Social transition in young trans people accessing gender-affirming care.

Abstract

Background: In-depth quantitative study of how young people undertake social transition is lacking. We aimed to provide a comprehensive profile of social transition among young people accessing gender-affirming care.

Methods: In this cross-sectional study (n = 482), young people aged 8-17 years completed online questionnaires before their first appointment at a pediatric gender clinic. Measures captured social transition in different contexts (home, school, online, friends, and extended family) by assessing extent of social transition, and changes to presentation, name and pronouns or intent to make these changes. Young people also reported their concerns about socially transitioning.

Results: The vast majority expressed preferences to socially transition by changing their presentation (96.0%), name (89.6%), and/or pronouns (94.3%). Compared to presentation (74.4%), fewer young people had changed their name (45.8%) or pronouns (44.1%) across all the examined contexts. Social transition was most commonly observed either online or with friends, with home and school being less common contexts, and extended family the least likely context in which to observe change. Overall, there were 129 unique patterns of social transition across contexts, highlighting the heterogeneous nature of social transition. Most young people reported being concerned about socially transitioning (88.8%), with the most prevalent concerns related to bullying, prejudice or discrimination (59.5%).

Discussion: Young trans people show a complex profile of social transition that is context-dependent and likely reflects differences in underlying levels of safety and support. Understanding these nuanced patterns of social transition is necessary to improve clinical care and develop relevant policies and guidelines.