"And I don't know how I can protect him from everything that's coming" - A qualitative study on minority stress among parents of transgender adolescents.

Background: Parents play a central role for transgender adolescents' well-being and their coping with minority stress, like discrimination, rejection and violence. Yet, little is known about the experiences of parents facing minority stress as they support their transgender children who are either awaiting or undergoing medical transition. Therefore, we aimed to first examine minority stress experiences reported by the parents with respect to distal and proximal stressors. Second, we aimed to explore whether experiences relate to children's stress experiences as secondary stress experiences, or if parents report minority stress directed at themselves as primary stress experiences.

Methods: In the context of the participatory TRANS*PARENT study in Berlin, Germany, from April 2022 to September 2022 five focus groups were conducted with a total of 24 parents who have a transgender and/or non-binary child at the age of 11-18 years. Qualitative structuring content analysis was applied.

Results: Parents reported distal stressors such as structural problems (in education, medical, psychiatric and psychological institutions, leisure activities and sports) and social rejection (peer rejection like bullying and violence, gaslighting, intersectionality, blame of others). Proximal stressors covered fears of future/anticipated discrimination, internalized gender stereotypes, and self-blame. Most experiences were secondary stressors, related to the child's minority stress causing frustration and sadness for the parents, while especially fears of the future/anticipated discrimination, gaslighting and blame of others emerged as central primary stressors.

Discussion: Results show a complex interaction of minority stressors affecting both parents and their transgender children on structural and social levels. The impairment of their child's education and worries about its safety and life prospects burdened parents the most. The additional direct and primary stress experiences might impede their efforts to navigate their child's transition process.

Conclusion: In transgender health care, the multidimensionality of the structural and social impacts of marginalization needs to be addressed not only with respect to the transgender adolescents themselves, but also with respect to their caregivers. Further research should explore how child and parental stress interact and how family-based health care can alleviate stress on both child and parent level.

Clinical trial number: Not applicable.