Policy Attitudes Toward Adolescents Transitioning Gender

Abstract

Anti-transgender policies and state legislative initiatives that focus on school bathroom use and hormone use have emerged in recent years. These policies are generally written by and voted on by cisgender people, and as such, it is crucial to understand influences on nonaffirming attitudes toward policies that can impact trans youth. The present study aimed to extend research on transphobic attitudes in general to attitudes toward policies that impact youth undergoing transition. Latent variable covariances and structural equation modeling were used to test the relations between transphobia, genderism, homophobia, need for closure, sexual orientation, social dominance orientation, attitudes toward sexual minorities, beliefs about gender roles, aggression, religious fundamentalism, and contact with sexual and gender minority individuals, as they are related to attitudes toward hormone use and bathroom use for trans youth. Analyses of data from a sample of 248 cisgender adults indicated that genderism and transphobia was associated with attitudes toward gender-affirming hormone use and bathroom use for trans youth; need for closure was associated with gender-affirming attitudes toward bathroom use, but was not associated with hormone use. Sexual orientation was linked to attitudes toward gender-affirming policies, such that nonheterosexual participants had more affirming attitudes toward trans youths’ bathroom use, but not hormone use. Implications for future research, advocacy efforts to promote rights for trans youth, and clinical work with trans youth and/or parents/guardians of trans youth are discussed.

Attitudes Toward Adolescents Transitioning Gender

The negative attitudes some cisgender people hold toward transgender individuals promote microaggressions and discrimination (Casey et al., 2019; Norton & Herek, 2013). When enacted at individual, system, or institutional levels, discrimination can impact the mental and physical health of trans individuals (Rodriguez et al., 2018). Research has documented the substantial disparities in mental health concerns among trans, gender diverse, and gender nonconforming children and adolescents compared to their cisgender peers (Reisner et al., 2015). For example, mental health conditions among trans youth are nearly ten times higher than among their cisgender peers (Becerra-Culqui et al., 2018). These disparities arise, to a large degree, due to individual and systemic discrimination (Meyer, 1995, 2003, 2015). Gender-based discrimination is associated with increased suicidal ideation and suicidal attempts during adolescence (Clements-Nolle et al., 2006; McNeil et al., 2017). Legislative policies permitting discrimination have been associated with increased risk of suicide among trans individuals (Perez-Brumer et al., 2015). Continued exposure to prejudice, such as through school bathroom use policies and denial of access to hormones, creates and maintains unsafe school and social environments for trans youth.

While discrimination may most often occur in interactions among individuals, system and institutional-level discrimination is shaped and reinforced by individual attitudes. Given the numerous barriers to running, winning, and keeping a publicly elected position in politics, few trans individuals have been elected to positions in which they may help to shape policy on issues pertaining to trans people (Lyons, 2017). Consequently, policy impacting trans individuals is typically written by cisgender individuals and with the intention of restricting liberties and protections for trans people. Policies that are related to trans youth include school bathroom use (Bracho-Sanchez, 2019; Murib, 2020) and access to hormones as part of gender transition (Clark & Virani, 2021). It is important to understand how attitudes toward policies that impact trans youth are informed by attitudes and beliefs among cisgender individuals, who can exert control over the lived experience of trans individuals though such policies.

Anti-Trans Legislation

Regarding bathroom access, in 2016, North Carolina introduced House Bill 2 (HB2) which required individuals to use the public bathroom that aligned with their sex assigned at birth (Barnett et al., 2018; Public Facilities Privacy & Security Act, 2016). Soon after, multiple states adopted legislation similar to North Carolina’s. Collectively, these rules are referred to as “bathroom bills.” Bathroom bills have been used to legally stigmatize and marginalize trans individuals in public settings. Furthermore, some bills have even wider reach; North Carolina’s HB2 prohibited local governments from passing any nondiscrimination legislation within their counties (Barnett et al., 2018).

Within the same year as HB2, various state legislators received more than 100 anti-LGBT proposals including “religious liberty” bills (People for the American Way, n.d.). Religious liberty bills are ostensibly aimed to promote personal freedom in practicing one’s religion. In reality, however, these laws target and marginalize specific minority groups (Ebin & Price, 2019). As a result of these types of laws, trans individuals may face legalized discrimination, such as denial of health care services (Grey, 2014). Furthermore, these laws may restrict trans youth from having access to hormone blockers that are used in gender transition processes (Kimseylove et al., 2020). Numerous bills have come forward for vote in states across the U.S., with Alabama and Arkansas passing HB 391 and HB 1,570 in 2021 (Alabama Legislature, 2021; Arkansas State Legislature, 2021). Under both bills, medical providers are banned from prescribing hormones or puberty-delaying drugs (also known as “puberty blockers”). In Arkansas, physicians who provide such affirming care can be sued and stripped of their medical licenses. In Alabama, physicians who provide gender-affirming treatments may face up to 10 years in prison (Reardon, 2021). Such policies are in direct opposition to medical science and to the position statements of numerous professional organizations, including the American Medical Association (American Medical Association, 2021), the American Psychological Association (American Psychological Association, 2015), the American Psychiatric Association (American Psychiatric Association, 2020), the Endocrine Society (Endocrine Society, 2020; Hembree et al., 2017), and others (e.g., American Academy of Child & Adolescent Psychiatry, 2017, the American Academy of Pediatrics; Rafferty & Committee on Psychosocial Aspects of Child and Family Health, 2018). Indeed, though ostensibly framed as policy to protect children (the Arkansas bill is titled the “Save Adolescents from Experimentation [SAFE] Act”), many advocates argue that anti-trans legislation such as these will have immediate and profound, maybe even fatal, impacts on the physical and mental health of trans youth affected by such policies (American Psychiatric Association, 2020; Endocrine Society, 2020). According to the American Academy of Pediatrics and the Endocrine Society, gender-affirming medical care is recommended for, and has shown to reduce suicide ideation and suicide attempts among, trans youth (Bauer et al., 2015; Hembree et al., 2017). Anti-trans polices are linked with damage to the mental health and well-being of trans individuals (Perez-Brumer et al., 2015).

Identity Development and Policies Affecting Trans Youth

Alongside pubertal changes, childhood and the transition into adolescence is a critical time for identity development. The onset of puberty is accompanied by sex-linked physiological changes (Dorn et al., 2019) and all adolescents must navigate the social construction of these physiological changes (Tobin-Richards et al., 1984). In addition to those challenges, trans adolescents are often recognizing and navigating their transgender identities (Boskey, 2014; Garrison, 2018). Thus, the timing of puberty creates unique challenges for trans adolescents who are navigating identity development processes, interpersonal interactions, and a variety of institutional structures while in the larger context of pervasive transphobia in U.S. society.

Some youth begin their gender transition process in adolescence (Churcher Clarke & Spiliadis, 2019). Such transitions can include using the school bathroom assigned to their gender and seeking access to gender-affirming hormone therapy. During this process, school district and medical support policies can help facilitate access to gender-affirming social and medical contexts. Access to puberty-delaying medication and hormones in the early stages of puberty as trans youth explore their identity is associated with a higher quality of life and better mental health (Shumer et al., 2016). Among trans adults, access to pubertal delaying treatment during childhood and adolescence was associated with lower odds of lifetime suicidal ideation and decreased behavioral problems, emotional problems, and depressive symptoms (Turban et al., 2020). Additionally, trans students who report experiences of feeling safe and supported in their school environment have better educational outcomes and improved psychological well-being (Kosciw et al., 2020). However, according to the 2019 Gay, Lesbian, and Straight Education Network National School Climate Survey, 28% of trans students reported being denied access to bathrooms that were consistent with their gender identity (Kosciw et al., 2020) and, as reviewed above, nascent legislation threatens access to correct bathroom facilities and physician-recommended hormone care for trans adolescents. The attitudes that underlie legal and policy decisions that affect trans youth (e.g., supportive and inclusive school policies, access to gender-affirming care) need to be examined due to the well-documented impact of policy on trans youth mental health and well-being.

Attitudes Toward Transgender People

Attitudes toward individuals who are not members of one’s own group are determined by an array of factors, with research on anti-trans attitudes suggesting both general and specific underlying correlates that may help us understand attitudes toward trans youth. Transphobia is characterized as a feeling of discomfort with or prejudice against trans people (Hill & Willoughby, 2005). Social and cultural expectations of gender norms for adolescents reinforce that gender expression and gender identities must match sex assigned at birth (John et al., 2017). Deviation from this norm can result in bullying, stigmatization, discrimination, victimization, and other forms of marginalization (Domínguez-Martínez & Robles, 2019). Although negative attitudes toward sexual minorities have a longer history in the research literature, anti-trans attitudes have some parallels with attitudes toward sexual minorities and some critical divergences from that literature base also exist.

Tebbe and Moradi (2012) conducted a thorough exploration of anti-trans attitudes by examining relations between anti-trans attitudes and relevant associated transtheoretical constructs. Specifically, they recruited 250 undergraduate students (90% White, 99% heterosexual, 100% cisgender). In addition to a version of a transphobia scale that was later improved upon by Tebbe et al. (2014), they administered measures of attitudes toward gay men, lesbian women, and bisexual men and women; attitudes toward women; gender role beliefs; need for closure; and social dominance. All of these variables were identified by Tebbe and Moradi as being relevant to anti-trans attitudes based on prior literature. They used structural equation modeling to examine their hypotheses; this model included anti-LGB attitudes (a latent variable indicated by the attitudes toward gay men, lesbian women, and bisexual women and men scales), traditional gender role beliefs (a latent variable indicated by the attitudes toward women and gender role beliefs scales, parceled), and the other variables (as latent variables indicated by item parcels). With the exception of social dominance orientation, all of the variables were uniquely linked with anti-trans attitudes in the SEM.

The present study sought to expand on this model of anti-trans attitudes proposed by Tebbe and Moradi (2012) in several crucial ways. First, attitudes toward trans children are reflected in pivotal and life-altering school and state policies, yet they are rarely the subject of inquiry. Thus, we sought to specifically examine attitudes toward policies that impact trans children. Second, we aimed to expand the range of theoretically relevant potential constructs of interest to include aggression, religious fundamentalism, and intergroup contact—all theoretically linked and relevant constructs pertaining to anti-trans attitudes regarding trans children. Below, we outline the hypothesized predictors, expecting small to large positive associations between predictive factors, as well as with study outcomes, as past research has found positive associations among study predictors (see Hill & Willoughby, 2005; Nagoshi et al., 2008; Tebbe & Moradi, 2012; Tebbe et al., 2014).

Genderism is one domain of anti-trans attitudes that captures negative cognitions about transgender and gender nonconforming individuals (Hill & Willoughby, 2005; Tebbe et al., 2014), while transphobia comprises a second, related domain that refers to negative emotional or affective responses. These anti-trans attitudes are expressed through prejudicial and violent behaviors toward trans people (Tebbe et al., 2014). We hypothesized that genderism and transphobia would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H1).

Homophobia and transphobia are strongly correlated (Nagoshi et al., 2008). This correction may reflect an overlapping negative sentiment toward perceived violations of gender norms and expressions and may also reflect that some people may not understand the distinction between sexual orientation and gender identity (Nagoshi et al., 2019), for example believing that being trans is the same thing as being gay. Despite this overlap, transphobia and homophobia are conceptually distinct, with transphobia being composed of prejudice and bias expressed in response to not just perceived gender norm violations but also views of essentialist gender as immutable (Makwana et al., 2018), and homophobia composed of prejudice and bias related to same-sex sexual behavior (Nagoshi et al., 2019). We hypothesized that homophobia (both toward gay men and lesbian women) would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H2 and H3).

Gender role beliefs promote a traditional view of how men and women are supposed to act, based upon cultural norms (Brown & Gladstone, 2012). Individuals who are seen as violating the gender norms may receive negative public backlash (Domínguez-Martínez & Robles, 2019). Strong endorsement of gender roles has been linked to transphobia (Perez-Arche & Miller, in press; Tebbe & Moradi, 2012). Thus, trans people may face discrimination and prejudice in various ways from cisgender individuals as a result of being perceived to transgress gender norms (Broussard & Warner, 2019). We hypothesized that gender role beliefs would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H4).

Need for closure is an internal desire to create stability or structure across various situations while having an aversion to ambiguity or situations without simple answers (Dijksterhuis et al., 1996). Those who have a higher need for closure prefer firm answers and reject information that may challenge their established viewpoints (De Keersmaecker et al., 2016). Need for closure has been linked to underlying prejudice and stereotyping of groups that may not seem to fit a presumed natural order or hierarchical social structure (Morgenroth et al., 2021). Groups that do not fit this presumed order or structure may be viewed negatively because they do not belong to an already-established social category (Burke et al., 2017). Need for closure has been positively associated with transphobia in prior research (Makwana et al., 2018). We hypothesized that need for closure would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H5).

Social dominance orientation (SDO) is an attitudinal orientation that reflects the degree to which one desires the group to which they belong be dominant over out-groups that may be competing for similar status (Pratto et al., 1994). Higher SDO has been linked with racism (Hiel & Mervielde, 2005), homophobia (Whitley, 1999; Whitley & Lee, 2000), and transphobia (Perez-Arche & Miller, in press; Puckett et al., 2020; Tebbe et al., 2014). SDO has also been linked to non-trans-affirming attitudes with regard to bathroom use in prior research (Parent & Silva, 2018). We hypothesized that SDO would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H6).

Aggression proneness has also been correlated with prejudice toward trans people (Tebbe & Moradi, 2012; Tebbe et al., 2014). Despite limited research examining the relationship between aggression proneness and anti-trans prejudice, domains of aggression proneness (e.g., physical aggression) have been found to be correlated with anti-trans prejudice (Nagoshi et al., 2008). Aggression has been correlated with negative attitudes toward trans people’s use of the bathroom that aligns with their gender identity (Callahan & Zukowski, 2019). We hypothesized that aggression would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H7).

Religious fundamentalism is an individual’s orientation toward a specific religious ideology including an absolute belief in the truth of that doctrine (Altemeyer & Hunsberger, 1992). Religious fundamentalism emphasizes the notion that those who disobey the religious doctrine are aligned with evil forces that must be combated (Altemeyer & Hunsberger, 1992; Hill et al., 2010). Anti-trans attitudes that are rooted in religious doctrine underlie some anti-trans sentiment (Hill & Willoughby, 2005), and religious fundamentalism has been theoretically and empirically associated with transphobia in prior work (Parent & Silva, 2018). Indeed, numerous conservative Christian organizations and political figures have explicitly tied Christian fundamentalist beliefs to anti-trans legislation and policy efforts in recent years (e.g., Posner, 2018). Thus, although as a construct religious fundamentalism is articulated explicitly as ecumenical, given the hegemony of Christianity in the U.S. today, implicitly, it likely reflects Christian fundamentalist views specifically. Given prior research findings and the political climate of today, we hypothesized that religious fundamentalism would be negatively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H8).

Knowing people who are trans has a powerful influence on attitudes and beliefs toward trans people (Tadlock et al., 2017). The contact hypothesis explains how social contact between majority and nonmajority group members can influence attitudes toward others (Barbir et al., 2017). Consistent with the contact hypothesis, knowing a trans person may reduce prejudicial attitudes toward trans people in general. We hypothesized that contact with trans people would be positively related to endorsement of policies that would enable trans youth to use the bathroom aligned with their gender and to access hormones (H9).

We expected that the predictive variables outlined above would relate not only to our study outcomes of interest but also evince small to large correlations with each other. Theoretically, many of these constructs represent beliefs related to social status and exposure and openness to dissimilar groups and ideas. In addition to the specific bivariate hypotheses, we had additional exploratory hypotheses. The contact hypothesis specifies that more frequent contact with individuals who are members of groups other than one’s own facilitates greater understanding and less bias, and intergroup contact has been found to be a powerful influence on attitudes toward and beliefs about other groups (Cunningham & Melton, 2013; Górska et al., 2017; King et al., 2009; Schiappa et al., 2006; Tadlock et al., 2017), though there are limitations to the contact hypothesis and the robustness of its effects (Paluck et al., 2019). Consistent with the contact hypothesis, we expected that having friends or relatives who were lesbian/gay would be associated with more affirming bathroom use and hormone use attitudes (H10). We also anticipated that specific demographics would be linked with hormone use and bathroom use attitudes. These included being a man (H11; men have often been found to have more negative attitudes toward sexual and gender minorities than women, Herek, 2000; Nagoshi et al., 2008), age (H12; age has at times been linked to attitudes toward sexual and gender minorities; Walch et al., 2010), whether participants had children of their own (H13; this was exploratory and we did not have a specific hypothesis), and sexual orientation (H14; sexual minorities generally have more favorable attitudes toward trans people than heterosexual individuals). Thus, participation in the study was open to cisgender sexual minority men, insomuch as sexual minority individuals may hold anti-trans attitudes (Weiss, 2011). We also included condition (H15; whether attitudes were in reference to a trans girl or trans boy) in the model. To this end, we planned to use structural equation modeling to investigate both latent variable correlations and unique relationships.

Method

Participants

Participants were 248 cisgender individuals recruited from Prolific.com. Regarding gender, 44% of participants identified as cisgender men and 56% identified as cisgender women. Participants identified as White (46%), Asian/Asian American (25%), multiracial (10%), Black/African American (9%), Native American (7%), or another group (2%). Ages ranged from 18 to 70 (M = 30.32, SD = 11.82). The majority of participants identified as heterosexual (77%), with others identifying as bisexual (15%), gay/lesbian (3%), or another identity (5%). Most participants reported not having children (78%). Participants reported their highest level of education as a high school degree (40%), a bachelor’s degree (31%), an associate’s degree (15%), a graduate degree (10%), a technical certification (3%), or less than a high school degree (1%). We examined the data for differences in scores on the variables used in the study as a function of race/ethnicity. There were no significant differences by race/ethnicity for any of the study variables, even before correcting p values for multiple tests.

Measures

Genderism and Transphobia Scale-Revised Short Form

Attitudes about gender and transphobia were measured by the Genderism and Transphobia Scale-Revised Short Form, genderism and transphobia subscale (GTS; Tebbe et al., 2014). The GTS consists of eight items (sample item: “If I found out that my best friend was changing their sex, I would freak out”). Responses were made on a 7-point scale (1 = Strongly Disagree to 7 = Strongly Agree). In past research using a sample of undergraduates, scores on the GTS were associated with prejudice toward trans people (Tebbe et al., 2014). In the same sample, Cronbach’s α for responses to items on the GTS was .93. In the present sample, Cronbach’s α for responses to items on the GTS items was .93.

Attitudes Toward Lesbians and Gay Men Scale (ATL and ATG)

Attitudes toward lesbian women and gay men were measured by the ATLGS (Siebert et al., 2014). The ATLGS consists of 10 items on two subscales (attitudes toward lesbians [ATL], sample item, “Lesbians just can’t fit into our society”; attitudes toward gay men [ATG], sample item, “I think male homosexuals are disgusting”). Responses were made on a 7-point scale (1 = Strongly Disagree to 7 = Strongly Agree). In past research using a sample of heterosexual adults, scores on the total ATLGS scale were associated with supporting discriminatory policies against sexual and gender minorities (Siebert et al., 2014). In the same sample, Cronbach’s α for responses to items on the ATL was .86 and for the ATG was .89. In the present sample, Cronbach’s α for responses to items on the ATL was .91 and for the ATG was .94.

Gender-Role Beliefs Scale (GRBS)

Attitudes about gender stereotypes were measured by the GRBS (Brown & Gladstone, 2012). The GRBS consists of 10 items (sample item, “It is disrespectful to swear in the presence of a lady”). Responses were made on a 7-point scale (1 = Strongly Disagree to 7 = Strongly Agree). In past research using a sample of adults, scores on the GRBS were associated with negative attitudes toward women, lesbian women, and gay men (Makwana et al., 2018). In the same sample, Cronbach’s α for responses to items on the GRBS was .84. In the present sample, Cronbach’s α for responses to items on the GRBS was .86.

Need for Closure Scale (NFCS)

Attitudes toward ambiguous situations were measured by NFCS (Roets & Van Hiel, 2011). The NFCS consists of 15 items (sample item, “I don’t like situations that are uncertain”). Responses were made on a 6-point scale (1 = Completely Disagree to 6 = Completely Agree). In past research using a sample of adults, scores on the NFCS were associated positively with transphobia (Makwana et al., 2018). In the same sample, Cronbach’s α for responses to items on the NFCS was .86. In the present sample, Cronbach’s α for responses to items on the NFCS was .85.

Social Dominance Orientation Scale (SDO)

Attitudes about social group hierarchy were measured by the SDO (Pratto et al., 2006). The SDO consists of 16 items (sample item, “Inferior groups should stay in their place”). Responses were made on a 7-point scale (1 = Strongly Disagree to 7 = Strongly Agree). In past research, using a sample of undergraduates scores for the SDO was associated with transphobia (Parent & Silva, 2018). In the same sample, Cronbach’s α for responses to items on the SDO was .92. In the present sample, Cronbach’s α for responses to items on the SDO was .93.

Buss-Perry Aggression Questionnaire—Short Form (AQ)

Aggressive attitudes and behaviors were measured by the Buss-Perry Aggression Questionnaire—Short Form (AQ; Bryant & Smith, 2001). The AQ consists of 12 items on four subscales (physical aggression [PHYSAGG], sample item, “Given enough provocation, I may hit another person”; verbal aggression [VERBAGG], sample item, “I can’t help getting into arguments when people disagree with me”; anger [ANGAGG], sample item, “Sometimes I fly off the handle for no good reason”; and hostility [HOSAGG], sample item, “I wonder why sometimes I feel so bitter about things.”). Responses were made on a 5-point scale (1 = Very Unlike Me to 5 = Very Like Me). In past research using a sample of male undergraduates scores on the AQ were associated with transphobia and homophobia (Nagoshi et al., 2008). In the same sample Cronbach’s α for responses to items on physical aggression was .85, verbal aggression was .73, anger was .82, and hostility was .83. In the present sample, Cronbach’s α for response to items on physical aggression was .82, verbal aggression was .76, anger was .76, and hostility was .82.

Intratextual Fundamentalism Scale (IFS)

Attitudes and beliefs about the religious ideologies pertaining to sacred texts were measured by the IFS (Williamson et al., 2010). The IFS consists of five items (sample item, “Everything in the Sacred Writing is absolutely true without question”). Responses were made on a 6-point scale (1 = Strongly Disagree to 6 = Strongly Agree). In past research using a sample of Christian university students and faculty scores of the IFS were associated positively with viewing nontraditional sexuality as sinful (Kelly et al., 2018). In the same sample, Cronbach’s α for responses to items on the IFS was .85. In the present sample, Cronbach’s α for responses on items on the IFS was .94.

Friends/Relatives Who Are LG/T

Friends or relatives who are trans were measured by the single item, “Are any of your friends or relatives transgender?” Friends or relatives who are lesbian or gay were measured using the single item, “Are any of your friends or relatives gay or lesbian?” Item responses were made on a dichotomous scale (0 = No,1 = Yes). Use of a single item to assess intergroup contact is common (Górska et al., 2017).

Bathroom Use and Hormone Use

Participants saw one of two versions of a vignette-based prompt. Both versions were identical, except that they varied about whether they were about an 11-year-old trans boy or a trans girl (vignettes included in Supplemental Material). The article was written in the style of a short newspaper article. The prompt explained that a student (Richard or Samantha) is the local school district’s first transgender student. The article made the direction of transition clear (“Samantha, who was born Richard .. . ” or vice versa). The article explains that the student will start taking hormones to transition soon, and that the school district is deciding which bathroom the student should use. It was made clear that the student plans to use the bathroom aligned with their gender (“Samantha [Richard] is planning on using the girls’ [boys’] bathrooms at school”). Two questions asked whether participants felt that the student should or should not be prescribed hormones (0 = Definitely not, 5 = Definitely yes) and which bathroom the student should use (0 = Definitely girls’,5 = Definitely boys’; responses were recoded by the gender of the student in the prompt, such that higher scores in the variable used in the analysis indicate support for the student using the bathroom for their gender).

Procedure

This study was approved by the University of Texas at Austin institutional review board. Participants were recruited via Prolific.co, a crowdsourcing web site for research participation and other tasks. Prolific.co is similar to other crowdsource web sites, such as Mturk, but Prolific.co requires members to provide detailed demographics information upon registration. Prolific.co members can see only studies for which they are eligible. This process reduces the opportunity for impersonation, which has been determined to be a problem with other sites such as Mturk (MacInnis et al., 2020; Sharpe Wessling et al., 2017). Prolific.co members were compensated with $2.00 credited toward their Prolific.co accounts.

Analytic Approach

Data were initially organized in SPSS v. 27 (IBM Corp., 2020). A total of 29 item-level responses were missing, representing a missing data rate of 0.1%. No participants were missing more than one item on any measure. Given this low rate of missing data, available item analysis (Parent, 2013) was used to calculate Cronbach’s and descriptive statistics, and full information maximum likelihood estimation was used to handle missing data in the structural equation model. Structural equation modeling was conducted using Mplus version 8 (Muthén & Muthén, 2017) using maximum likelihood estimation.

To construct the structural equation model, we first parceled items for multi-item measures. Consistent with recommendations for item parceling (Little et al., 2002), for the GTS-R-SF, ATG, GRBS, NCS, SDO, and IFSP we conducted principal axis factor analyses with items constrained to load onto a single factor. We then assigned items to parcels in countervailing order of the magnitude of factor loadings to create three indicators per latent variable. For the ATL, we attempted to use item parceling but one item did not load onto the single factor at p < .05 and demonstrated low correlations with all other items (item 4: “Female homosexuality in itself is no problem, but what society makes of it can be a problem”). Thus, for ATL, we used the four remaining items as indicators of the latent factor. For the four subscales of the AQ, we assigned items to factors based on their subscales. All parcels or items loaded onto their intended latent construct at p < .001. For single item-measures (gay/lesbian friends or family, transgender friends or family, vignette condition, participant gender, age of participant, and whether participants had children themselves), we used the manifest single items in the model. Skew and kurtosis of all manifest variables were within tolerance (skew < 3 and kurtosis < 10 for all variables). A Monte Carlo power analysis using moderate parcel loadings for latent variables (0.70) moderate loadings from the hypothesized predictor variables to the dependent variables (0.30) indicated that the sample size was adequate to assess the hypothesized model, with power well above .80.

Of the demographic variables, we included gender, age, whether the participant had a child, and sexual orientation in the initial model. Sexual orientation was coded as heterosexual versus not heterosexual (all participants who identified as “other” input another nonheterosexual sexual identity, e.g., pansexual; we did not detect any unusual responses in this category).

Results

Descriptive statistics and latent variable intercorrelations are presented in Table 1. To investigate the latent variable correlations, we first constructed a model in which all constructs were allowed to covary with each other (i.e., a measurement model). Model fit was adequate to good: χ²(679) = 1162.014, p < .001; CFI = 0.94, RMSEA = 0.053 (90% CI = 0.048, 0.058); SRMR = 0.042. H1 was supported; genderism and transphobia was linked with less affirming attitudes toward bathroom use (r = −0.59, SE = 0.04, p < .001) and hormone use (r = −0.57, SE = 0.05, p < .001). H2 and H3 were supported; negative attitudes toward lesbian women was linked with less affirming attitudes toward bathroom use (r = −0.47, SE = 0.51, p < .001) and hormone use (r = −0.44, SE = 0.05, p < .001); negative attitudes about gay men was linked with less affirming attitudes toward bathroom use (r = −0.50, SE = 0.05, p < .001) and hormone use (r = −0.46, SE = 0.05, p < .001). H4 was supported; gender role beliefs were linked with less affirming attitudes toward bathroom use (r = −0.37, SE = 0.06, p < .001) and hormone use (r = −0.32, SE = 0.06, p < .001).

Table 1.

Correlations and Descriptive Statistics

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20
1. GTS	—
2. ATL	0.73**	—
3. ATG	0.81**	0.86**	—
4. GRBS	0.67**	0.57**	0.64**	—
5. NFCS	0.19**	0.10	0.08	0.12	—
6. SDO	0.46**	0.30**	0.38**	0.51**	0.04	—
7. PHYAGG	0.19**	0.04	0.14*	0.24**	0.07	0.25**	—
8. VERBAGG	0.11	−0.02	0.04	0.14*	0.07	0.28**	0.39**	—
9. ANGAGG	0.13*	0.04	0.12	0.19**	0.16*	0.24**	0.41**	0.47**	—
10. HOSAGG	0.07	−0.01	−0.01	0.04	0.29**	0.15*	0.34**	0.35**	0.46**	—
11. IFS	0.57**	0.65**	0.70**	0.61**	0.04	0.35**	0.06	−0.02	0.07	−0.09	—
12. Friends-GL	0.36**	0.41**	0.42**	0.30**	0.08	0.04	0.03	−0.13*	−0.03	−0.11	0.33**	—
13. Friends-T	0.28**	0.23**	0.28**	0.22**	0.08	0.10	0.06	−0.06	0.05	−0.02	0.21**	0.30**	—
14. Condition	−0.10	−0.03	−0.07	−0.11	0.02	−0.05	−0.07	−0.01	−0.01	−0.10	−0.11	0.03	0.01	—
15. Gender	−0.19**	−0.03	−0.11	−0.12	0.09	−0.12	−0.17**	0.08	0.01	0.07	0.05	−0.06	−0.10	0.09	—
16. Age	0.23**	0.19**	0.22**	0.25**	−0.05	0.10	−0.12	−0.01	−0.17**	−0.05	0.19**	0.07	0.07	0.03	0.05	—
17. Child	−0.19**	−0.22**	−0.22**	−0.24**	0.03	−0.16**	−0.05	0.06	0.03	−0.02	−0.19**	−0.12	0.01	0.01	−0.10	−0.34**	—
18. SexOr	−0.31**	−0.23**	−0.29**	−0.29**	0.06	−0.12	0.01	0.10	0.10	0.04	−0.25**	−0.19**	−0.29**	−0.03	0.14*	−0.16**	0.17**	—
19. Hormones	−0.55**	−0.41**	−0.45**	−0.32**	−0.16**	−0.21**	−0.12	−0.05	−0.02	−0.06	−0.27**	−0.14*	−0.19**	−0.01	0.12	−0.18**	0.10	0.20**	—
20. Bathroom	−0.57**	−0.44**	−0.49**	−0.35**	−0.26**	−0.27**	−0.11	−0.01	−0.02	−0.07	−0.32**	−0.14*	−0.25**	−0.03	0.08	−0.16*	0.11	0.30**	0.62**	—
21. M	2.51	2.38	2.44	2.54	4.02	2.09	2.03	2.46	2.26	2.73	2.69	1.29	1.76	—	1.56	30.32	1.78	0.22	3.36	3.72
22. SD	1.62	1.35	1.69	1.13	0.73	1.03	1.05	0.99	1.03	1.13	1.64	0.45	0.43	—	0.50	11.82	0.42	0.41	1.40	1.19

Note. GTS = genderism and transphobia scale. ATL = attitudes toward lesbians scale. ATG = attitudes toward gay men scale. GRBS = gender role beliefs scale. NFCS = need for closure scale. SDO = social dominance orientation. PHYAGG = physical aggression. VERBAGG = verbal aggression. ANGAGG = anger. HOSAGG = hostility. IFS = intratextual fundamentalism scale. Friends-GL = any friends who are gay or lesbian. Friends-T = any friends who are transgender. Friends-GL and Friends-T were coded such that 0 = no friends of that group, 1 = at least one friend of that group. Condition was coded such that 0 = trans girl, 1 = trans boy. Child was coded such that 0 = no children 1 = any children. SexOr = Sexual Orientation, coded such that 0 = heterosexual, 1 = not heterosexual. Hormones and bathroom were coded such that higher scores = more affirming attitudes.

^*p < .05

^**p < .01.

H5 was supported; need for closure was linked with less affirming attitudes toward bathroom use (r = −0.28, SE = 0.06, p < .001) and hormone use (r = −0.18, SE = 0.07, p = .007). H6 was supported; SDO was linked with less affirming attitudes toward bathroom use (r = −0.28, SE = 0.06, p < .001) and hormone use (r = −0.21, SE = 0.06, p = .001).

H7 was not supported for physical aggression; physical aggression was not linked with attitudes about either bathroom use (r = −0.12, SE = 0.07, p = .08) or hormone use (r = −0.13, SE = 0.07, p = .06). H7 was also not supported for verbal aggression for bathroom use (r = 0.00, SE = 0.08, p = .95) or hormone use (r = −0.06, SE = 0.07, p = .44). H7 was not supported for anger for bathroom use (r = 0.00, SE = 0.07, p = .99) or hormone use (r = 0.05, SE = 0.07, p = .49). Finally, H7 was also no supported for hostility for either bathroom use (r = −0.07, SE = 0.07, p = .348) or hormone use (r = −0.07, SE = 0.07, p = .29).

H8 was supported; religious fundamentalism was linked with less affirming attitudes toward bathroom use (r = −0.33, SE = 0.06, p < .001) and hormone use (r = −0.26, SE = 0.06, p < .001). H9 was also supported; having trans friends was linked with more supportive attitudes toward bathroom use (r = 0.25, SE = 0.06, p < .001) and hormone use (r = 0.19, SE = 0.06, p = .002). H10 was supported; having gay or lesbian friends was linked with more supportive attitudes toward bathroom use (r = 0.15, SE = 0.06, p = .02) and hormone use (r = 0.14, SE = 0.06, p = .030).

H11 was not supported; participant gender was not linked with attitudes toward bathroom use (r = 0.08, SE = 0.06, p = .179) or hormone use (r = 0.114, SE = 0.06, p = .067). H12 was supported, with older age being linked with less affirming attitudes toward bathroom use (r = −0.15, SE = 0.06, p = .01) and hormone use (r = −0.18, SE = 0.06, p = .004). H13 was not supported; having children was unrelated to attitudes toward bathroom use (r = 0.10, SE = 0.06, p = .096) and hormone use (r = 0.10, SE = 0.06, p = .12). H14 was supported; sexual minorities had more affirming attitudes toward bathroom use (r = 0.30, SE = 0.06, p < .001) and hormone use (r = 0.20, SE = 0.06, p = .001). Finally, for H15, condition (whether the vignette was about a trans girl or a trans boy) was unrelated to attitudes toward bathroom use (r = −0.04, SE = 0.06, p = .489) and hormone use (r = −0.01, SE = 0.06, p = .889).

We then moved toward examining unique relationships using regression in the model. The initial model was constructed to parallel the work of Tebbe and Moradi (2012). Both the hormone and bathroom items were regressed onto all intended independent variables. Independent variables were allowed to covary.

The model demonstrated adequate to good fit; χ²(735) = 1284.38, p < .001; CFI = 0.93, RMSEA = 0.055 (90% CI = 0.050, 0.060); SRMR = 0.064. Despite this acceptable fit, many of the paths to hormone and bathroom variables were not significant; path coefficients are displayed in Table 2. To make the model more parsimonious, we removed variables that demonstrated nonsignificant associations with the hormone and bathroom items.

Table 2.

Path Coefficients for the Initial Model

IV	DV	B	SE	p
GT	Hormones	−0.79	0.20	< .001
ATL	Hormones	−0.38	0.43	0.372
ATG	Hormones	0.42	0.55	0.448
GRBS	Hormones	0.18	0.13	0.151
NCS	Hormones	−0.04	0.07	0.573
SDO	Hormones	0.07	0.08	0.369
PHYSAGG	Hormones	−0.08	0.08	0.309
VERBAGG	Hormones	0.01	0.09	0.888
ANGAGG	Hormones	0.03	0.10	0.780
HOSAGG	Hormones	0.00	0.10	0.978
IFS	Hormones	0.04	0.11	0.708
Friends-GL	Hormones	−0.10	0.06	0.115
Friends-T	Hormones	0.05	0.06	0.385
Condition	Hormones	−0.05	0.05	0.377
Gender	Hormones	0.01	0.06	0.813
Age	Hormones	−0.07	0.06	0.267
Child	Hormones	−0.02	0.06	0.727
Sexual Orientation	Hormones	0.05	0.06	0.417
GT	Bathroom	−0.55	0.18	0.003
ATL	Bathroom	−0.06	0.39	0.870
ATG	Bathroom	−0.02	0.50	0.966
GRBS	Bathroom	0.18	0.12	0.123
NCS	Bathroom	−0.20	0.07	0.003
SDO	Bathroom	−0.06	0.07	0.419
PHYSAGG	Bathroom	−0.11	0.08	0.174
VERBAGG	Bathroom	0.07	0.09	0.420
ANGAGG	Bathroom	0.09	0.09	0.354
HOSAGG	Bathroom	0.01	0.09	0.894
IFS	Bathroom	−0.01	0.10	0.963
Friends-GL	Bathroom	−0.13	0.06	0.028
Friends-T	Bathroom	0.08	0.06	0.148
Condition	Bathroom	−0.08	0.05	0.121
Gender	Bathroom	−0.03	0.06	0.570
Age	Bathroom	−0.02	0.06	0.691
Child	Bathroom	−0.02	0.06	0.701
Sexual Orientation	Bathroom	0.15	0.06	0.013

Note. GT = genderism and transphobia scale. ATL = attitudes toward lesbian women. ATG = attitudes toward gay men. GRBS = gender role beliefs scale. NCS = need for closure scale. SDO = social dominance orientation. PHYSAGG = physical aggression. VERBAGG = verbal aggression. ANGAGG = anger. HOSAGG = hostility. IFS = intraxtextual fundamentalism. Friends-GL = friends who are gay/lesbian. Friends-T = friends who are transgender.

The second model, using only genderism and transphobia, need for closure, sexual orientation, and having gay/lesbian friends as independent variables, was run. In the first iteration of this model having gay/lesbian friends was no longer associated with the dependent variables and was removed for another run (path coefficients are presented in Supplemental Materials). The final model demonstrated strong fit, χ²(20) = 32.60, p = .04; CFI = 0.99, RMSEA = 0.050 (90% CI = 0.012, 0.080), SRMR = 0.036. Path coefficients are presented in Figure 1. Model R² for bathroom access and hormone access were 0.39 and 0.33, respectively.

Figure 1.

Final Model With Standardized Path Coefficients and Standard Errors

Note. Sexual Orientation Coded Such That 0 = Heterosexual, 1 = Sexual Minority

* p < .01. ** p < .001.

Genderism and transphobia was linked with responses to the bathroom access and hormone access items on the vignettes, such that greater transphobia was associated with more disaffirming responses. This finding is consistent with past work on the influence of attitudes toward groups on voting and policy behaviors toward those groups (Parent & Silva, 2018; Zingora & Graf, 2019). Need for closure and sexual orientation were linked only with bathroom access; greater need for closure was associated with more disaffirming attitudes toward bathroom access, and being a sexual minority was linked with more affirming attitudes toward bathroom access. Neither need for closure nor sexual orientation was linked with affirming hormone access.

Discussion

The goal of the present study was to adopt nascent theoretical frameworks developed to study attitudes toward transgender people and apply them to better understand policy attitudes toward adolescents transitioning gender. This study fills an important gap in the literature by investigating factors predicting two major policy initiatives that have been or are under consideration in state and municipal governing bodies across the U.S. Beyond formal and explicit policy initiatives, this study’s outcomes reflect specific and realistic challenges trans youth face in their local communities, such as access to hormones and access to bathrooms appropriate for their gender. This study demonstrated that, consistent with prior literature, genderism and transphobia and need for closure were associated with attitudes about hormone use. However, only genderism and transphobia was linked with attitudes about which bathroom trans youth should use. Sexual orientation was linked with attitudes toward bathroom use, but not attitudes toward hormone use.

The first finding pertaining to genderism and transphobia’s links with adolescent hormone use and bathroom usage is consistent with prior research on this variable in studies about attitudes toward trans people in general. This is not surprising, given that genderism and transphobia would likely be linked to low support for trans-affirming school policies. Our second finding of need for closure being linked with bathroom use attitudes, but not hormone use attitudes, was more surprising, however. Need for closure has been linked with generally negative attitudes toward trans people in prior work (Makwana et al., 2018; Tebbe & Moradi, 2012). It is possible that it was not linked to hormone use attitudes because, for some, hormone use may resolve perceived ambiguity rather than enhance it. In contrast, because the subjects of the prompts were youth only beginning to medically transition, participants’ attitudes related to bathroom use may still be shaped by low tolerance for ambiguity when considering which bathroom a trans child should use (Callahan & Zukowski, 2019). Another possible explanation for this mixed finding is the degree to which hormone use and bathroom use are private versus public acts. More specifically, a trans child who, in concert with their parents and health provider, makes a decision to start puberty suppression medication and/or masculinizing or feminizing hormones is doing so out of the public eye. However, when considering where a trans child should (or should not) use a bathroom, participants may instead be able to imagine more clearly their reaction to encountering a trans child in the bathroom and the various questions that may arise in response (e.g., child’s assigned sex at birth, gender, appearance, etc.).

When entered as a predictor in the path analysis, sexual orientation was linked with bathroom use but not hormone use attitudes. That is, nonheterosexual participants had more affirming attitudes toward trans youths’ bathroom use, but no attitudes related to hormone use were not different by sexual orientation. The reason for this finding is not entirely clear, though cisgender sexual minorities to a degree demonstrate transphobic attitudes (Warriner et al., 2013). It is possible that cisgender sexual minorities may be affirming of youths’ social transitions (e.g., name change, bathroom use) but hold some ambivalence about medical transitioning (e.g., using hormones). This result suggests that cisgender sexual minorities may not be reliable allies for trans youth on the basis of sexual orientation alone, especially with regard to medical transition processes.

Notably, although this study included other variables theoretically linked to attitudes toward trans youth (e.g., attitudes toward sexual minorities, beliefs about gender roles, social dominance orientation, aggressiveness, religiosity, and contact with sexual and gender minority individuals), little to no association emerged with attitudes toward hormone use and bathroom use for trans youth. However, bivariate correlations among study variables support theoretical suppositions and past empirical findings on the nature of anti-trans attitudes, with most being linked to genderism and transphobia, even though they held no unique relationships with this study’s two dependent variables.

Given the degree to which popular discourse that has opposed trans rights has often focused on trans girls in the case of hormone use and trans boys in the case of bathroom use (Bolton, 2019; Stone, 2018), an additional surprising result from the present study was that no differences on hormone or bathroom use attitudes emerged based on whether participants reviewed a prompt about a trans boy or a trans girl.

Advocacy Implications

Together, the results from the present study indicate the need for continued advocacy for trans youth. Many instances of state legislation that have recently been under consideration with regard to trans youth, such as attempts to prevent gender-affirming hormone treatment or force children to use the wrong bathroom (or, to ban them from using any bathroom), run contrary to health research and scholarship on what promotes the well-being of trans youth (Achille et al., 2020; Cicero & Wesp, 2017; Olson et al., 2016). With cisgender people far more often occupying positions of relative power and authority in determining policy agendas and outcomes for trans people, cisgender individuals must partner with trans people to advocate for policies that can support and promote health within trans communities. For trans individuals who belong to or identify with other nondominant groups (e.g., Black, Indigenous or Native, trans People of Color), intersecting forms of stigma, discrimination, and oppression often further result in barriers to stable employment, financial security, housing, and health support (James et al., 2016). The enormous personal, social, political, and economic resources needed for sustained advocacy efforts may present additional barriers for trans individuals who might otherwise value and personally align with contemporary social movements. Despite this disparity, Black and Brown trans people have long been at the forefront of advocacy efforts for LGBTQ civil rights (e.g., Miss Major Griffin-Gacy, Cece McDonald, Marsha P. Johnson, Angelica Ross, Kylar Broadus, Zahara Green). Their success has led to the formation of community coalitions and the breaking down of some barriers to trans inclusion and representation in community and policy (e.g., trans inclusion in sports, testimony in the U.S. Congress, employment nondiscrimination laws). It is clear, however, that further advocacy is needed, and the weight should be carried by all.

Alongside these efforts, we contend that it is essential to understand what underlies negative attitudes toward trans people and how these negative attitudes impact the positions policymakers and the voting public hold regarding the politics and policies that have direct implications for the lives of trans people. This study extended the extant literature in that regard to include examinations of attitudes toward two policies relevant to trans youth.

Clinical Implications

This study has implications for clinical work with trans youth and/or the parents/guardians of trans youth. First, in light of the recent spate of legislation aimed at decreasing access and quality of life for trans youth, it is important to note that the concerns many parents have for their trans youth about the systemic transphobia they might encounter when trying to access medical care or navigating public spaces (e.g., restrooms) are justified. Rather than working with clients (and their parents) to encourage increased resilience to oppression—which locates the need for change within the person experiencing oppression and not within the dysfunctional social context—modern counseling psychology emphasizes the need to take collective action in the face of oppression (Conlin et al., 2021; DeBlaere et al., 2014). Thus, counseling psychologists should seek means by which to promote such collective action to advocate for trans youth, using their places of relative personal and professional power and privilege to engage in advocacy in opposition to legislation aimed at curbing trans civil rights, and in support for trans-affirming policies. Although we (and others; see e.g., Singh & Burnes, 2010; Singh et al., 2011) argue that counseling psychologists should conceptualize their work with trans populations as extending beyond the walls of the therapy room to advocacy in institutions, communities, and government, prior research has also shown that when trans individuals and their families have the resources and capacity for it, engaging in advocacy themselves has led to an increased sense of resilience and can be beneficial to well-being (e.g., Birnkrant & Przeworski, 2017; Budge et al., 2010; Singh, 2013). However, this work can be exhausting and difficult; counseling psychologists could engage more actively in supportive roles alongside community members as another way of engaging in collective action. For counseling psychologists working within schools, the present study indicates the need for these professionals to be active advocates for trans youth in the school setting itself as well as within the realm of school policy decisions.

An additional role of many counseling psychologists in communities is to provide education and training to organizations and groups. For counseling psychologists who are asked or invited to present on topics related to trans inclusion, equity concerns, and basic foundational knowledge (e.g., “Trans 101”) in the communities in which they live and work, these are excellent opportunities to work potentially directly with cisgender individuals. Drawing on clinical and educational skills, counseling psychology presenters can guide training participants through reflection activities to identify and challenge implicit and explicit biases and to educate participants on the harmful impacts these policy efforts have on trans individuals and their family members.

Limitations and Future Directions

This study must be interpreted in light of its limitations. First, our data were cross-sectional and causality cannot be inferred from the results. Data were collected online via a crowdsourcing platform, and thus cannot be generalized to the population at large; in particular, the data may not represent those at very low incomes (who may not have access to the Internet) or very high incomes (who may have no need for the small income that can be obtained from participating in surveys on Prolific.co). Second, though we varied the gender of the trans child (boy, girl) in the prompts, we did not investigate nonbinary gender or other intersecting identities (e.g., race/ethnicity, socioeconomic class) that could have potentially impacted how participants responded to study outcome measures. Third, we used a simple assessment of intergroup contact. Intergroup contact is challenging to assess in the present study given that many cisgender individuals may confuse sexual orientation and gender identity and because complete assessment of intergroup contact may include terms with which many participants would be unfamiliar (e.g., pansexual, genderqueer, unlabeled, etc.). Fourth, we used a well-established measure of religious fundamentalism that implicitly appears to reflect Christian fundamentalism. We did not collect data on participants’ religious affiliation; therefore, it is unclear the degree to which participants’ felt as though this measure may have been relevant to their own religious backgrounds and belief systems. Fifth, our sample included a subset of sexual minority individuals, but it would be fruitful to understand how sexual orientation may be associated with attitudes toward transgender children, especially in intersectional contexts of participants who are diverse in terms of race/ethnicity, age, etc. Sixth, our sample did not parallel U.S. demographics and included a disproportionate number of Asian American individuals. It would be fruitful to examine the ways in which attitudes toward transgender people vary by racial/ethnic identity as well as other crucial factors such as generational status and acculturation. Finally, we examined two specific variables (hormone use and bathroom use) that are relevant to trans youth, but many more variables may be the subject of future analysis. It is also possible that participants could have read the outcome questions as what they believed Susan/Richard should do based on other motivations (e.g., concern for Susan/Richard’s safety), rather than as a question about policy.

Extending this line of research, therefore, future research could investigate temporal relations among study variables and constructs, as well as identify potential moderating factors that may predict policy endorsement among the voting public. For example, future research in this area could tease apart the degree (i.e., effect size) to which genderism and transphobic attitudes independently predict anti-trans policy endorsement over time from the potential moderating effects of exposure to increased media attention and visibility of anti-trans rhetoric. Continued research in this area could also investigate the degree to which policy endorsement correlates with individuals’ civic behaviors (e.g., voting, signing petitions). That is, when presented with a survey asking about whether an individual supports or opposes a certain policy, the individual may express their views on that policy, but might never engage in the type of activity or behavior that would be needed for the proposed policy to be adopted. As a result, more is needed to understand how attitudes do (or do not) translate to behaviors. Finally, although this study investigated attitudes and endorsement related to anti-trans policies, in light of contemporary legislative efforts across the country, future research could also explore additional direct and moderating factors related to trans-affirming policies and legislation.

Public Significance Statement.

This study advances the understanding of factors related to supporting affirming social and medical transition for transgender youth. It demonstrates the role of transphobia and the need for closure as they relate to nonaffirming attitudes.