Social gender affirmation may help lessen depression, anxiety in gender diverse children

Compared with other youth, transgender youth have higher risk of being diagnosed with depression and/or anxiety. Social gender affirmation may help.

Transgender children are more at risk for depression, anxiety, suicidal thoughts and suicide attempts than their non-transgender peers, according to researchers. Social transitioning, or social gender affirmation, is a way for children to express their gender identity. Recent studies show that the mental health of transgender youth who get social affirmations of their gender identity is nearly indistinguishable from their non-transgender peers.

What is a social gender affirmation?

Social gender affirmations are increasingly common for transgender children. For parents of gender diverse children (children who identify as transgender or nonbinary), a social gender affirmation is a completely reversible nonmedical intervention to allow a child to live their life as their asserted gender. A social gender affirmation can include:

  • Changing their name
  • Using pronouns of their asserted gender
  • Changing their hairstyles and clothing

A social gender affirmation is usually an outcome of gender diverse children externally expressing their gender identity as different from their sex assigned at birth. These children often may express frustration and/or disgust with their anatomy. In some cases, this distress may cause threats or attempts at self-harm or even suicide in the child.

For parents, a social gender affirmation will mean allowing a child to freely convey their asserted gender with social adaptations.

How a social gender affirmation may affect depression, anxiety

“Gender is a crucial part of identity,” said Suzanne E. Kingery, M.D., pediatric endocrinologist with Norton Children’s Endocrinology, affiliated with the UofL School of Medicine.

Dr. Kingery serves as director of the Pediatric and Adolescent Gender Education (PAGE) Program.

“If a child feels like they’re not being seen for who they are, if they’re feeling rejected by their family or peers, it can be incredibly distressing. Studies have shown that there are high rates of depression and anxiety for gender diverse children who are not socially affirmed.”

A study published in the Journal of the American Academy of Child and Adolescent Psychiatry examined self-reported depression, anxiety and self-worth measures in socially affirmed transgender children compared with control groups of age and gender matched non-transgender children and the siblings of transgender children.

Study participants were enrolled at the time of the study in the TransYouth Project (TYP), a national, longitudinal study of socially transitioned transgender children. The study’s sample included 63 transgender children, 63 age-matched controls and 38 siblings 9 to 14 years old. The children completed the depression and anxiety measurements. Their parents also reported on their child’s depression and anxiety symptoms. The sample size for the self-worth measurement included 116 transgender children, 122 control children and 72 siblings 6 to 14 years old, inclusive of most children who completed the mental health measurements.

Norton Children’s Endocrinology

Norton Children’s Pediatric and Adolescent Gender Education (PAGE) Program provides gender-affirming care for children, teens and young adults whose gender identity is different from their sex at birth (transgender) and those who don’t identify with the traditional definitions of male or female (gender diverse).

Call (502) 588-3400

The study showed that the transgender children’s depression and self-worth did not differ from the non-transgender children, while anxiety remained slightly elevated in comparison with the control group. However, these levels of self-reported depression and anxiety are much lower in comparison with previous studies of transgender children who were not socially affirmed, which found very high rates of depression and anxiety.

How to get help

For gender diverse youth and their parents, talking to your pediatrician can be a first step to get access to gender-affirming support and care. Additionally, youth and parents can self-refer to a program such as the PAGE Program, which provides access to pediatric endocrinologists, nurses, behavioral and mental health specialists, and social workers that can come up with a unique, comprehensive care plan that meets your child’s short- and long-term goals for their gender-affirming care.

“Working with a program such as PAGE gives gender diverse youth the opportunity to be supported and receive the latest evidence-based care,” Dr. Kingery said. “It’s not just medical and mental health services. We provide support services, including social workers to guide patients and caregivers through school and legal challenges and a support group so youth can feel empowered by sharing personal experiences and thoughts.”