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. Author manuscript; available in PMC: 2023 Nov 25.
Published in final edited form as: J Homosex. 2019 Nov 27;68(8):1260–1277. doi: 10.1080/00918369.2019.1696103

Parental Responses to Transgender and Gender Nonconforming Youth: Associations with Parent Support, Parental Abuse, and Youths’ Psychological Adjustment

Arnold H Grossman a, Jung Yeon Park b, John A Frank c, Stephen T Russell d
PMCID: PMC10676004  NIHMSID: NIHMS1913083  PMID: 31774377

Abstract

The purpose of this study was to examine parental responses to transgender and gender nonconforming [TGNC] youths’ gender identities and explore associations of parent support with parental abuse, depressive symptoms, and LGBT-identity disclosure stress. TGNC youth (N = 129), ages 15–21 (M = 18.00, SD = 1.74), completed surveys (2011–2012); experiences of transfeminine (TF; n = 58) and transmasculine (TM; n = 71) youth were analyzed separately. Among mothers of TF youth, 42.0% of initial and 45.3% of current responses were positive; among fathers, 30.0% of initial and 36.0% of current responses were positive. Among mothers of TM youth, 26.0% of initial and 53.3% of current responses were positive; among fathers, 24.0% of initial and 44.6% of current responses were positive. Among TM youth, higher levels of parental support were associated with more positive responses from mothers and fathers. Among both TF and TM youth, greater parent support was associated with less parental abuse, depressive symptoms, and LGBTQ-identity disclosure stress. Parental responses to youths’ gender identities became more positive with time for TF youth; however, approximately 50% of all TGNC youth continued to experience minority stress related to parent rejection. Limitations and implications for practice and research are discussed.

Keywords: Transgender, gender nonconforming, transfeminine, transmasculine, youth, parents, parent support, parental abuse, depression, stress

Fundamental to the role of parenting is the task of transmitting the norms and values of a culture to its youth. This process of socialization includes the youths’ acceptance and learning of the attitudes, values, and actions that are socially appropriate to their assigned gender (McGuire, Kuvalanka, Catalpa, & Toomey, 2016). Most parents identify and name children at birth, being guided by the newborn’s external sexual (genital) features and Western society’s cultural expectations, as they envisage their children embracing one of two binary gender identities, i.e., girl/woman or boy/man (Singh & Dickey, 2017). Outside of the home, societal institutions (e.g., schools, athletic leagues) reinforce parents’ rigid gender binary focus by asking youth to behave as masculine and feminine in harmony with society’s pre-determined gender role expectations (Pardo, 2008; Singh & Dickey, 2017). Although the large majority of youth discover that their gender identities and expressions are aligned with their assigned sex and gender roles, this is not the case for all youth (Budge et al., 2018; Olson & Gulgoz, 2018; Singh & Dickey, 2017).

When parents become aware that their child’s gender identity and/or gender expression are no longer in accord with their assigned gender at birth, whether through their own discovery or through the youths’ disclosure, their responses to their child may change from those conveying acceptance to those perceived as signals of rejection (Fuller, 2017; Grossman, D’Augelli, Howell, & Hubbard, 2005). Coupled with the expectations of rejection in their day-to-day interactions with others (Rood et al., 2016), transgender and gender nonconforming [TGNC] youth worry whether their parents initial negative reactions will become positive over time and if their parents’ responses to their authentic gender identities will affect the level of support they can expect (Rahilly, 2015; Ryan, Huebner, Diaz, & Sanchez, 2009; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010).

A growing body of research examining parent and family rejection, acceptance, and support among lesbian, gay, and bisexual (LGB) youth has emerged (McConnell, Birkett, & Mustanski, 2016; Rothman, Sullivan, Keyes, & Boehmer, 2012; Samarova, Shilo, & Diamond, 2013; Savin-Williams, 2001a); and it shows that while negative familial responses to the youths’ sexual orientation have often been linked to negative health outcomes such as depression, substance abuse, homelessness, and sexual risk-taking (Ryan et al., 2009), family acceptance has been associated with psychosocial support and protective against LGB youths’ psychological distress (Ryan et al., 2010). Empirical studies on the responses of parents to TGNC youth are starting to emerge, but more studies are needed (Institute of Medicine [IOM], 2011; Katz-Wise, Rosario, & Tsappis, 2016). Klein and Golub (2016) found that family rejection was associated with higher odds of suicide attempts and substance misuse among TGNC people; and they concluded that family rejection related to gender identity is an understudied interpersonal stressor affecting the health outcomes of TGNC people. Similarly, Fuller and Riggs (2018) identified a positive relationship between family rejection and psychological distress among a sample of TGNC people.

The primary goals of the current study was to examine chronic stressors experienced by TGNC youth in relationships with their parents as related to the stigmatization of their gender minority identities in order to identify negative psychosocial outcomes, and to recommend efficacious interventions. The study aimed to examine TGNC youths’ experiences of their parents’ initial reactions and current responses to their gender identities, occurrences of parental psychological and physical abuse, perceived parental support, and indicators of the youths’ psychological adjustment. Recognizing the importance of respecting the participants’ self-designated gender identities, we examined TGNC youths’ experiences with their parents from two perspectives, i.e., transfeminine (assigned male at birth) and transmasculine (assigned female at birth) rather than as one group.

Terminology

Acknowledging that “self-identification is related to self-determination and is the ability, right, and freedom of each individual to make a decision about their gender identity and/or expression in a manner that is authentic,” (Singh & Dickey, 2017, p. 20), the authors recognize youth who self-identify a gender other than the one assigned at birth as “transgender”; and, if youths’ expression of gender goes beyond society’s parameters of girl/woman or boy/man—or neither or both, they are recognized as “gender non-binary,” “gender variant,” or “gender nonconforming” (Burdge, Licona, & Hyemingway, 2014; Singh & Dickey, 2017). Aware that a variety of terms are used to describe self-identified gender variant youth, for the sake of consistency, the authors refer to the group of youth as “transgender and gender nonconforming” [TGNC], an umbrella term that is broadly inclusive and recognizes gender identity and behavior as varying along a continuum (APA, 2015).

Conceptual framework and research questions

The minority stress model was used as the conceptual framework for the current study (Meyer, 2003; Meyer & Frost, 2012). Previous empirical studies have demonstrated the usefulness of the minority stress model in examining chronic stress experienced by people in sexual and gender minority communities (IOM, 2011). The model is based on the premise that chronic stress arises from the stigmatization of sexual and gender minority people, and that social stress is stable within their social and cultural contexts (IOM, 2011; Meyer, 2003). The major processes of the minority stress model include both proximal (e.g., concealment of one’s sexual and/or gender identity) and distal (e.g., actual experiences of prejudice, discrimination and victimization) stressors. We examined the distal stressors by assessing TGNC youths’ experiences of maternal and paternal initial and current responses to their gender identities and reported occurrences of parental abuse. With regard to the proximal stressors, we assessed the TGNC youths’ perceived parent support, levels of LGBTQ-disclosure stress, and symptoms of depression.

The research questions explored in this study were as follows:

RQ1: What are the levels of maternal and paternal figures (i.e., mothers and fathers) awareness of TGNC youths’ gender identities?

RQ2: Are there differences between maternal and paternal initial and current reactions (i.e., responses) to TGNC youths’ gender identities?

RQ3: Are maternal and paternal current responses to TGNC youths’ gender identity associated with their levels of parent support?

RQ4: Are levels of parent support associated with TGNC youths’ experiences of parental psychological and physical abuse?

RQ5: Are levels of parent support associated with indicators of TGNC youths’ psychological adjustment, i.e., depressive symptoms and LGBTQ-identity disclosure stress?

Method

The data examined in this study were provided by TGNC youth who participated in the first panel of a longitudinal study exploring risk and protective factors for suicide among sexual and gender minority youth. Youth were recruited in three U.S. urban cities (located in the Northeast, Southwest, and on the west coast) between November 2011 and October 2012; and notices requested that youth, who were between the ages of 15 and 21 and who were interested in participating in a study about the developmental experiences of lesbian, gay, bisexual, and transgender youth, contact a research coordinator at the site in their respective city. Recruitment strategies focused on inviting sexual and gender minority youth who attended community organizations and college groups for LGBTQ youth as well as those who participated in LGBTQ Pride activities or visited websites frequented by LGBTQ youth. Additionally, snowball sampling was used successfully to enhance the diversity of the participants, e.g., race, ethnicity, non-organizational membership. Study participation involved the completion of a survey packet (paper and pencil) that included questions appertaining to birth sex, assigned gender at birth, sexual orientation (i.e., identity and attraction), gender identity; standard measures assessing mental health symptoms and aspects of psychosocial adjustment; and assessments developed to ascertain youths’ perceptions of parental support, parental psychological and physical abuse, and parental responses to their gender identities.

Youth provided informed consent prior to completing the survey; and as seeking parental consent could place youth at risks associated with the disclosure of their sexual and gender identities or could lead to verbal or physical harm, parental consent was not sought. In place of parental consent, a youth advocate was present at each site to answer questions about the study and to respond to youths’ concerns about potential participation; in addition, assent procedures were implemented for youth under the age of 18. The procedures and materials were approved by the institutional review boards of New York University and the University of Arizona; and, all approvals contained a debriefing process that included an assessment of participants’ suicidal thinking and plans as well as access to mental health and other LGBTQ-affirmative resources. Additionally, all members of the research team were mandated reporters and were prepared to report any occurrence of ongoing abuse of a minor. Data are protected by a federal certificate of confidentiality. Youth completed the surveys in 40 to 80 minutes; they were offered $30 for their participation at two sites and $25 at the third site. [Note: Payment rates were determined based on the cost of living in different regions and restrictions set by affiliated institutional review boards.]

Participants

Of the 129 TGNC participants, 58 (45%) were recruited in the Northeast, 51 (39%) on the west coast, and 20 (16%) in the Southwest. Using the youths’ self-reported gender identities, each participant was placed in one of four mutually exclusive subgroups, following the work of Beemyn and Rankin (2011): trans-women [MTF]: 44 (34%); trans-men [FTM]: 40 (31%); female-to-a-different gender [FTDG]: 31 (24%); and, male-to-a-different gender [MTDG]: 14 (11%). No significant differences were found between sites in the proportion of TGNC youth in each of the subgroups based on self-recognized gender identities. For the purpose of reaching significant statistical power in the current study, the four gender-identity subgroups were transformed into two groups, as follows: the MTF and MTDG subgroups were combined to form a group identified as transfeminine youth (n = 58; 45%), and the FTM and FTDG subgroups were combined to form a group identified as transmasculine youth (n = 71; 55%) as in White-Hughto, Rose, Pachankis, and Reisner (2017).

Measures

Parents’ knowledge and reactions to youths’ gender identities

Parental knowledge of and reactions to youths’ gender identities were assessed separately for mothers and fathers (including foster, step, adoptive, etc.) with questions used previously by the first author (Grossman et al., 2005). Participants were asked: “Do the people listed below know that you are LGBTQ?” (Reply options: definitely, probably, probably not, and definitely not); “When you first told … or they found out that you were LGBTQ … reaction was … ? and “What is the person’s reaction to you now?” (Reply options: 4 (very positive), 3 (positive), 2 (negative), 1 (very negative), 0 (no reaction), and does not know). We report the youths’ perceptions of their mothers’ and fathers’ initial reactions as first reactions, and, of mothers’ and fathers’ reactions now as current responses. Higher scores correspond to greater levels of positive parental reactions/responses to youths’ gender identities.

Parental abuse

The Child and Adolescent Psychological Abuse Measure was used to assess parental psychological abuse. The measure assesses verbal abuse and physical abuse with two subscales with reported reliabilities ranging from .75 to .87 (Briere & Runtz, 1990). Cronbach’s alphas in the current sample ranged from .91 to .95. Participants were asked to report how often seven kinds of verbal abuse by mother/father happened, if ever, when they were growing up–before the age of 15 (Sample items: “yelled at you,” “made you feel like you were a bad person.”). Similarly, participants were asked to report how often six kinds of physical abuse by mother/father happened, if ever, when growing up–before the age of 15 (Sample items: “slapped you,” “beat you,” “kicked you.”). The four response options for each of the 13 items were: 1 (never), 2 (rarely), 3 (sometimes) and 4 (often). Higher scores on each scale correspond to greater levels of parental verbal abuse and parental physical abuse, respectively.

Parent support

General parental support was measured by participants’ responses to the 12-item sub-scale of the Child and Adolescent Social Support Scale (CASSS; Malecki, Demaray, & Elliott, 2000). For each item, participants rated the frequency they received that support from their parents (Sample items: My Parent(s): “give me good advice,” “help me solve problems by giving me information,” and “take time to help me decide things.”). The response options for each item are: 1 (never), 2 (almost never), 3 (some of the time), 4 (most of the time), 5 (almost always) and 6 (always); Cronbach’s alpha for the entire scale is .96 (Malecki et al., 2000), and for the parent subscale in the current sample is .96. Higher scores correspond to higher levels of perceived parent support.

Depressive symptoms

The Beck Depression Inventory for Youth was used to measure depressive symptoms (BDI-Y; Beck, Beck, Jolly, & Steer, 2005). The BDI-Y is a 20-item scale that assesses the presence and magnitude of symptoms commonly associated with clinical samples of depressed persons (Sample items: “I feel no one loves me,” “I feel lonely,” and, “I hate myself.”). Participants choose responses that correspond to how they feel, using a four-point scale: 1 (never), 2 (sometimes), 3 (often), and 4 (always). Beck et al. (2005) reported a reliability coefficient of .75; and in the current sample it is .95. Higher scores correspond to greater levels of depressive symptoms.

LGBTQ disclosure stress

The stress associated with the participants’ LGBTQ-identity disclosure to parents was measured using two items from the LGBTQ Coming-Out Stress Scale, a modified version of the Gay-Related Stress Scale (Rosario, Rotheram-Borus, & Reid, 1996). The items assessed how stressful the participants felt the situation was, from 1 (no stress) to 5 (extremely stressful), when they either (a) told their parents about their LGBTQ identity for the first time or (b) when the parents found out that they embraced a LGBTQ identity. Higher scores correspond to higher levels of disclosure stress.

Demographic characteristics

Participants reported demographic information pertaining to age, ethnicity, race, birth sex, gender identity, and sexual identity. Age was assessed in years; and in accordance with federal guidelines, ethnicity was assessed as being Hispanic/Latino or not. Seven standard categories were used to assess race, with “write-in” as an added response option. As some racial categories had small values, the categories used for analysis were: White, Caucasian, Anglo or European American; Black or African American; Multi-Racial; and “Other.” Participants were asked to indicate their birth sex (i.e., male, female, intersex); gender identity (i.e., man, woman, trans-man, trans-woman, queer, write-in); and sexual identity (i.e., gay; lesbian; bisexual: mostly gay or lesbian; bisexual: equally gay/lesbian and heterosexual/straight; bisexual: mostly heterosexual/straight; questioning/uncertain, don’t know for sure).

As noted above, youths’ responses to the questions pertaining to their birth sex and gender identity were used to assign participants into one of four mutually-exclusive categories, following the work of Beemyn and Rankin (2011): trans-men (FTM), trans-women (MTF), female to a different gender (FTDG), and male to a different gender (MTDG). Youth reporting their birth sex as female and their gender identity as trans-men or men were classified as trans-men (FTM); participants reporting their birth sex as male and their gender identity as trans-women or women were classified as trans-women (MTF); youth reporting their birth sex as female and their gender identity as genderqueer were classified as female to a different gender (FTDG); and participants reporting their birth sex as male and their gender identity as genderqueer were classified as (MTDG). When the youth depicted their gender identity in their own words, the responses and their identified birth sex were examined, and the participants were categorized as either FTDG or MTDG. [Note: None of the youth identified as intersex].

Analytic approach

Data analyses were conducted with IBM SPSS Statistics 21. Descriptive statistic procedures were used to examine the distributions of maternal and paternal knowledge of and reactions to the youths’ gender identities by fathers and mothers. Correlational analyses using Pearson correlation coefficients were conducted to: (a) measure the direction and strength of the relationships between the degree of parent support and maternal and paternal current responses to the youths’ gender identities, and (b) examine the relationships between parent support and parental abuse as well as between parent support and two indicators of youths’ psychological adjustment (i.e., depressive symptoms, and LGBT-disclosure stress).

Results

Participant characteristics

The mean age of the participants (N = 129) was 18.0 years (SD = 1.74), with a range of 15 to 21; and, there was no significant difference in ages of the youth among the subgroups. The participants were ethnically and racially diverse: 31.8% of the youth indicated they were Hispanic/Latino; and regarding race, 32.6% identified as White/Caucasian/Anglo/European American; 31.8% as Black/African American; 8.5% as American Indian/Native American/Alaskan Native; 7.8% as Asian/Asian American (Chinese, Japanese, Korean, and others); 1.6% as Native Hawaiian or other Pacific Islander; and 16.3% as multiracial. The remaining 1.6% did not report a race.

Maternal and paternal knowledge of TGNC youths’ gender identities

Among transfeminine youth, 50 of 57 (86.7%) reported that their mothers know of their gender identities; 42 of 54 (72.8%) reported that their fathers know of their gender identities. Similarly, among transmasculine youth, 58 of 71 (81.6%) reported that their mothers know of their gender identities, and 49 of 67 (72.7%) reported that their fathers know of their gender identities (Table 1).

Table 1.

Maternal and paternal knowledge of TGNC youths’ gender identities by subgroup (N = 129).

Knows Transfeminine
 Transmasculine
Mother
 Father
 Mother
 Father
n % n % n % n %
Definitely Not 5 8.8 10 18.5 10 14.1 14 20.9
Probably Not 2 3.5 2 3.7 3 4.2 3 4.5
Probably 5 8.8 8 14.8 5 7.0 4 6.0
Definitely 45 78.9 34 63.0 53 74.6 45 66.7
Total (valid) 57 100.0 54 100.0 71 100.0 67 100.0
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Parents’ initial reactions and current responses to TGNC youths’ gender identities

The mean difference in years between the parents’ initial reactions and parents’ current reactions was approximately three and one-half years (M = 3.44, SD = 3). Among transfeminine youth, 80% of mothers and 66% of fathers knew of and manifested initial reactions to the youths’ gender identities among both transfeminine and transmasculine youth (Table 2). Among transmasculine youth, 77% of mothers and 62% of fathers knew of and manifested initial reactions. More than two-fifths of transfeminine youths’ mothers (42.0%) and more than one-quarter of transmasculine youths’ mothers (26.0%) revealed very positive/positive initial reactions to their gender identities. The percentages of fathers revealing initial very positive/positive reactions were 30.0% among transfeminine youth and only 24.0% among transmasculine youth. Of note, 34.0% of the transfeminine youths’ fathers and 20% of mothers showed no initial reactions or did not know of the youths’ gender identities. Similarly, 38.0% of transmasculine youths’ fathers and 23% of mothers showed no initial reactions or did not know of the youths’ gender identities.

Table 2.

Parental initial reactions and current responses to youths’ gender identities by subgroup (N = 129).

Transfeminine
 Transmasculine
Mother
 Father
 Mother
 Father
n % n % n % n %
Initial
Reactions
Positive and Very Positive 21 42.0 14 30.0 18 26.0 15 24.0
Negative and Very Negative 19 38.0 17 36.0 36 51.0 25 38.0
No Reaction and Does Not Know 10 20.0 16 34.0 16 23.0 25 38.0
Total 50 100.0 47 100.0 70 100.0 65 100.0
Current
Responses
Positive and Very Positive 24 45.3 18 36.0 32 53.3 25 44.6
Negative and Very Negative 13 24.5 14 28.0 17 28.3 15 26.8
No Reaction and Does Not Know 16 30.2 18 36.0 11 18.4 16 28.6
Total 53 100.0 50 100.0 60 100.0 56 100.0
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When we compared parental current responses to youths’ gender identities to their initial reactions, we learned there were no statistically significant increases in percentages of transfeminine youths’ mothers and fathers having very positive/positive responses. That being said, 45.3% of the transfeminine youths’ mothers and 36.0% of their fathers were reported as showing very positive/positive current responses to the youths’ gender identities. In contrast, when we compared current parental responses of transmasculine youths’ to their initial reactions, the percentage of mothers with very positive/positive responses increased from 27.3% (initial reaction) to 53.3% (current reaction), which was statistically significant as indicated by the results of Wilcoxon signed rank tests (Z = −4.16, p < .001). Among fathers of transmasculine youth, the percentage with very positive/positive responses increased from 20.6% (initial reaction) to 44.6% (current reaction), which was also statistically significant (Z = −4.26, p < .001).

Parental current responses to TGNC youths’ gender identities and parent support

Among transfeminine youth, the results suggested that there were no significant relationships between level of parent support and mothers’ current responses to the youths’ gender identities. Among transmasculine youth, there were significant relationships between the level of parent support and parents’ current responses to youths’ gender identities: higher levels of parent support were associated with more positive current responses to youths’ gender identities from mothers (r = .52, p < .001) and from fathers (r = .46, p = .003).

Parent support and TGNC youths’ experiences of parental abuse

Associations between the level of parent support and TGNC youths’ experiences with psychological abuse and psychological adjustment were examine. Descriptive statistics for transmasculine and for transfeminine youth are presented in Table 3. There were significant relationships between the level of parent support and TGNC youths’ experiences of parental psychological abuse i.e., verbal and physical. Specifically, a higher level of parent support was associated with a lower level of parental verbal abuse among transfeminine youth (r = −.51, p < .001) and transmasculine youth (r = −.43, p = .001). Similarly, a higher level of parent support from was associated with a lower level of parental physical abuse among both transfeminine youth (r = −.45, p < .001) and transmasculine youth (r = −.34, p = .005).

Table 3.

Descriptive statistics of parental support, abuse, depressive symptoms, and LGBTQ-identity disclose stress by subgroup (N = 129).

Transfeminine
 Transmasculine
Question n M SD Min Max n M SD Min Max
Parent Support 57 36.68 18.64 12 72 70 38.48 14.92 12 72
Parental Abuse (Verbal) 58 2.46 0.78 1 4 69 2.52 0.75 1 4
Parental Abuse (Physical) 58 1.79 0.81 1 4 69 1.52 0.74 1 4
Depressive Symptoms 58 17.71 12.79 0 45 70 20.87 12.95 0 57
LGBTQ-identity Disclosure Stress 55 1.64 1.19 0 4 69 2.03 1.04 0 4
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Parent support and TGNC youths’ psychological adjustment

Among both transfeminine and transmasculine youth, the results suggested that there were significant relationships between the level of parent support and the level of depressive symptoms. Specifically, higher levels of parent support were associated with lower levels of depressive symptoms among transfeminine youth (r = −.33, p = .013) and transmasculine youth (r = −.27, p = .024).

Parallel findings resulted from our analysis of the relationships between the level of parent support and the level of LGBTQ-identity disclosure. Among TGNC youth, results suggested significant relationships between level of parent support and level of LGBTQ-identity disclosure stress: a higher level of parent support was associated with a lower level of LGBTQ-identity disclosure stress among transfeminine youth (r = −.40, p = .002) and transmasculine youth (r = −.27, p = .024).

Discussion

The current study explored parental responses to TGNC youth’s gender identities and examined the relationship of those responses to experiences of support, abuse, and depression. Although the majority of parents in the current study know or probably know of their youth’s gender minority identity, the finding that lower percentages of fathers than mothers were knowledgeable is consistent with previous research findings about sexual minority youth coming out to their parents about their sexual identities, i.e., greater percentages of youth come out to their mothers than their fathers (Savin-Williams, 1989, 2001a, 2001b). The pattern of differing maternal and paternal responses was observed in the findings of parents’ initial reactions and current responses to TGNC youths’ gender identities: higher percentages of mothers than fathers had positive/very positive initial reactions and current responses to the youths’ gender identities. At the end of the time period between the initial reactions and current responses (approximately three and one-half years, on average), higher percentages of transmasculine youths’ mothers and fathers were reported as being positive/very positive and lower percentages of both mothers and fathers were reported as being negative/very negative. This pattern is similar to that reported for parents of sexual minority youth (lesbian, gay, bisexual): not withstanding initial reactions, parents tend to become more accepting of lesbian, gay, and bisexual children over time (Rosario & Schrimshaw, 2013).

Among the most disturbing findings were the high levels of negative initial and current response of both mothers and fathers. Specifically, 38.0% of mothers’ initial reactions of transfeminine youth and 51.0% transmasculine youth were reported as negative/very negative, respectively; similarly, 36.0% and 38.0% of fathers’ initial reactions of transfeminine and transmasculine youth were reported as negative/very negative, respectively. As indicated previously, mothers and fathers of transmasculine youth became more accepting (i.e., showed positive/very positive reactions) over time; however, approximately one-fourth of the mothers’ and fathers’ current responses to both transfeminine and transmasculine youth were reported as being negative/very negative. Additionally, approximately one-third of the current reactions of mothers and fathers of transfeminine youth were reported as no reaction/do not know (30.2%, 36.0%, respectively); lower percentages of the current reactions mothers and fathers of transmasculine youth were reported as no reaction/do not know (18.4%, 28.6%, respectively). Examining parents’ current responses to TGNC youths’ gender identities revealed two overall distressing outcomes: approximately 50.0% TGNC youth reported maternal current responses that were either negative/very negative or no reaction/do not know; and 55%—65% TGNC youth reported paternal current responses that were either negative/very negative or no reaction/do not know. The two outcomes suggest that approximately 50.0% of TGNC youth were limited in the extent to which their gender identities were affirmed or supported by their parents and were experiencing various levels of minority stress as their mothers or fathers either reacted negatively, did not respond, or did not know of the youths’ gender identities. Minority stressors experienced by TGNC youth (such as those in the current study) in relationships with their mothers and fathers often lead to a chain of stressors that have been found to be linked to diminished well-being (Pearlin, 1999; Pearlin & Bierman, 2013). Additionally, the stressful essence of these relationships are indicative of attributes that characterize other relationships in TGNC youths’ lives that often lead to harmful encounters, such as expecting rejection, needing to conceal a stigmatized gender identity, internalizing negative social attitudes about TGNC people, which have been found to account for health disparities between sexual and gender minority and heterosexual populations (Hendricks & Testa, 2012).

Findings from the current study related to parent support were consistent with those reported previously for gender and sexual minority youth. Notably, feeling greater parent support was associated with a healthier psychological state and with experiences of lower levels of parental abuse, whereas, perceiving lower levels of parent support was related to higher levels of depressive symptoms and higher levels of parental abuse (Katz-Wise et al., 2016; Klein & Golub, 2016; Simons, Schrager, Clark, Belzer, & Olson, 2013). In other words, perceiving their parents as supportive/accepting was potent protective factor for TGNC youth; and it was associated with healthy adolescent development. On the other hand, perceiving parents as unsupportive/rejecting was a risk factor among TGNC youth, and it was linked to psychological maladjustment, including higher levels of depressive symptoms and LGBTQ-identity disclosure stress. TGNC youth experiencing parental rejection related to their gender identities are likely to find it overwhelming “because it is a rejection of who the adolescent is, not just a criticism of something they have done” (italics in original; Mills-Koonce, Rehder, & McCurdy, 2018, p. 640). When parent rejection is perceived to be severe, e.g., when youth receive consistent messages of rejection from parents over time, youth may develop “rejection sensitivity”; and TGNC youth who are sensitive to rejection and who internalize parents’ negative actions as metric of their self-worth and value, may struggle to disclose their gender identity to others for fear of anticipated rejection—even when no evidence of rejection exists (Meyer, 2003; Meyer & Frost, 2012).

From the perspective of the minority stress model (Meyer, 2003), the youth were conveying proximal stressors in their daily lives resulting from the experiences of feeling different and distal stressors when their behaviors were at variance with the gender role expectations associated with their assigned sex at birth. Higher degrees of parent rejection were correlated with lower levels of parent support and higher levels of parental abuse; and these parental responses were correlated with youths’ experiencing higher levels of depressive symptoms and higher levels of LGBTQ-identity disclosure stress. Clearly, experiences of distal stressors by TGNC youth, as result of interactions with their parents, point to a critical need for the development of resources and implementation of programs and services that promote acceptance of TGNC youth and support parents (and other family members) in the best ways to navigate for their families and to advocate for their TGNC offspring.

Limitations, implications, and concluding remarks

Since the study was conducted, there have been efforts to roll back the rights of TGNC individuals in the United States (Goodnough, Green, & Sanger-Katz, 2019, May, p. 24), and consideration should be given to how this may attenuate the impact of negative parental reactions. The participants were self-identified TGNC youth recruited from three cities in the United States; the findings may not be generalizable to TGNC youth in other cities, rural areas or other parts of the country. Additionally, the participants had access to community-based organizations or college groups for LGBTQ youth or who knew others who did and volunteered to participate in the study; the impact of parental reactions to one’s gender identity may be different for TGNC youth without access to such resources or who may be unwilling to participate in a study in which they report on their experiences as TGNC youth. Furthermore, the current study relied on cross-sectional, self-reported data, and, thus, recall of initial parental reactions may be biased by participants’ perceptions of their current relationships. Finally, the measure used to assess parents’ knowledge and reactions to youths’ gender identities was designed for family structures which include one mother and one father and, thus, may not reflect the family structure of all participants. It is unclear whether participants who responded with “no reaction,” “does not know,” or chose not to respond for items about one of the parent roles did so because that role was not present in their family structure.

Despite these limitations, we reason the findings, which are consistent with those of previous studies (Factor & Rothblum, 2007; Grossman et al., 2005), point to an indisputable need of providing psychoeducational programs for parents of TGNC youth that focus on youths’ freedom and rights to self-determined gender identities and expressions, parental acceptance and affirmation of youths’ gender identities, parent support for TGNC youth, and parental awareness of the potential outcomes of their acceptance-rejection decisions on the adult lives of gender diverse youth, especially in light of the current socio-political landscape (Goodnough et al., 2019, May, p. 24).

Counselors, psychologists, social workers and other mental health professionals, who provide services to gender minority people, should not only become culturally and linguistically competent in providing direct services but also in establishing therapeutic alliances that facilitate outreach to parents and other significant caregivers of TGNC youth (Israel, 2006). Primary psychoeducational programs should focus on providing accurate information and education about TGNC people and on addressing the myths and misconceptions about them (e.g., Erickson-Schroth & Jacobs, 2017). Widely held false and negative beliefs about TGNC people lead to experiences of stigma, discrimination, and victimization and minority stress (Grossman & D’Augelli, 2006). Secondary programs should address the vital roles of parent emotional and social support and validation of personal and gender identities play in positively impacting TGNC youths’ development while countering deleterious effects of adverse experiences (Hildago, Chen, Garofalo, & Forbes, 2017; Russell, Pollitt, Li, & Grossman, 2018). Tertiary programs and services should aim to assist parents and other significant caregivers in coming to terms with embracing TGNC youths as family members, in promoting the youths’ acceptance without shame, and in navigating youths’ safety in private and public arenas (Koken, Bimbi, & Parsons, 2009).

In the current study, parents expressed a range of emotional reactions and display diverse behaviors in learning of youths’ disclosures of non-binary gender identities. Although negative parental responses are not universal, they have been well documented as leading minority stressors, maladaptive or problematic coping strategies, and risks of mental health issues associated with expecting rejection, including fear, anxiety, and depression (Rood et al., 2016; Su et al., 2016). Conversely, parental acceptance and nurturance have been shown to bestow social supports that enhance youths’ well-being (Ryan et al., 2010; Watson, Grossman, & Russell, 2016). As they remain understudied, future research is needed to explore the distinctive needs of parents and caregivers of TGNC youth and to examine the implications of their actions on the long-term mental and physical health outcomes of TGNC youth in their care.

Funding

This study uses data from “Risk and Protective Factors for Suicide among Sexual Minority Youth,” grant R01MH091212 from the National Institutes of Mental Health (NIMH). The content is solely the responsibility of the authors and does not represent the official views of NIMH or the Institutes of Health.

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