Abstract
Objectives: For transgender and gender diverse (TGD) adolescents, the internet and social media have several risks and benefits. The present study aims at assessing how and for which purposes TGD adolescents use the internet and social media and how often they experience support compared to cyberbullying online.
Methods: The sample comprised 114 TGD adolescents diagnosed with gender dysphoria who attended a Gender Identity Service for children and adolescents (Hamburg GIS). Internet and social media use and experiences were assessed using modified items from a German representative study and self-constructed items relating to TGD-specific online experiences. Frequencies of internet/social media use and various online experiences were analyzed and compared to data from the German general population.
Results: Compared to peers from the general population, TGD adolescents reported similar offline and online activities and spent similarly long time online (internet: M = 4.16 h, social media: M = 2.84 h). All TGD adolescents sought TGD-specific information online. TGD adolescents used the internet to experiment with their gender identity (60%), and for the purpose of their coming out (31%) and their social transition (88%). About half of the sample each reported either online support (45%) and/or cyberbullying (48%).
Conclusions: While TGD adolescents used the internet and social media for similar purposes as peers from the general population, they also used the internet and social media to gain TGD-specific information and for gender identity expression and exploration. They reported both positive and negative experiences online, calling for future studies investigating how online experiences affect TGD adolescents’ mental health and gender identity development.
Keywords: Cyberbullying, gender diverse, internet, online experiences, social media, support, transgender
Introduction
The rise in using online and social media platforms has substantially changed the way individuals communicate and connect socially, especially among young people. For minority groups such as transgender and gender diverse (TGD) adolescents, online spaces have several potential benefits (e.g. getting TGD-specific information or feeling supported) but also bear risks (e.g. cyberbullying) (Berger et al., 2021). However, there is little knowledge on the ways in which TGD adolescents use the internet and social media platforms and which (positive and negative) experiences they have online.
Social media can be defined as a communication format where individuals can create and exchange content, set up profiles, interact with other users, and develop social networks by connecting their profile to others (Craig et al., 2021; Obar & Wildman, 2015). Examples of common social media platforms include Instagram (focus on sharing and watching photos and short-form videos), TikTok (focus on sharing and watching short-form videos), and YouTube (focus on sharing and watching long-form videos). These days, nearly all adolescents in the USA use at least one social media platform, with YouTube being the most frequently used platform by 95% of adolescents. Furthermore, 97% of US American adolescents use the internet daily (Pew Research Center, 2022). The numbers for Germany, where the present study was conducted, are similar: 88% of German adolescents are online on a daily basis and spend on average four hours on the internet (Feierabend et al., 2021). With approximately five hours daily, lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth seem to spend even more time online than their non-LGBTQ peers (GLSEN et al., 2013). Within this gender and sexual minority group, especially TGD youth are defined as “high users” (56%) and spend on average more than five hours online each day (McInroy et al., 2019).
Social media platforms offer unique opportunities for minority groups such as LGBTQ youth because of the possibility of anonymity and the far reach. Since making friends with similar experiences offline may be difficult, many LGBTQ adolescents, particularly TGD adolescents, make use of the internet and its possibilities to connect with other young LGBTQ individuals (Berger et al., 2021; Berger et al., 2022; GLSEN et al., 2013; Hillier et al., 2012). Especially during the COVID-19 pandemic or in rural areas, online platforms can be crucial for minority youth to gain access to information or build and maintain friendships despite geographical distances (Fish et al., 2020).
Furthermore, many adolescents prefer to seek sensitive or LGBTQ-specific information online due to their anonymous accessibility and because they feel more comfortable discussing these topics with online contacts and like-minded peers (Berger et al., 2021; Berger et al., 2022; Craig et al., 2021; Fox & Ralston, 2016). Additionally, LGBTQ youth can learn from other LGBTQ individuals’ experiences and behavior (e.g. by watching videos from role models on YouTube). Especially for TGD adolescents, online role models are relevant because their identities are seldom represented in mainstream media (Fox & Ralston, 2016; McInroy & Craig, 2015). Therefore, many young TGD individuals watch personal experience videos created by TGD individuals typically documenting their story or experience across time (“transvlogs”) (Etengoff, 2019).
Moreover, the internet plays a crucial role for LGBTQ youth in their identity development (Berger et al., 2022; Craig et al., 2021; Fox & Ralston, 2016). Many of them feel safe online and use online platforms to experiment with and practice their identities (e.g. by changing their names or pronouns on their social media profiles) (Bates et al., 2020; Fox & Ralston, 2016). They can also control the degree of self-disclosure by managing their privacy settings (Bates et al., 2020; Craig et al., 2021). Thus, some LGBTQ adolescents disclose their identity online before they do so offline. For instance, in a population-based study by the Gay, Lesbian and Straight Education Network (GLSEN), more than one in ten LGBT youth had first disclosed their identity to someone online, and three in ten were more out online than in person, particularly TGD adolescents (38%) (GLSEN et al., 2013).
For TGD adolescents, lacking social support is a significant risk factor for mental health problems (Levitan et al., 2019). Studies show that TGD adolescents and young adults can receive this kind of support online (e.g. on social media platforms), which may impact their well-being positively (Austin et al., 2020; Evans et al., 2017; Selkie et al., 2020).
However, despite these positive possibilities and experiences, the internet can also be a source of negative experiences, such as cyberbullying (Abreu & Kenny, 2018; Berger et al., 2021). Cyberbullying can be defined as using digital media to communicate aggression or cause harm to others, for example, by posting embarrassing pictures or spreading rumors or threatening or hate messages (Abreu & Kenny, 2018; O’Reilly et al., 2018). In the 2013 GLSEN study, more than four in ten LGBTQ youth reported online cyberbullying. Additionally, they were three times as likely as non-LGBTQ youth to experience cyberbullying. Three out of ten LGBTQ youth had been cyberbullied because of their sexual orientation or gender expression (GLSEN et al., 2013). A population-based study from Germany on the free time of LGBTQ adolescents highlights that TGD adolescents may experience even more cyberbullying than other subgroups within the LGBTQ community: Almost half of TGD adolescents, compared to one in four LGB adolescents, reported cyberbullying (Krell & Oldemeier, 2018). In a recent clinical study, more than one in four TGD adolescents had experienced cyberbullying themselves, and all participants had seen hurtful comments or content related to TGD individuals (Selkie et al., 2020).
Next to youth with gender dysphoria, other clinical groups report similar positive and negative online experiences. For example, depressive as well as autistic adolescents may benefit from connecting to others without needing to leave their homes. Sharing and being confronted with risky behaviors online may be more relevant for depressive youth, whereas the risk of abusive online interactions may be more prominent in autistic youth (Gillespie-Smith et al., 2021; Radovic et al., 2017).
Despite growing research on the internet/social media use and experiences of LGBTQ youth, there are only three studies (all from the USA and Canada) focusing specifically on TGD youth (Austin et al., 2020; Evans et al., 2017; Selkie et al., 2020). Data from Europe is, however, currently lacking. Therefore, the present study from Germany seeks to answer the following research questions:
How do TGD youth use the internet and social media in comparison to adolescents from the general population (in relation to frequencies, activities, platforms, and content)?
On which TGD-specific topics do TGD youth inform themselves online and which platforms do they use?
To what extent do they use the internet and social media to explore and express their gender identity?
How often do they have positive (support) compared to negative experiences (cyberbullying) online?
Materials and methods
Study design
The present study used a cross-sectional, questionnaire-based study design and assessed a clinical cohort of TGD adolescents. Data were collected from January 2020 to December 2021, thus during the COVID-19 pandemic, at the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). The Hamburg GIS at the University Medical Center Hamburg-Eppendorf provides specialized diagnostics, counseling, and treatment for TGD youth. At the time of their first appointment, before undergoing any form of counseling or treatment, all families attending the Hamburg GIS are invited to participate in the study.
The present study was part of an updated research project on “Gender- and Neurodiversity in Childhood and Adolescence,” assessing various updated questionnaires on the living situations and psychological health of TGD youth since 2020. Ethical approval for this study was granted by the local ethics committee. Written informed consent for voluntary participation was obtained from all participants.
Participants
The original study population consisted of children (aged 5–10 years) and adolescents (aged 11 years and older) who had been referred to the Hamburg GIS from January 2020 to December 2021. During that time, 263 families attended the Hamburg GIS (79% assigned female at birth (AFAB), 21% assigned male at birth (AMAB); Figure 1). After excluding incomplete data sets and other cases (e.g. children) for various reasons (Figure 1), the final sample included 114 TGD adolescents aged 11–18 years with a diagnosis of gender dysphoria (88% AFAB, 12% AMAB). Detailed descriptions of the data collection and the sample characteristics at the Hamburg GIS can be found, for example, in Herrmann et al.(2023).
Figure 1.
Participants and sex ratios at the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS).
Variables and instruments
Sociodemographic characteristics
The following sociodemographic characteristics were analyzed: Birth-assigned sex, age at assessment (upon clinical entry), and gender identity (for more details, see Herrmann et al., 2023).
Internet and social media use and online experiences
Different aspects of internet/social media use and online experiences were assessed, focusing on the following aspects:
Frequencies, activities, platforms, and content of internet and social media use
Seeking transgender-related information online
Exploring and expressing gender identity online
Positive (support) compared to negative online experiences (cyberbullying)
For these different online activities, several items were used that can be found in Table A1 (Appendix; items translated from German to English) and Table A2 (original items in German). Several items from two large representative German studies on adolescents’ free time and media activities were used: The Jugend, Information, Medien [Youth, Information, Media] (JIM) (Feierabend et al., 2018) and the Deutsches Jugendinstitut [German Youth Institute] (DJI) studies (Krell & Oldemeier, 2018). Some items were modified to match TGD youths’ unique experiences. Based on these items and the literature, an adapted questionnaire including TGD-specific items, the Trans Youth Social Media Questionnaire (TYSMQ), was developed. Additionally, one item of the Gender Diversity Questionnaire (GDQ) (Twist & de Graaf, 2019), and other single self-constructed items (on feeling understood and accepted in different life domains) were used.
Statistical analyses
For all variables, frequencies were analyzed, and if possible, data were compared to adolescents from the general population using data from different German representative studies on adolescents’ media and online activities (DAK-Gesundheit, 2020; Feierabend et al., 2020, 2021). For time spent online, mean values were estimated from grouped data to calculate the average hours spent online/on social media from the categorical variables. Paired t-tests were performed to compare the degree of feeling understood and accepted on the internet/social media with different life domains. Free-text answers on a variety of topics (e.g. platforms for accessing transgender-related information; Table A1) were evaluated qualitatively. For this purpose, categories were defined, comments were broken down into meaningful segments and systematically coded, and the frequency of different themes was subsequently quantified (Mayring, 2022). All analyses were performed using SPSS 27. Single missing values were imputed by using the expectation maximization algorithm (Little & Rubin, 2019) and the mean values.
Results
Sociodemographic characteristics
The majority (88%) of TGD adolescents (n = 114), were AFAB, and approximately one-tenth (12%) AMAB (Table 1). TGD adolescents presented themselves at the Hamburg GIS around the age of 15.5 years. Most TGD adolescents identified as binary (22% as female or male) or trans binary (61% as trans woman/girl or trans man/boy).
Table 1.
Sociodemographic characteristics of TGD adolescents.
| TGD adolescents |
||
|---|---|---|
| (n = 114) | ||
| Birth-assigned sex (n, %) | ||
| Female | 100 | 87.7 |
| Male | 14 | 12.3 |
| Age at assessment (in years; M, SD) | 15.45 | 1.39 |
| Gender identity (n, %) | ||
| Binary (female or male) | 25 | 21.9 |
| Trans binary (trans woman/girl or trans man/boy) | 70 | 61.4 |
| Partly female, partly male | 1 | 0.9 |
| Diverse or intersex | — | — |
| Open, undefined, non-binary, queer | 4 | 3.5 |
| Other, e.g. agender | 2 | 1.8 |
| I’m still exploring my gender identity | 12 | 10.5 |
Note. “Other” gender identities were “genderfaun” and “genderqueer”. TGD = transgender and gender diverse.
Frequencies, activities, platforms, and content of internet and social media use
On average, TGD adolescents were approximately 4 h and 10 min online daily. On social media, TGD adolescents spent, on average, 2 h and 50 min daily (Figure 2).
Figure 2.
Time spent online and on social media of TGD adolescents in comparison to adolescents from the general population.
TGD adolescents reported several online and offline free time activities (Figure 3). Among the most common free time activities were two predominately online free time activities, i.e. watching videos, movies, or series (92%) and using social media/communicating online (87%).
Figure 3.
Free time and online activities of TGD adolescents in comparison to adolescents from the general population.
TGD adolescents used the internet/social media most frequently for entertainment, i.e. listening to music or making music (90%), watching movies or series (89%), and communicating/socializing, i.e. talking to friends (87%). Many TGD adolescents reported additionally identity-specific activities, including getting information about specific transgender-related topics (40%), experimenting with/expressing identity (22%), and using LGBTQ platforms (15%).
TGD adolescents’ favorite online services were YouTube (61%), Netflix (29%), i.e. services for (passively) watching videos, and WhatsApp (22%; Figure 4), i.e. a service for communication. On YouTube, TGD adolescents mostly watched music videos (78%) and personal experience videos of TGD people talking about their life or treatment (65%; Figure 4).
Figure 4.
Favorite online services and activities on YouTube of TGD adolescents in comparison to adolescents from the general population.
Seeking transgender-related information online
All TGD adolescents (n = 114) used social media or the internet to seek information on transgender-related topics (17% rarely, 49% occasionally, and 34% often). In total, 51 adolescents specified which transgender-related information they searched for online (Table A6, Figure 5): The majority (65%) sought information on gender-affirming interventions (e.g. “Changes due to hormone therapy, gender-affirming surgeries, …”). Additionally, experiences and tips (18%; e.g. “… how other transgender [people] live”) and more general information on the transition (18%; e.g. “transition”) were topics most commonly named by TGD youth.
Figure 5.
Topics and online resources of transgender-related information TGD adolescents sought online.
Furthermore, 68 TGD adolescents answered which platforms they most commonly used for accessing transgender-related information (Table A7, Figure 5). More than half of these adolescents used YouTube (60%; e.g. “A lot on Youtube because that’s where I find the most information”), 38% Instagram (e.g. “Instagram featuring transgender people who are already further along in their treatment”), and 25% Google (e.g. “… and Google”).
Exploring and expressing gender identity online
TGD adolescents mentioned puberty (79%), distress around body (70%), and social media (36%) most frequently as factors influencing the development of their gender experience (Table 2).
Table 2.
Exploring and expressing gender identity online.
| TGD adolescents |
Comparisons |
||||
|---|---|---|---|---|---|
| (n = 114) | test | p | effect | ||
| Factors influencing the development of gender experience (n, %) | |||||
| Puberty | 90 | 78.9 | |||
| Distress around body | 80 | 70.2 | |||
| Social media | 41 | 36.0 | |||
| Meeting other TGD people | 31 | 27.2 | |||
| TV programs/documentaries | 25 | 21.9 | |||
| Friends | 16 | 14.0 | |||
| Family | 10 | 8.8 | |||
| Other | 5 | 4.4 | — | ||
| Experimenting with gender identity online (n, %) | |||||
| No, experimented in everyday life first (then online) | 46 | 40.4 | |||
| Yes, experimented online first (then in everyday life) | 68 | 59.6 | — | ||
| Coming out online first (n, %) | |||||
| No, came out with friends or parents first (then online) | 79 | 69.3 | |||
| Yes, came out online first (then with friends or parents) | 35 | 30.7 | — | ||
| Gender role online (n, %) | |||||
| Gender role of their birth-assigned sex online | 14 | 12.3 | |||
| Gender role of another gender online | 100 | 87.7 | — | ||
| Feeling understood and accepted in different life domains (M, SD) | |||||
| Internet/social media | 3.29 | 0.81 | Comparison to different life domains: | ||
| Parents | 2.70 | 1.15 | t(113) = 5.01 | <.001 | d = 0.47*** |
| Friends | 3.44 | 0.83 | t(113) = −1.61 | .110 | d = −0.15 |
| Classmates/peers | 2.36 | 1.21 | t(113) = 7.36 | <.001 | d = 0.69*** |
| Teachers | 2.70 | 1.11 | t(113) = 4.82 | <.001 | d = 0.45*** |
Note. Bold values highlight the main results. See Table A8 for “other” factors influencing TGD adolescents’ gender experience. Other online gender roles (than those of their birth-assigned sex) were the gender roles of the other gender (84%), both genders (6%), and “in-between, agender, diverse, trans, or other” (10%). TGD = transgender and gender diverse.
p < .001.
The majority of TGD adolescents (60%) had experimented with their gender identity online before they did in everyday life (Table 2). One-third of TGD adolescents (31%) came out online before telling their friends or parents. At the time of the assessment, as many as nine in ten TGD adolescents (88%) had presented themselves not as their birth-assigned sex online but in another gender (role).
TGD adolescents felt rather understood and accepted online for who they are (M = 3.3; Table 2). They felt significantly more understood and accepted online than by their parents (M = 2.7), classmates/peers (M = 2.4), and teachers (M = 2.7), but equally well understood and accepted by their friends (M = 3.4).
Positive (support) compared to negative online experiences (cyberbullying)
Nearly half of TGD adolescents (45%) had used online groups or platforms for support or networking (Table 3). Additionally, 38 adolescents specified (free-text answers) which groups or platforms they used for support or networking (Table A9). WhatsApp (34%; e.g. “on Whats App, I’m in a lot of LGBTQ + groups or trans groups”), Instagram (18%; e.g. “Instagram accounts that educate”), and Reddit (16%; e.g. “Reddit Trans Subreddits”) were the most common online resources for support.
Table 3.
Positive (support) vs. negative online experiences (cyberbullying).
| TGD adolescents |
||
|---|---|---|
| (n = 114) | ||
| Use of online support networks (n, %) | ||
| Never | 63 | 55.3 |
| Rarely | 18 | 15.8 |
| Occasionally | 17 | 14.9 |
| Often | 16 | 14.0 |
| Any total | 51 | 44.7 |
| Negative online experiences/cyberbullying (n, %) | ||
| Never | 59 | 51.8 |
| Rarely | 32 | 28.1 |
| Occasionally | 16 | 14.0 |
| Often | 7 | 6.1 |
| Any total | 55 | 48.2 |
| Adolescents with negative online experiences | TGD adolescents (n = 55) | |
| Cyberbullying related to identity/orientation (n, %) | ||
| Neither related to gender (identity) nor sexual orientation | 19 | 34.5 |
| Related to gender (identity) | 20 | 36.4 |
| Related to sexual orientation | 2 | 3.6 |
| Related to both | 14 | 25.5 |
| Victim or perpetrator of cyberbullying (n, %) | ||
| Victim | 30 | 54.4 |
| Perpetrator | 4 | 7.3 |
| Both victim and perpetrator | 7 | 12.7 |
| Neither victim nor perpetrator (other negative online experiences) | 14 | 25.5 |
Note. Bold values highlight the main results. TGD = transgender and gender diverse.
Almost half of TGD adolescents (48%) had experienced cyberbullying or reported other negative experiences online (Table 3). Among these participants, in most cases (66%), the cyberbullying was related to their gender identity (36%), their sexual orientation (4%), or both (26%). Over half of the adolescents with cyberbullying experiences (54%) had been on the receiving end of this behavior. Another 20% had been both a victim and a perpetrator of cyberbullying (13%) or only a perpetrator (7%). Additionally, one in four adolescents had neither been victims nor perpetrators of cyberbullying but still reported negative online experiences. Free-text answers (n = 9) gave further insights into these experiences (Table A10), for example, “It happened in groups that I wasn’t in myself. Friends told me about it”.
Discussion
The current study aimed to assess the following aspects of social media and internet use and experiences among TGD youth: Frequencies, activities, platforms, and content of internet and social media use, getting transgender-related information online, exploring and expressing gender identity online, and positive (support) vs. negative online experiences (cyberbullying).
Compared to adolescents from the German general population (DAK-Gesundheit, 2020; Feierabend et al., 2021), TGD adolescents spent similar amounts of time on the internet (4.16 vs. 4.02 h daily) and tended to spend slightly less time on social media (2.84 vs. 3.22 h daily) (Figure 2), underscoring a similar internet/social media use of TGD youth and peers from the general population. Interestingly, these results contrast those of the literature indicating that LGBTQ youth, especially TGD youth, spend more time online than non-LGBTQ youth (GLSEN et al., 2013; McInroy et al., 2019). However, the present clinical data are not representative for LGBTQ populations. Future research should thus look at more representative samples of minority groups and how they use social media compared to the general population to determine whether the differences found in a few studies are robust across different settings, populations, and countries. It is, however, also a possibility that differences between LGBTQ and the general population have disappeared or even changed their direction as a result of the increasing time adolescents spent online during the COVID-19 pandemic, in general (DAK-Gesundheit, 2020; Feierabend et al., 2020).
Moreover, TGD adolescents in the present study reported similar free time activities and reasons for using the internet/social media compared to adolescents from the general population (Figure 3) (Feierabend et al., 2020, 2021): Watching videos, movies, or series and using social media/communicating online were the most common free time activities of both TGD adolescents in the present study (92% and 87%) and adolescents from the general population in a recent population-based study (80% and 91%) (Feierabend et al., 2021). However, in addition to using the internet/social media for entertainment, gaming, communicating/socializing, and information, many TGD adolescents used the internet/social media for identity-specific purposes, i.e. getting information about transgender-related topics, experimenting with/expressing identity, and using LGBTQ-specific platforms. Other differences are that TGD adolescents, compared to peers in the general population, tended to engage less often in sports in their free time, possibly due to their gender dysphoria, and engaged more often in creative hobbies (making art or music), which may act as resilience factors against common mental health problems.
In summary, TGD adolescents’ favorite online services and activities on YouTube resembled those of adolescents from the general population (Feierabend et al., 2020) (Figure 4): YouTube was the most popular online service and similarly popular in both groups (61% vs. 57%), and their favorite YouTube activity was watching music videos (78% vs. 51%). However, the main difference was that TGD adolescents’ second most common activity on YouTube was watching personal experience videos of TGD people talking about their life or treatment. In our study, 65% of the clinically referred adolescents watched such videos (“transvlogs”), highlighting their importance for informational support for TGD youth on their pathway to seeking transition-related (medical) support (Etengoff, 2019; Fox & Ralston, 2016; Selkie et al., 2020).
Additionally, when exploring and expressing their identity, the internet and social media played a crucial role for TGD adolescents: Altogether, 36% said that social media had influenced the way they experienced their gender identity, the majority (60%) had experimented with their gender identity online, one-third came out online before offline, and nearly nine in ten adolescents presented themselves as another gender role (than their birth-assigned sex) online. Furthermore, TGD adolescents felt significantly more understood and accepted online than in most offline life domains and felt similarly accepted online as they did by their (offline) friends. These results are in line with other studies on the coming out experiences of LGBTQ youth (GLSEN et al., 2013; Hillier et al., 2012) and highlight the benefits of online spaces for the identity development of TGD youth. However, although the internet/social media seems to be especially relevant for the identity development of TGD adolescents because their identities are seldom represented offline (McInroy & Craig, 2015), it is not something that is completely TGD-exclusive. For gender and sexual minority youth, as well as non-LGBTQ youth, social media can play a crucial role in identity development (Uhls et al., 2017).
All TGD adolescents in the present study used social media or the internet to acquire information on transgender-related topics, underscoring the relevance of online resources for TGD adolescents to seek sensitive and identity-specific information (Berger et al., 2022; Craig et al., 2021; Fox & Ralston, 2016). They mainly sought information on gender-affirming interventions (65%) and via YouTube (60%), highlighting once more the role of personal experience videos of TGD individuals that often document medical transitions and related challenges. Although these personal experience videos thereby serve as a valuable resource for young TGD individuals, they can also reproduce transnormative narratives and suggest that there is just “one right way” of being TGD—including, for example, certain medical interventions and excluding, for example, non-binary individuals (Etengoff, 2019). Additionally, narratives of “successful” transition stories with apparently quick or positive results can create or reinforce unrealistic expectations toward desired treatment outcomes in youth.
In summary, the most common online resources for transgender-related information were social media platforms (such as YouTube, Instagram, and TikTok), whereas other nonsocial media resources (such as Google) were less common. This result may highlight the attractiveness of interactive informational content produced primarily by similar individuals with whom TGD adolescents can identify compared to text-based informational resources that are typically less interactive and less personal.
Positive and negative online experiences were reported similarly often: About half of the sample of TGD adolescents had each used online groups/platforms for support or networking and experienced cyberbullying, which was in most cases related to their gender identity, sexual orientation, or both. The percentage of cyberbullying was even higher than in a recent qualitative clinical study (Selkie et al., 2020) and similarly high compared to a German population-based study (Krell & Oldemeier, 2018). Although the internet/social media can be a safe and empowering space for TGD youth—as highlighted by some qualitative studies (Austin et al., 2020; Hiebert & Kortes-Miller, 2021)—it also poses risks. However, it is unclear whether experiencing bullying online versus offline has the same effects and whether the many benefits do or do not outweigh the risks of the internet/social media for TGD youth.
Limitations
Our study has several strengths, such as examining various aspects of internet and social media use and experiences, while focusing on the unique experiences of TGD adolescents. The present study is, to our knowledge, the first to assess these experiences in a cross-sectional quantitative design in Europe. However, there are also three main limitations.
First, as this is one of the first studies focusing specifically on the internet and social media use and experiences of TGD adolescents, several self-constructed or adapted items and no validated questionnaires were used.
Second, the present study took place during the COVID-19 pandemic. TGD adolescents may likely have spent even more time online during the pandemic than they used to before. Therefore, the results may not reflect the internet and social media use of TGD adolescents after the pandemic. Additionally, all participants came from one gender identity clinic, limiting the generalizability of the present results. In other words, the clinical sample might not be representative of TGD adolescents in the general population.
Third, the present study was solely descriptive without examining possible group differences within TGD adolescents. However, it is possible that, for example, binary and non-binary TGD adolescents have different online experiences. Analyzing these possible differences would have gone beyond the scope of such a first explorative evaluation.
Future directions and implications
While our data confirm that the internet and social media are valuable informational resources for TGD adolescents, it is questionable how accurate these always are (e.g. personal experience videos of TGD individuals). Future studies could examine which specific transgender-related information TGD adolescents search for and find online (i.e. not only topic-wise, such as transition, but more with regard to content of information). Furthermore, youth who seek information online might face risks such as cyberbullying. Also, support groups and platforms might not always be safe if unmoderated. Therefore, online resources with relevant and trustworthy information, moderated by experienced or trained peers, could be a good choice instead because youth can interact openly with their peers without adults being present (Berger et al., 2021).
In our study, TGD- or identity-specific content was popular, and youth experimented with and expressed their gender identity online a lot. On the one hand, this result might reflect how helpful online spaces for TGD gender identity development are (McInroy & Craig, 2015). It is unclear whether the number of referrals to specialized gender clinics may also be increasing because youth today are better informed through online resources and can freely develop and try out their gender identity online (Pang et al., 2020). In some cases, uncertainty about one’s gender identity and a tentative conclusion that one is TGD might also lead to a referral. Even the World Professional Association of Transgender Health acknowledges in their new guidelines (Standards of Care, version 8) that “[f]or a select subgroup of young people, susceptibility to social influence impacting gender may be an important differential to consider” (p. S45)(Coleman et al., 2022). An individualized assessment and treatment are therefore crucial in clinical care.
In summary, TGD youth had both positive and negative experiences online. While TGD youth might often feel different and disconnected in real life, they can experience a sense of belonging online and find a supportive community (Austin et al., 2020). However, the effects of these positive and negative experiences and internet/social media use, in general, on the mental health of TGD adolescents are not well understood and require further research. Clinicians and policymakers should be aware of the advantages and disadvantages of the internet/social media use for TGD youth (Berger et al., 2021). Online prevention and intervention programs targeting the mental health of TGD adolescents are promising because they can reach young people online, where they are already spending time (Renner et al., 2022).
Conclusion
The present study demonstrated that TGD adolescents used the internet and social media for the most part similarly to peers from the general population. In addition, TGD youth often used the internet and social media for accessing TGD-specific information, gender identity expression, and exploration and had unique positive and negative experiences online. From a clinical perspective, there is a need to make accurate information more accessible and attractive (e.g. professional websites providing information more interactively) and to collect and, if necessary, correct the pieces of online information during counseling. Further research on the effect of internet/social media use on the mental health of TGD adolescents is urgently needed to improve our understanding of their potential benefits and harm.
Supplementary Material
Acknowledgments
We would like to thank the young people and parents for participating in and contributing to this study.
Funding Statement
The first author received a scholarship for her PhD from a nonprofit foundation (FAZIT-Stiftung), of which the present study was part.
Disclosure statement
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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