such as educating the public and
policymakers through workshops and other ways of disseminating
scientificfindings, and lobbying with their local, state, and
national representatives, among other actions. Using their training
and knowledge to engage in social justice work, practitioners can
help leverage the stress experienced by parental figures of TGD
youth, who then are able to use their cognitive and emotional
resources to support their TGD child.
Our findings also have implications for other service providers
such as teachers, school staff, and social workers. Teachers and
school staff can use the findings in this study to better understand
how the extra layers of stress as a result of antitransgender laws
and bills affect the academic performance and emotional well-
being of TGD youth in school. For example, current research
shows that when transgender students are exposed to victimization
in school, they choose to be more absent and their GPA tends to
decline (see review in Abreu, Audette, et al., 2021;Day et al.,
2019). Teachers and other school staff (e.g., school counselors)
may be crucial in reducing stress by allowing TGD youth to miss
school days without consequences to allow them to attend appoint-
ments to take care of their physical and emotional well-being. In
addition, given that our results show that exposure to the evolving
nature of these laws and bills negatively impacts parental figures
of TGD youth, social workers could use their privilege and knowl-
edge about how systems affect the individual to stay informed
about the status of these laws and bills and regularly check-in with
parental figures of TGD youth to see what they might need at the
moment for their TGD child and themselves to stay safe.
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Received December 14, 2020
Revision received March 21, 2021
Accepted March 22, 2021 n
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