Parents of Gender Diverse Youth: Support Sought, Received, and Still Needed

Abstract

Purpose

Gender diverse youth (GDY) have improved mental health when affirmed by parents, but little is known about the support parents of GDY seek, receive, and still need. This qualitative study explored experiences of parents of GDY to better understand their support needs.

Methods

Parents of GDY submitted videos and were interviewed about their journey supporting their GDY. Data collection continued until thematic saturation was reached. Audio recordings from videos and interviews were transcribed and analyzed via inductive thematic analysis using the RADaR technique.

Results

In total, 25 parents of GDY (mean age 15 years, range 6–21 years) from 12 states provided video recordings and interviews; 36% were People of Color, 28% were fathers. We identified four themes and 12 subthemes. Theme 1: Support through Education included acknowledging ignorance about gender diversity and remedying ignorance. Theme 2: Engaging Community noted that support was multilayered and based around the family unit and pre-existing community. Theme 3: Expanding Community included acknowledgement that seeking new community was important for many to reduce feelings of isolation. It also highlighted that “safe spaces” for parents of GDY were not always safe for those of other marginalized groups, particularly People of Color. Theme 4: Support in Healthcare Spaces centered experiences navigating medical and mental health care for GDY and feeling supported and unsupported in those spaces.

Conclusions

Parents identified numerous ways they sought, received, and needed support to understand and affirm their GDY. These findings will aid development of targeted support interventions for parents of GDY. Further research is needed to evaluate the impact of these interventions on GDY health.

Introduction

Gender diverse youth (GDY) are those whose gender identity differs from their sex designated at birth. Estimates of the prevalence of GDY in the United States range from 1.8% - 9.2%.^1–4 This population of young people experience mental health concerns, including anxiety, depression, and suicidal ideation, at 2–3x the rate of their peers; however, this inequity is reduced in GDY who have a robust support network, particularly when they feel supported and affirmed in their gender identity by their parents.^1,5–8 Reducing health inequities affecting GDY is a core goal of the National Institutes of Health, the American Academy of Pediatrics, and Healthy People 2030.^9–11

Though parental support has been established as a powerful means to reducing mental health inequity for GDY, there is little research on how to best secure that support. Parental support programs have been studied in the context of childhood chronic disease, but these existing systems and structures do not encompass the social and political impacts of raising a gender diverse child.^12–14 There has been an unprecedented increase in anti-transgender legislation in the United States, much of which has specifically targeted access to gender-affirming healthcare for GDY.^15–18 The impact of this legislation and the threat of additional efforts to limit access to services and support for GDY increases stress on GDY and their parents.^19–20 In light of the current sociopolitical environment, identifying and meeting parent needs related to understanding and affirming GDY has taken on increased urgency.

In prior studies, parents emphasized the importance of connecting to other parents of GDY and the accessibility of information.^20–21 In-person support groups have served as sources of both knowledge and relationships, and many parents described their support group as an important part of their journey.^20,22–23 Due to the COVID-19 pandemic, online resources have become increasingly key and especially beneficial for rural parents with long-standing limited access to in-person support.²⁴ Current qualitative research aimed at understanding the needs of parents has been limited by geographical location and connection to clinics, resulting in participants from mostly urban areas with close proximity to large, academic medical centers.^20,22 Additionally, most studied populations have been almost exclusively white, cisgender, heterosexual, and female.^20,22 Furthermore, much of the research on parents of GDY has attempted to understand the experiences of their children and not the parents themselves. Due to our continued limited understanding of the support parents of GDY seek, receive, and still need, this study aimed to enable diverse parents of GDY to share their stories and to explore opportunities to meet the needs of these parents.

Methods

The Research Team

Our team is diverse in our lived experiences and these experiences impacted the design, conduct, analysis, and writing of this research. The team consists of not only medical and mental health providers with experience supporting GDY and their parents, but also individuals of transgender and other gender diverse experience, and parents of both gender diverse and cisgender children. Furthermore, this work was developed, conducted, and interpreted in partnership with the Gender Research Stakeholder Program, a group of 20 transgender individuals and parents of GDY who met with the research team regularly to pilot test drafts of the interview guide and review progress on this study while providing critical member checking and guidance.

Study Recruitment

Parents of GDY were informed about this study through electronic email discussion list mailings (PFLAG chapters, regional support groups), social media posts (Facebook groups), and flyers in pediatric gender centers (UPMC Children’s Hospital of Pittsburgh, Children’s Hospital of Philadelphia, Lurie Children’s Hospital of Chicago). We shared with clinics and leaders of parent support organizations that we were hoping to find a more diverse group than had previously been studied and requested assistance in connecting with parents who were fathers, People of Color, LGBTQ, and/or foster parents as well as those from more rural areas. Inclusion criteria included 1) being the parent or caregiver of a gender diverse child under age 26, 2) currently living in the United States, 3) being able to read, speak, and understand English, and 4) having the ability and technological equipment (usually a cell phone) to film a video sharing their experience. Parents interested in learning more reached out to the study team via email and were provided with consent materials and the following study prompt: “We are asking parents to film short videos (approximately 10 minutes) talking about their stories. You would only share what you and your young person are comfortable sharing. We would then like to interview you by phone to discuss the topics you raised in your video.”

Data Collection

Participants recorded self-made videos giving context for their experience without interruption. To submit videos, participants received a unique login to upload their video file to the research site. A member of the study team (KMK) reviewed the video file and scheduled the phone interview. Interviews lasted up to one hour, were semi-structured, and followed an interview guide developed for this study with emphasis on the content participants shared in their video. All participants were paid $20 for their time. This study was deemed exempt by the University of Pittsburgh Institutional Review Board (STUDY19090032).

Data Analysis

This study utilized the rigorous and accelerated data reduction (RADaR) technique, which allows researchers to reduce large qualitative datasets through serial data tables focused on the research question²⁵: “What supports do parents of GDY seek, receive, and still need?” All video and interview audio files were transcribed verbatim with any identifying information removed. Transcripts were reviewed by members of the study team (ED and HH) who familiarized themselves with the data before creating the initial Phase 1 Table for RADaR technique analysis. To create this table, all transcripts were imported into a Microsoft Excel spreadsheet wherein each video and interview couplet was added within its own tab. The table included five columns denoting the participant number, the question posed (if part of the interview transcript), the participant response or video text, and columns for future coding and notes from the research team.

Two members of the study team (ED and HH), under the supervision of a third member (KMK), developed de novo codebooks based on review of the full Phase 1 Table. These codebooks were adjudicated to full agreement with KMK resolving any disagreements. The final codebook consisted of 50 codes and was applied to the full Phase 1 Table by ED and HH separately, and adjudicated to full agreement. KMK and ED then produced a Phase 2 Table by noting observations within the “notes” column and removing any content from the Phase 1 Table that was not relevant to the research question. This data was then reviewed again by KMK and ED, who created a Phase 3 Table through additional elimination of content not felt to contribute to the research question and recording notes about potential themes. KMK then created the final Phase 4 Table through one more round of data reduction. KMK and ED reviewed this table to determine key themes and subthemes addressing the research question.

Member Checking

Initial themes and subthemes were presented to community partners and a subset of study participants for feedback. This member checking resulted in the expansion of one subtheme into two, alteration of the language used to name a theme, and a general reorganization of the presentation of themes and subthemes in this manuscript.

Results

In total, 25 parents in this study had 25 gender diverse children with an average age of 15 years (median 16 years, range: 6–21 years). All participants who submitted a video also completed an interview. Parents had known about their child’s identity for an average of 4 years (median 3 years, range: 1–10 years) and lived 10–180 minutes from the nearest pediatric gender clinic. More than a third of participants identified as People of Color and 20% identified as LGBTQ+. They lived in 12 states with 52% living in the Northeast Region (Table 1). The four themes and 12 subthemes are summarized below with additional representative quotes provided in Table 2. US region provided is per US Census classification.²⁶

Table 1:

Demographic Characteristics of Parents (N=25) and Their Gender Diverse Children (N=25)

Characteristics	n (%)
Parent Gender Identity
Male	7 (28)
Female	17 (68)
Nonbinary	1 (4)
Parent LGBTQ+ Identity
Yes	5 (20)
No	20 (80)
Foster Parents
Yes	2 (8)
No	23 (92)
Parent Race/Ethnicity
Non-Hispanic White	16 (64)
People of Color*	9 (36)
US Regions**
Northeast	13 (52)
South	4 (16)
Midwest	5 (20)
West	3 (12)
Driving Time to Nearest Pediatric Gender Clinic (in minutes)
Mean (SD)	49.7 (46.2)
Gender Identity of Gender Diverse Children***
Masculine	13 (52)
Feminine	9 (36)
Nonbinary	3 (12)
Current Age of Children (in years)
Mean/Median (SD)	15.3/16.0 (4.0)
Time Since Coming Out to Parents (in years)
Mean/Median (SD)	4.0/3.0 (2.4)

^*People of Color includes those who identified as Black, African American, and/or Hispanic or Latino/a/e/x

^**Per United States Census Regions and Divisions,²⁶ States of participants included Arizona, California, Georgia, Illinois, Indiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania, Texas, and West Virginia

^***As reported by parent participants

Table 2:

Additional Representative Quotes

Theme 1: Support Through Education
Subtheme 1.1: Acknowledging Ignorance	“‘What does that mean? How do you even know what a boy is? How did this come about?’ And I don’t think I really addressed it in a clinical way…I didn’t even know the word transgender, really. You hear with all those other words and blend together and meaning, transvestite, trans…” -Black, Latina mother of a transgender son from the Northeast “And I would just literally, instead of saying something completely stupid, I would just say, “I don’t quite understand how that makes you feel. Could you rephrase it or say it a different way or, say, even simpler like I’m a little tiny child and you’re just trying to explain it to me for the first time.” -White father of a transgender son from the Northeast
Subtheme 1.2: Remedying Ignorance	“So obviously, rampant Google searches to try and make some sense of it. Get some education, see who’s out there. Is there books you can read? Is there people we can talk to?” -White father of a transgender daughter from the Northeast “In that moment? Wow. I wished I had had material that I could have sat down and read with my child to understand, because I didn’t know where to turn…so at first you rely on your child to educate you and they’re going through enough stress. That really shouldn’t be their job.” -White mother of a transgender son from the Northeast
Subtheme 1.3: Identifying Misinformation	“And thank goodness, I was at that time online doing research for myself. And the articles that he had given me was [an] article in [a journal]. And I’m a scientist, so I immediately was like, “Well, this is a piece of crap,” because I read his references and realized his references do not support his opinions. So that was kind of disconcerting that you had professionals basing their opinions off of somebody who was twisting the truth. As a scientist researcher, I found it appalling that this guy would do this and publish it, but it wasn’t a peer-reviewed journal so it was essentially opinion.” -White mother of a transgender son from the Northeast
Theme 2: Engaging Community
Subtheme 2.1: Family	“And my ex-husband, although he was somewhat open, was also blaming me for this. And so I felt like that was no support.” -White mother of a transgender son from the Midwest “My ex-husband is also pretty quiet. But he, for not one second, acted like I didn’t expect him to. He said, “I love you. There’s no difference. I don’t care. You’re my child. There’s nothing that could ever be who you are or anything that you are and who you love that would change that, period.” -Latina mother of two gender diverse children from the Northeast
Subtheme 2.2: School	“And school was very supportive also. But I think that they were supportive because when we had the meeting, I have already educated myself. I have already got so many resources from [a support organization] about what the rights of my child were in public school, about how to request the change of name.” -Latina mother of a transgender son from the West
Subtheme 2.3: Religion	“The Latino group from [a support organization] had a [theologist] speaker…He actually [explained] about in the different religions, not only Catholic that the Christians and started talking about the interpretation of the Bible and how different groups have different interpretations. And it was actually a great meeting because the person who’s in charge…knew that we as a [Latino] community needed to have that conversation.” -Latina mother of a transgender son from the West “She does attend a youth group for the Mennonite Church that we go to and they have all been very accepting there as well.” -White, LGBTQ+ parent of a transgender daughter from the Northeast “And it’s hard to start something new as well because you’re still kind of healing from the hurt of what I would just consider it rejection almost of your other faith family.” -White father of a transgender son from the Northeast
Subtheme 2.4: The Broader Community	“But what we’ve learned in this process is that, obviously, our community can make their opinions well-known and opinions about their moral opposition to who we are and who our child is. But the other thing that we’ve learned is that a very large portion of our community is kind and supportive. Even if they see the world different, that they have expressed their support and, again, in some surprising kinds of ways.” -White mother of a transgender daughter from the Midwest “I was afraid to talk to any of the parents of his friends because I didn’t want him ostracized from his friends or me from those friends. And it was really this double life that was happening.” -White mother of a transgender son from the Midwest
Theme 3: Expanding Community
Subtheme 3.1: Isolation	Our world as we had known it had turned on its head, and it came crashing on us. Now the child that we knew was gone. Mostly depression, anxiety, and loneliness was left. -Latina mother of two gender diverse children from the Northeast “And people don’t get it…It has been very, very challenging and very, very hard. And you feel so alone. And you feel judged.” -Black, Latina mother of a transgender son from the Northeast My husband and I at first really didn’t know who to talk to about it. We didn’t really know who we felt safe talking to about it. -White mother of a transgender daughter from the Midwest
Subtheme 3.2: Safe Space	“And so I started walking in [the direction of the support meeting], and I just realized how many other people were walking in that same direction. And then we all sat down, and I remember…I almost cried. I was like, ‘Oh, my God. There’s this many?’…But just having other people that were…other parents that were going through the same thing we were, and knowing that I could be open and I could trust the people I was with, that it was a safe place, that I wasn’t going to be judged, was absolutely wonderful.” -White father of a transgender son from the Northeast “I would wish there were like an online video chat room for parents. I’m very visual. So I need to…find parents or transgender kids, all that stuff. But I almost wish there could be a video space to be like, ‘Hi, I just found out is there another mom who could video chat with me tomorrow at 8:00?’ And because I have like 10,000 questions. I think the face to face even if it’s over video is so critical.” -White mother of a transgender son from the South
Subtheme 3.3: Lack of Safe Space	“They have a community outreach program connected with the gender clinic where we go. But since we’re not there in that town, we don’t go to any of the support groups. They’ve offered online support groups and that’s just not something that we have taken advantage of. I think probably if we were there, we would at least check it out. It would be nice if we had a support group here for parents and for kids…we just don’t have it.” -White mother of a transgender daughter in the Midwest
Theme 4: Support in Health Care Spaces
Subtheme 4.1: Relationships with Providers	“But I think had I known that the [gender specialty center existed], that they could have gotten us the help we needed, that’s where I would have gone immediately. But the doctor I talked to never shared that information with me.” -White mother of a transgender son from the Northeast “Yeah. I mean, so our primary physician is, where we live, which is more rural. And I mean, we’re dragging him along. He’s willing. He’s a wonderful man and he’s willing to learn with us. But he has no other patients. He has no experience. I don’t think he’s taken the initiative to get a lot of education on it.” -White father of a transgender daughter from the Northeast “So we were able to get in pretty early on and this doctor, he was just amazing. He’s been doing this for a really long time and he was just kind of very comforting, really assured us that this is the real thing, this isn’t a stage or a phase…This is the real deal.” -White mother of a transgender daughter from the Midwest
Subtheme 4.2: Logistics of Care	“I called them, and I got to speak to the receptionist within five minutes of making the phone call. I didn’t have to wait on hold for five hours. I got to speak to the receptionist. And that receptionist, just right then and there, had me talk to the social worker. And she picked up the phone, and I have to say. It was one of the best feelings…to have this person who knew things, to be able to talk to her.” -White mother of a nonbinary child from the Northeast “I also think a key step that my wife and I talk about is it’s very difficult to talk in front of our child with it to ask some of the questions that we know we need info on…we needed more of that time to be able to say things that she’s too embarrassed or she’s got too little of ears to hear what is entailed with some of these processes, you know?” -White father of a transgender daughter from the Northeast “I chose to go to a much bigger health system for a couple of reasons…the fact that they’re very large [and] they’re probably more likely to have more up to date education, training, maybe a little bit more broad minded…They haven’t even skipped a beat…immediately used the pronoun that we asked. And there was literally not even a pause or hesitation by them at all.” -White mother of a transgender son from the South

Theme 1: Support Through Education

Subtheme 1.1: Acknowledging Ignorance

Parents frequently recognized their own ignorance related to gender diversity. They shared immediate reactions to their child coming out that centered on how much they did not know.

“And I left the room and I just could not breathe because I didn’t know how to help my child…This just was not something I had any knowledge of. I didn’t know who to turn to. And I didn’t know how to help my child and that’s the worst feeling as a parent is not knowing how to help your kid.”

-White mother of a transgender son from the Northeast

Several parents noted struggling to understand the differences between sexual and romantic attraction and gender identity.

“I thought, as a father, I don’t know how to identify this. I didn’t really have the language to identify it … [I] didn’t know gender versus sexuality.”

-White father of a transgender daughter from the Northeast

A few parents shared their ignorance was based on an assumption that gender diversity was seen in only some cultures or racial identities.

“When my child came out, the first thing out of my mouth, it was like, ‘What are you talking about? That is only for white people’, I didn’t know anybody that was transgender. I have seen the documentaries. I have seen the movies of the week. I have read the articles. But every one of those articles were white. Nobody looked like my family. Nobody sounded like my family.”

-Latina mother of a transgender son from the West

Subtheme 1.2: Remedying Ignorance

Parents readily sought information through media, friends, and professional organizations.

“And I read everything, everything I could get my hands on. I was like, ‘I don’t want to not read something.’ I read medical journals. I read books from Amazon. I joined groups on Facebook.”

-White mother of a transgender son from the South

Many felt they needed to find information from a source other than their child to not put the task of education on the young person.

“I really didn’t know what transgender really meant. I knew it was part of the LBGTQ community, but I felt that I needed to do some research myself and not put that on him.”

-Black, Latina mother of a transgender son from the Northeast

Some parents noted that, given legislative and policy impacts on gender diverse children, they also had to educate themselves on current events that could impact their child.

“It’s more about speeding up our own knowledge of things because what seems to be a good, nice little pace to now having to speed read just to stay up-to-date with, really, just law.”

-White mother of a transgender daughter from the Midwest

Subtheme 1.3: Identifying Misinformation

Some parents shared they found information that ultimately turned out to be incorrect and, in some cases, intentionally misleading.

“Or there’s some organization out there, for instance. It seems like an offshoot of the American Academy of Pediatrics, but it’s really a conservative background group… And I was able to identify that this group is actually kind of bogus and they’re spreading misinformation. I don’t know that most people would know that, and it just breaks your heart to think that there’s so many parents out there that if they went searching, they’re going to find that and think it’s a legitimate organization.”

-White mother of a nonbinary child from the South

Theme 2: Engaging Community

Parents almost universally expressed that they sought, received, or needed support from their family, faith group, or broader community.

Subtheme 2.1: Support & Family

Most parents shared their experiences navigating conversations about their child’s identity with family and the challenges, conflicts, and support associated with these conversations. Sometimes the challenge was the parent’s fear that conversations with family about gender identity would go poorly.

“And so, I really felt so afraid that I couldn’t get through this without my momma and my sister’s support, that I just let it get really big in my head, this fear of, well, what if I’d tell them and they were just like, ‘Sorry, we can’t get behind that.’”

-White mother of a transgender daughter from the Midwest

Some parents explained that sharing news of their child’s gender identity led to difficulties in their immediate and extended families.

“My mother was like, and I hear this from a lot of people, she said, ‘She’ll always be my granddaughter to me.’ ‘He is not. He’s your grandson now.’”

-White mother of a transgender son from the Northeast

Some parents noted their child’s other parent or grandparents seemed to blame them for their child’s gender diversity, while others emphasized their spouse or family were important sources of support.

“My spouse’s parent made one comment about how I was influencing [my child]. And so that was hurtful, obviously, and just played on all the fears that I’ve already described.”

-White, LGBTQ+ parent of a transgender son from the South

“I think we’ve done a really great job that’s actually brought us closer. I feel like this could easily end a marriage. I mean, as I knew from the beginning, that if my husband wasn’t on board, I was going to choose my daughter … and fortunately, my husband has been amazing.”

-White mother of a transgender daughter from the Midwest

Some noted their culture made family support a central piece of their experience.

“I remember saying, ‘Oh, no, we’re Mexican, family first, family’s everything and we’re going to talk to the family.’ I know that there probably will be a lot of mental health providers that do not agree with me. However, from a cultural perspective and from tradition, family, we needed to do it.”

-Latina mother of a transgender son from the West

A few shared that knowing and loving their child helped family members to be supportive despite not fully understanding gender diversity.

“In fact, my brother said, ‘It’s very easy to deny a concept. It’s different when you put a face and a name in a person in that conflict.’ It’s hard to deny a person, especially someone that you know, and that you love, and that you’ve known, and that’s a part of your blood.”

-Latina mother of two transgender children from the Northeast

Subtheme 2.2: School

Parents shared they often needed support to navigate challenges with their child’s school. Sometimes they needed information to help better advocate for their child.

“And so somebody [from a support organization] told me, ‘Oh yeah, that’s what they’re telling you that you can’t change the information on the public access that the teachers see, that’s not true.’ … Then I contacted our school and said, ‘Hey guys, you can change this information and in fact, you need to.’ And then they changed it.”

-White mother of a transgender son from the West

Parents frequently shared that there were, and in many cases continue to be, challenges with bathrooms.

“The bathroom situation and people just being so against someone using the bathroom of their choice and making it out like this is a perversion and it’s putting their daughter in danger is just such a gross misrepresentation. And it hurts. Yeah, you can’t help but be protective then. Right? It’s like my kid just wants to use the bathroom.”

-White father of a transgender daughter from the Northeast

A few parents, especially those who are part of the LGBTQ+ community or those who are People of Color, shared that when it was clear the school needed additional training to support students like their children, they were asked to provide that education themselves.

“They wanted to have a trainer come in and train all the teachers…But their initial question was, ‘Can you do it?’ You being lesbian, basically…So it’s just a really good example of how…marginalized communities are constantly asked to do all of the emotional labor to educate everybody about all the things.”

-White, LGBTQ+ parent of a transgender son from the South

Subtheme 2.3: Religion

Parents often identified faith as an important part of their lives. For some their faith practice was an important source of support.

“At the same time that my kids came out to us, we were planning a bar mitzvah for my youngest child. And our rabbis were extremely supportive in helping us make it a gender-neutral service.”

-White mother of two transgender children from the Northeast

Some parents felt that their faith practice was important for their culture, which contributed to a need to hold onto faith traditions for support.

“In a lot of cultures, church is your family…and we’re also immigrants, first-generation. So I immigrated to this country, my husband immigrated to this country…making it even harder for us to feel that we had established a community of support… outside of the church.”

-Latina mother of a transgender son from the West

For many other parents, their child’s gender diversity was associated with conflict and a lack or even loss of support.

“When he came out socially or to everyone, he had some good friends that were religious and said that they didn’t hate the sinner. They hated the sin and that they would pray for our son. And we told them very clearly our son was not sinning. And we did not need their prayers…So we’re like, ‘Thanks, but no thanks.’”

-White father of a transgender son from the Northeast

Subtheme 2.4: Broader Community

Many parents shared their experiences navigating relationships with friends, coworkers, and others in their community. Some parents found support.

“And so [my old friend and I] see each other… And I tell about my youngest child…And then everything just opens up because I didn’t know that she was doing work…on [transgender advocacy]. She was the point person for the community, so it was just like, ‘Wow.’ And now my son has an aunt, an advocate, a real friend, someone who loves him…God, did I need that.”

-Black mother of a transgender son from the Northeast

Some parents feared or experienced rejection.

“And one lady came up, and it was at the orientation night for [school]. And they were like, ‘Oh, how’s your kid?’ And I was like, ‘Oh, well, this is them,’ and I pulled a picture of my child in a dress and long hair. The woman was like, ‘Oh. I’ll pray for you,’ like super religious. And clearly, she was horrified, and she meant, ‘I’ll pray for that to go away for you.’”

-White mother of a nonbinary child from the South)

A few parents shared that support in their community came in an unexpected way such as a piece of technology.

“It took me a long time to be comfortable with the new restroom use. We found an app that helps us locate gender-neutral or family restrooms, and that was a huge relief for me.”

-White father of a transgender daughter from the Northeast

Theme 3: Expanding Community

Subtheme 3.1: Isolation

Parents frequently shared that they initially felt alone in their experience of having a gender diverse child. This often manifested in a recognition that their current community was not able to provide the support they needed.

“A lot of my closer friends didn’t quite understand. And even my closest ones, probably, even though they didn’t understand, they weren’t negative about it, but they weren’t positively supportive either.”

-White father of a transgender son from the Northeast

For parents who are People of Color, this loneliness was often further complicated by a lack of gender diversity represented in their community.

“It is important because this feeling of loneliness and despair that I have for my child who came out as transgender, because… I didn’t know anyone that sounded or looked like us, I felt very lonely.”

-Latina mother of a transgender son from the West

In some cases, parents felt that there was no way to get support without compromising anonymity, and this led to hesitance in reaching out.

“But it really made me aware of in small communities, in particular, where every gathering of people you go to, there’s somebody who knows somebody. The chances of knowing someone were 75% maybe…I think it’s hard. In small communities, you can’t really be anonymous.”

-White mother of a transgender daughter from the West

Subtheme 3.2: Safe Space

Most parents expressed a need for a new community to provide a safe space for them to talk and grow in their understanding of their gender diverse child.

“I guess [I needed] a safe space for me to just speak openly to others and also where my child would be able to do the same.”

-Latina mother of a transgender son from the Northeast

Some parents expressed surprise or relief that there were other parents like them.

“And other people messaged me, and were like, ‘I don’t talk about it at all, that I have a child that’s transgender and came out like 15 years ago.’ And I’m just like, ‘What?’ Yeah. And they’re like, ‘If you need anything, I’m here.’…one of the biggest things that surprised me was just how many people came to me that had been living the same experience.”

-White mother of a transgender son from the South

Parents who were LGBTQ+ themselves acknowledged that they still needed help sometimes, despite their own lived experience.

“What resulted was really a very private and internal struggle and a need for support around having a trans kid that I really just wouldn’t have expected that I would need support about because I felt like I should be the one prepared to have a trans kid as a trans person.”

-White, LGBTQ+ parent of a transgender son from the South

Subtheme 3.3: Lack of Safe Space

Despite a desire to grow a supportive community, some parents shared that they were unable to find one for a variety of reasons. These included People of Color feeling unseen in spaces that were intended to be supportive, foster parents feeling constrained and unsupported by the child welfare system, and having geography limit the ability to access support groups.

“I definitely was not getting my needs met because, in the very beginning, I was the only Person of Color in the room. So while I share the experience of having a transgender child, it kind of stopped there…My journey with my son, who was a male Child of Color, I don’t think people really get the fear I have and holding my breath and wondering and worrying all the time when my son steps out into this world.”

-Black mother of a transgender son from the Northeast

“[A better system of support] would be a system that is less judgmental of biological parents of children in care. And a system that doesn’t give up on people as easily. And a system that is supposed to work with families… Whatever they have there is not working for me. It’s not working for my foster children.”

-Black, Latina foster mother of two transgender daughters from the Northeast

Theme 4: Support in Health Care Spaces

Subtheme 4.1: Relationships with Providers

Several parents noted struggling to find a provider who was knowledgeable enough to guide them in relation to their gender diverse child’s needs.

“And you see that the doctor is…just not experienced in dealing with this type of thing and in any type of gender care. And then at that point, you’re just like, ‘Well, that’s just great. This is a waste of time.’ And then you start to wonder, ‘Where do I find what my child needs?’”

-White father of a transgender son from the Northeast

Most parents acknowledged the important role their pediatrician played in supporting them directly as well as aiding in navigating care for their child.

“She always took an interest on my child as a person, as a whole person. And I’m very grateful for that…she gave us all kind of links and websites and articles for me and my husband to educate ourselves.”

-Latina mother of a transgender son from the West

Many parents expressed that finding providers who understood their child’s and family’s needs made a positive impact on their journey.

“She helped our family, not only the dynamics of our family, and she was a very…open to our culture. She was very respectful of my family, our values, our cultural experience, which I think is very important.”

-Latina mother of a transgender son from the West

Several parents recognized their own need for therapy to help them better understand and support their child.

“We also found a therapist for my wife and I because we needed counseling. We needed to learn more about the whole process, to learn about how our behavior towards our child had to change.”

-Latino father of two gender diverse children from the Northeast

Subtheme 4.2: Logistics of Care

Parents frequently cited difficulty finding providers. Some found resources through electronic email discussion lists or parent groups.

“I had been seeing a thread [on an electronic email discussion list] about…practitioners who [provided gender-affirming care] and parents’ opinions about them…and this was the moment I went back, and I got that whole list.”

-White mother of a nonbinary child from the Northeast

Many noted that they faced significant barriers including mental health assessment requirements and financial costs that made seeking care challenging.

“My only concern…is how long it actually takes for a child to get in and get treatment. And when I mean treatment, I don’t mean hormones, even a blocker. You have to have a [psychiatrist]. You need to see these therapists. You need to have all these letters…I paid $500 for my son’s letters.”

-Black, Latina mother of a transgender son from the Northeast

A few parents noted discriminatory experiences in pharmacies and in both primary care and specialty clinics.

“When we went to go fill our son’s prescription for testosterone, they refused, on the basis of faith. So they tried to say it was because…it was risking his life but I’m like, ‘No. You can talk to the doctor. This is actually a life-saving medication for him now,’ and finally, they came out and said, ‘Well, because of our faith we can’t sell this prescription,’ so that was kind of horrifying.”

-White mother of a transgender son from the Northeast

Some parents noted that they had individual time with the providers to ask questions without their child present and that this was helpful.

“And her process was, one, I think it was one session with just the parents. Then we had a session with the parents and the kid.”

-White mother of a nonbinary child from the Northeast

Others noted that they did not have an opportunity to talk with providers privately but wished they had. They worried their child would be embarrassed about the subject matter, or that they or their spouse were not on the same page as their child and worried that explicitly saying so could cause harm.

“And so it was, unfortunately, with my ex-husband, which I didn’t want that experience with him, but so I didn’t have a chance to really talk on my own.”

-White mother of a transgender son from the Midwest

Some parents shared that they sought gender centers in larger cities despite significant travel time, due to necessity or their view that larger health systems would be more supportive. But some parents found that, even in more urban areas, support from the medical system was not guaranteed.

“‘Oh, the resources will be in [a large southern city]. This will be easy. I’ll just go to [the large southern city].’ And they weren’t there, either…It is not clear cut. [They said], ‘You’re about five years too early. This is being talked about. There is resistance. People don’t exactly know what to do with it. So you’re just too early.’”

-White mother of a transgender son from the South

Discussion

This qualitative interview study of parents of GDY identified numerous themes and subthemes that illustrate significant support needs including a need for education and resources from healthcare providers and systems as well as engagement with pre-existing community and with new community who shared similar lived experiences.

In prior research, parents have shared that they sought additional information and resources after their child came out to them as gender diverse,²⁷ which is also echoed in this data through Theme 1: Seeking Support Through Education. They have also expressed difficulties accessing care for their GDY due to geography, cost, and a lack of knowledgeable providers, reflected in our Theme 4: Support in Health Care Spaces.²⁸ These shared themes were also reflected in a study of GDY that sought to understand youth perceptions of parental support and to characterize supportive actions (e.g., parents being willing to listen and learn about the GDY’s experiences and help them seek medical intervention).²⁹

Unlike many prior studies, this sample included several groups that have been minimally reflected in the literature, including fathers, foster parents, LGBTQ+ parents, and parents who are People of Color. This intentional inclusion of previously under-represented groups served to provide several novel insights. Pullen-Sansfaçon et al. found that mothers often carried both emotional and organizational burdens for families with GDY.³⁰ Some of the fathers in the current study echoed similar sentiments, noting that they felt they took longer in their adjustment process while their female spouse sought information and resources more readily. Although some parents in this study ascribed this to traditional gender roles, it was not a universal experience, as some fathers in our sample noted that they were the ones attempting to outwardly express their support in the hopes that doing so would show other fathers and families that they were not alone.

While there is a paucity of literature exploring the experiences of LGBTQ+ parents of GDY, there is often an assumption that these parents do not need support in their journey because they are LGBTQ+ and thus already have insight into GDY experiences. This assumption was present in the current study, where multiple parents expressed surprise that they needed support despite having a gender diverse identity or identifying as a member of the queer community more broadly. However, in addition to the struggles experienced by cisgender, heterosexual parents, LGBTQ+ parents may simultaneously experience both external and internalized blame that they somehow impacted their child’s identity through their own existence, resulting from the cisheteronormative implication that having an LGBTQ+ child is undesirable.^31–32

Despite the overrepresentation of LGBTQ+ youth, and especially GDY, in the foster system due to higher rates of abuse, neglect, and familial rejection,³³ little is known about foster parent needs related to support in affirming their children. This study is one of the first to intentionally include these perspectives. The foster parents in this sample noted additional difficulties receiving and demonstrating support for their children due to system-level restrictions on the kinds of support and affirmation they can provide for their children.

Hillier and Torg found that while support groups for parents of GDY were important, there were limitations in relatability based on age and gender identity of the child as well as little information about the experiences of People of Color.²² Our study echoed the importance of an inclusive community intentionally grown with the shared lived experience of parents of GDY. Parents shared feeling isolated until they were able to connect with others like them through support groups, organizations, or electronic email discussion lists. Yet despite finding these spaces, they did not always feel safe, particularly for People of Color. Consistent with Minority Stress Theory³⁴ and the experiences shared in this study, intersectionality likely compounds stress on parents who fear discrimination against their children not only due to their gender identity but also from deep-rooted systems of racism, oppression, misogyny, and violence. This unique lived experience likely limits relatability for those seeking support from spaces occupied by those without that foundational understanding.

Strengths and Limitations

The narrative-centered video methodology employed in this study contributes to the richness of the study findings. Video storytelling has been an increasingly present avenue for mixed methods research³⁵, though use of this modern medium has been minimally applied in work with GDY and their families or other marginalized groups, likely due to concern for misuse or loss of privacy. Our team took these potential risks seriously and developed several layers of security to protect submitted videos.

While more diverse than prior samples of parents of GDY, this study likely does not capture the full complexity of support needs, particularly those of parents whose lived experience is not represented within the study cohort. This may include those not connected to electronic email discussion lists, parent organizations, or pediatric gender clinics. Due to the small sample size, we were not able to further breakdown participant race and ethnicity. Additionally, the use of a self-filmed narrative video prior to the interview may have limited participation due to technological difficulties or privacy concerns, despite our efforts to facilitate and safe-guard this process. This study was also only available to those who were able to communicate via written and spoken English.

Recommendations

Participants in this study frequently shared the need for and benefits of having a safe space to talk about their experiences as well as the ways in which these spaces, when they existed, did not universally feel safe. It is likely that ideal safe spaces for parents will vary, but those designing such spaces should strive for representation beyond simple inclusion of parents and caregivers of GDY to ensure People of Color, LGBTQ+ people, and others experiencing multiple layers of marginalization are heard and provided with support in line with their needs. While for some this may take the format of a traditional support group, others may prefer opportunities that allow for more individualized support. In addition, virtual communities may lessen the disproportionate impact of geography on accessibility for those living in more rural areas. Health care providers and systems should note the desire parents shared to speak one-on-one with their child’s care team to better express their concerns and facilitate a clinic flow that allows opportunities for these individual conversations.

Conclusion

This study used the novel approach of having parents first tell their story via video followed by semi-structured interviews to better understand their journeys and support needs. It is one of the most diverse cohorts of parents of GDY studied to date. The depth of understanding gained from this study has the potential to impact future interventions aimed at improving support programs and systems for parents, thereby improving health outcomes for GDY.

Implications & Contribution.

This study identified numerous ways parents of gender diverse youth (GDY) sought support to understand and affirm their children. Results illustrate need for resources from providers, engagement with pre-existing community, and opportunities for building community with other families with GDY. This study should inform future interventions for parents of GDY.

Abbreviations

GDY

gender diverse youth

LGBTQ

lesbian, gay, bisexual, transgender, questioning or queer

RADaR

rigorous and accelerated data reduction