Through their Eyes: A Qualitative, Daily Diary Exploration of Oppression-Based Stress Experiences among Sexual and Gender Minority Adolescents

Abstract

The purpose of this study was to provide an in-depth, daily, and qualitative examination of oppression-based stress experiences among sexual and gender minority adolescents (SGMA) across varying social contexts–that is, varying interpersonal relationships and social environments. A sample of 94 SGMA were recruited and completed up to 21 days of daily diaries, in which respondents answered an open-ended question surrounding their daily negative experiences—or “lows”—associated with their marginalized identities. A total of 1,629 entries were analyzed using qualitative content analysis methods. Five themes of daily oppression-based stress experiences emerged from the responses, encompassing: (1) social rejection and discomfort, (2) relationship stressors, (3) stress related to identity development and disclosure, (4) negative or inadequate representation, and (5) structural cissexism-related stressors. Our findings further elucidate the content and type of oppression-based stressors SGMA experience across multiple intrapersonal, interpersonal, and structural domains; additionally, we identify salient, intervenable areas for future research to reduce the everyday oppression-based stress experiences of SGMA.

Prior research has identified the unique health disparities which exist for sexual and gender minority (e.g., lesbian, gay, bisexual, transgender, nonbinary, intersex, two-spirit, asexual) adolescents (SGMA). Particularly, the extant literature on SGMA has demonstrated that this population is at a greater risk of experiencing lower academic functioning (Aragon et al., 2014), homelessness (Morton et al., 2018), and poor mental and physical health outcomes as compared to their heterosexual and cisgender peers (Marshal et al., 2011; Russell & Fish, 2016). Such inequities can be explained in the context of an oppression-based stress framework, which proposes that the inequities experienced by SGMA exist as a result of the perpetuation and reinforcement of systems of oppression at the: structural (i.e., heterosexist and cissexist laws, policies, and cultural institutions), interpersonal (i.e., heterosexist, anti-bisexual, and cissexist discrimination and harassment), and internalized levels (internalized forms of heterosexist, anti-bisexual, and cissexist prejudice; Mereish, 2024). This oppression-based stress framework can also be understood from a social safety perspective—through this lens, both the presence of threats, traditionally thought of as minority stressors, and the absence of safety signals, can negatively impact a person’s safety schema and contribute to identity-related stigma (Diamond & Alley, 2022). As such, an oppression-based stress framework includes any factors that either signal identity-based threat or fail to signal social safety for said marginalized identity. The oppression-based stress framework builds upon prior minority stress theories which primarily focus on experiences of minority stressors at the individual and interpersonal levels (e.g., discrimination) that arise due to societal stigmatization and mistreatment of SGM people (Brooks, 1981; Hendricks & Testa, 2012; Meyer, 2003). Ultimately, the oppression-based stress framework offers a cohesive and intersectional overview of how systems of oppression-based stressors manifest at multiple societal levels to contribute to negative health outcomes in the lives of SGM communities (Mereish, 2024).

Experiences of oppression-based stress and lack of safety are pervasive in the lives of SGM youth; for example, SGM youth are more likely to experience parental rejection, or fear of parental rejection, than they are to experience parental support (Katz-Wise et al., 2016). Additionally, many SGM youth experience both verbal and physical harassment at school, with 79.6% of SGM students reporting feeling unsafe in their school environments (Kosciw et al., 2020). SGM youth also experience oppression-based stress related to disclosing their marginalized identities, with prior literature demonstrating that sexual identity disclosure can increase feelings of perceived burdensomeness—particularly in sexual minority girls (Baams et al., 2015). In response to experiences of anti-SGM stigma, SGM youth may also experience stress regarding decisions to conceal their SGM identities from others (Goldbach & Gibbs, 2017). Such identity concealment can hurt interpersonal relationships and even reduce feelings of belonging (Newheiser & Barreto, 2014).

Plurisexual adolescents—adolescents who identify as bisexual, pansexual, queer, or similar labels, as opposed to monosexual or homosexual (e.g., lesbian or gay)—may experience distinct stressors and safety threats when compared with monosexual peers. Often called biphobia, these forms of double discrimination may leave plurisexual adolescents particularly vulnerable and lacking social safety in both heterosexual and gay/lesbian communities (Anderson & Maugeri, 2024). The nuances of plurisexual stigma and biphobia have historically been understudied compared to stigmas experienced primarily by monosexual people (Beach and Hall, 2020).

In addition to the stressors that sexual minority adolescents experience, gender minority (e.g. transgender, nonbinary, and gender diverse) adolescents are at risk of experiencing additional, cissexism-related stressors and lack of social safety as compared to their cisgender peers. Gender minority youth may experience identity invalidation and misgendering from friends and family, which can include negative comments about their gender identities, use of incorrect pronouns, and promotion of cis-and hetero-normativity (Munro et al., 2019). Some gender minority youth may also experience gender dysphoria-based minority stress (Lindley & Galupo, 2020), as well as fear and hypervigilance in connection to expectations of rejection of their gender identities (Rood et al., 2016). Beyond family and peers, school environments can also serve to invalidate the gender experiences of gender minority youth, particularly in relation to educational policies and practices which strictly enforce gender norms and gender separation (Kosciw et al., 2020). Prior research has additionally found that gender minority youth are more susceptible to experiences of bullying or harassment as compared to their cisgender peers (Reisner et al., 2015).

In research with SGMA, it is important to consider how sexual identity and gender identity are concurrently constructed and afforded privilege and marginalization alongside other social identities. Intersectionality theory, coined by Black feminist scholars and activists, posits that experiences of oppression are not experienced on a single axis of one’s identities. Rather, oppressive systems can interact and converge in multidimensional ways due to the intersection of one’s social identities and lived experiences (Bowleg, 2008; Crenshaw, 1989). Thus, it is also important to consider how oppression-based stressors manifest within the lives of SGMA who also identify as racial/ethnic minorities. Particularly, research has demonstrated that intersectional experiences of oppression-based stressors are associated with negative health outcomes for SGMA of color, such as depressive symptoms (Ching et al., 2022; Mereish et al., 2022) and lower self-esteem (Mereish et al., 2022). Racially diverse samples of SGMA are needed within research to continue to examine within-group comparisons and differences in the daily experiences of intersectional oppression-based stressors for SGMA of color.

Adolescence is a critical time period for neurocognitive, social, and emotional development (Blakemore & Mills, 2014; Schriber & Guyer, 2016). Particularly, adolescence exists as a time period where social contexts and social acceptance play a large role in influencing developmental outcomes (Blakemore & Mills, 2014). Given the importance of social acceptance and social relationships during this time period, it is important to consider how SGMA experience and navigate social contexts, especially as these contexts are shaped by multiple and intersecting forms of oppression, including experiences of isolation and rejection. Thus, it is important for research to further understand the impacts of oppression-based stressors within this unique age group. Beyond the interpersonal level, SGMA are also susceptible to structural and institutional influences of anti-SGM oppression. For example, at both the federal and state levels, there are fewer legal protections for SGM youth as compared to adults (Russell & Fish, 2019), leaving this age group uniquely vulnerable to experiencing oppression-based stressors.

Although the extant literature on oppression-based stress has been important in documenting the frequency of oppression-based stressors and their associations with negative health outcomes among SGMA, there are several limitations worth noting. Prior research on oppression-based stress and health has focused primarily on cross-sectional and retrospective experiences of SGM adults or young adults, as demonstrated by a systematic review of 632 studies (Walch et al., 2020). Thus, an in-depth exploration of how SGMA experience and describe oppression-based stress is warranted, particularly given the salience of identity development processes for this age range (Goldbach & Gibbs, 2017). Further exploration is also needed into the experiences of gender minority adolescents, as gender minority participants are underrepresented in prior research, or are often conflated with the experiences of cisgender sexual minority participants in heterogenous SGM samples (Walch et al., 2020). Additionally, many prior studies do not analyze the nuances of SGMAs’ experiences across varied social contexts (e.g., school, family, community environments), especially given that acceptance and rejection can fluctuate depending on the social environment (Fish, 2020). Finally, prior research has been limited in using experience sampling methods (e.g., daily diary) to capture the specific daily experiences of SGMA across adolescence (Fish, 2020). Daily diary methods are beneficial in understanding the nuances of everyday life, with their ability to capture daily stressors and reveal how these stressors unfold over time (Gunthert & Wenze, 2012). Rather than capturing major events retrospectively, this methodology addresses recall bias limitations by allowing for discussion of day-to-day experiences as they occur (Almeida, 2005), which is especially important for research among adolescents.

Given the limitations of the current literature in understanding everyday oppression-based stress experiences among SGMA, the present study aimed to conduct an extensive examination of these experiences across a variety of daily interpersonal contexts. Understanding the ways in which SGMA experience oppression-based stressors across different social contexts is crucial for identifying interventions to reduce everyday oppression-based stress among SGMA. Additionally, asking about instances of stress and oppression via everyday experiences has been theorized as beneficial for tracking the malleability and fluidity of oppressive systems over time (Jackson et al., 2021). Further explorations at the granular, day-to-day level can help provide a holistic understanding of how oppression-based stressors manifest in the lives of SGMA, paving the way for future research to explore targeted interventions. Considering the risks posed to SGMA in the context of the perpetuity of heterosexism, anti-bisexual prejudice, and cissexism in current U.S. society, as well as the potential for the accumulation of oppression-based stressors in the lives of SGMA, it is important to further understand precisely how oppression-based stressors manifest for SGMA across multiple social environments and intra/interpersonal domains. Therefore, by leveraging daily diary methods, this study builds upon prior research to offer qualitative insights into the content and type of oppression-based stressors experienced by SGMA on a daily basis.

Method

Participants

A total of 94 SGMA, ages 12 to 18 years old, were recruited for this study (M = 16.10, SD = 1.50). Using the two-step method of assessing sex and gender identity (Reisner et al., 2014), participants were cisgender (68.1%; n = 64) and 31.9% were gender minority (n = 30). Gender identities reported included: female (58.5%), gender queer/gender non-conforming (11.7%), trans male/boy/man (11.7%), male (10.6%), or a different gender identity (7.4%; e.g., agender, gender fluid). Participants’ sex assigned at birth was majority female (90.4%) and 9.6% were male. Participants’ sexual orientation identities were 29.8% monosexual (e.g., gay, lesbian), 61.7% plurisexual (e.g. queer, bisexual, pansexual), and 8.5% another sexual identity (e.g. asexual, questioning, don’t know). Sexual identity labels included: bisexual (35.1%), lesbian (17%), pansexual (16%), gay (12.8%), queer (10.6%), asexual (5.3%), questioning (2.1%), and don’t know (1.1%).

Participants represented diverse racial groups, with 54.8% of the sample identifying as White, 23.7% as Black/African American, 16.1% as Biracial or Multiracial, 2.2% as Asian/Asian American or Pacific Islander, and 3.2% identifying as other. Only 11.7% of the sample identified their ethnicity as Hispanic or Latino/a/x/e. A majority of participants were in high school (81.9%), with several others in middle school (8.5%), or were incoming and current first-year college students (9.6%). As an indicator of socioeconomic status, 34% of the sample received free or reduced lunch at school.

Procedures

This study was reviewed and approved by the Institutional Review Board at the senior author’s institution. Participants were recruited from the community and screened for eligibility criteria in a Mid-Atlantic metropolitan city, as part of a larger study of sexual and gender minority adolescents’ wellbeing (Mereish et al., 2021). Inclusion criteria were: 1) self-identification as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and 2) aged 12 to 18 years old. Potentially eligible adolescents were invited to an in-person meeting, where study procedures were explained, and participants provided written consent (for 18-year-old participants) or assent (for participants under 18 years). Parental consent to participate was waived for participants under 18 to mitigate potential safety risks related to disclosure of one’s sexual orientation and/or gender identity.

A total of 96 adolescents completed the baseline survey and were invited to participate in the daily diary portion of the study. Two participants declined, leaving a total of 94 participants who agreed to participate in the 21-day daily diary. Our total participant sample size is sufficiently comparable to sample sizes in prior studies using daily diary methodologies with sexual minority youth (Parnes et al., 2024) and SGM youth samples (Mereish et al., 2023). Instructions for completing the daily diary surveys were provided to participants. Every evening at 7:30 p.m., participants received an individual, personalized email with a link to their daily diary survey, alongside tailored feedback regarding their progress in the study. Participants received a reminder at 9:30 p.m. if they had not yet completed the survey. Uncompleted surveys expired at 5 a.m. the next morning and were considered missed reports. Participants received compensation through daily incentives, as well as a weekly bonus, in the form of gift cards. Detailed study procedures are provided in a prior work (Mereish et al., 2021). Participants were asked daily, “What were your ‘lows’ or negatives about being LGBTQ today and in the last 24 hours?” and were provided with an open-ended response option to describe their daily negative experiences. This question was developed specifically for this study by SGMA using focus groups, which included adolescents drafting possible questions and providing feedback on which question could best fit their experiences, especially within a context of a daily diary study.

Participants completed a total of 1,629 surveys (days). This produced a response rate of 82.52%. Of the 1,629 entries, 943 were not provided (57.9%; e.g., participants described their lows as “none,” “nothing today,” “not applicable,” “there were no lows in the last 24 hours,” or skipped the question). Entries with a negative identity endorsement (n = 672) were then analyzed through qualitative conventional content analysis, a methodology which allows for themes to be constructed and assembled directly from the participants’ data, as opposed to imposing predetermined theories upon the data (Hsieh & Shannon, 2005). Our research team prioritized the use of qualitative content analysis methods, as they allowed for flexibility in the analytic interpretation of both directly stated and implied content within our participants’ data (Cho & Lee, 2014). This strength of qualitative content analysis—the ability to interpret both manifest and latent content within participant data (Kleinheksel et al., 2020)—is particularly important when considering the fluidity of social identity categories among SGMA, which may encompass themes that are socially constructed, dependent on the context, and are not always explicitly stated. The data was coded using several steps. All the daily diary entries were reviewed and cleaned (e.g., removed those that were not true daily negative experiences or ones in which participants stated “not applicable” or “none”). The study team developed a codebook to capture topics that reflected the negative experiences observed in participants’ responses. Two of the authors then independently coded all data entries using NVivo, adding new codes as additional topics were identified. Each participant’s daily entries were reviewed together to understand their day-to-day negative identity experiences. Discrepancies in coded responses were identified and discussed within the research team until a coding consensus was reached. After the coding was finalized, the researchers collaboratively identified and defined the larger emerging themes present in the coded data, as well as subthemes and exemplars thereof.

Positionality and Reflexivity

The researchers of this study recognize the importance of naming, and reflecting upon, how their social identities influence their positionality to the data analyses conducted and the framing of the study results (Olmos-Vega et al., 2023). The first author identifies as a Multiracial, Black, queer, and genderqueer postbaccalaureate researcher. Their positionality as a queer and gender diverse person of color influenced their level of understanding of participants’ responses and subsequent identified themes, due to similarities in lived experiences as SGM young people. This author’s subjectivity is particularly manifested within their interpretations of the study results and decisions made to frame the implications and future interventions resulting from the data. Simultaneously, the first author’s experiences living at the intersection of multiple systems of oppression informed their desire to shed further light on the daily experiences of oppression-related stressors experienced by SGMA. The second author is a lesbian and cisgender White woman with Latin American heritage. She was a high school student at the time of data analysis and is currently an undergraduate student. Given her positionality as an SGMA, her interpretations of participant entries, as well as her subsequent creation of codes and designation of entries within these, were certainly shaped by her lived experiences and resulting understandings of being an SGMA high school student and her overall goals of increasing the wellbeing of SGM young people—this “insider status” as an adolescent researcher could both bias and strengthen her analysis. The third author is a bisexual, cisgender, White woman. During data analysis, she was an undergraduate student but is currently a working professional. At the time of analysis, her experience as an undergraduate student, who had recently been an SGMA herself, allowed for further understanding of the participants’ experiences. Her perspective as someone who was recently a high schooler and was entering emerging adulthood likely informed her analysis of participant entries. The fourth and senior author identifies as a queer, Arab American, cisgender man who is a doctoral-level researcher and licensed psychologist. His intersectional social identities and related experiences of oppression, as well as prior experiences conducting research and clinical work with SGMA, guided his understanding and development of the codebook, interpretation of the data, framing the findings within the extant literature from a social justice approach, and his overall mentorship and supervision of the co-authors throughout the study.

Results

During analysis of participant responses, five themes emerged to characterize the daily, negative, oppression-based stress experiences of SGMA: (1) social rejection and discomfort, (2) relationship stressors, (3) stress related to identity development and disclosure, (4) negative or inadequate representation, and (5) structural cissexism-related stressors. In the text below and within Table 1, the range of ‘lows’ described by these five themes, as well as their respective subthemes, are enumerated along with specific examples of participant experiences.

Table 1.

Identified Oppression-Based Stress Themes, Subthemes, Definitions, and Exemplar Quotes

Theme	Subtheme		Exemplar Quotes
Social Rejection and Discomfort Experiences of being rejected and made uncomfortable, whether intentionally or unintentionally, by another individual or group because of SGM identity. Sources of rejection included family, peers, teachers, other members of school communities, and other or unspecified groups/individuals. Includes harassment, verbal bullying, anti-SGM humor, and misgendering.	Family Rejection perpetrated by family member(s), whether immediate or extended.	Negative Comments	“I was driving with my mom and she said something kind of stereotypical about gay people that made me uncomfortable” (Asian and White pansexual and cisgender girl, age 15).
		Slurs	“My mother calling me the f word and thinking that it’s just a phase and I’m just experimenting and hoping that I’m done with my “faggotry” after I finish school” (Latine and bisexual cisgender girl, age 14).
		Misgendering	“My relatives constantly misgendering me, even after being corrected” (White bisexual transgender boy, age 14).
		Identity Erasure	“My parents never understand and always question me about my identity and if I really know or understand” (White asexual transgender boy, age 14).
		Reactions to Gender Expression and Presentation	“My fostermom said I didn’t look lady-like today. I struggle with being physically a woman” (Black/African American pansexual genderqueer person, age 16).
		General or Unspecified Judgment	“Family is in town that is homophobic so that’s ugh” (Multiracial Latine lesbian cisgender girl, age 16).
	Friends and Peers Rejection perpetrated by friends, classmates, and other acquaintances of the same age/life stage.	Negative Comments	“My classmates were making rude remarks and jokes about LGBTQ people and I was offended” (Multiracial and Latine pansexual demigirl, age 15).
		Insulting Jokes	“I had to hear these boys in class making crude jokes at the expense of women and gay men and it made my stomach churn to hear it and see them all laughing” (White bisexual cisgender girl, age 17).
		Slurs	“A friend consistently used words like ‘tranny’ and implied sexuality was a choice even after multiple people asked him to stop” (White gay cisgender boy, age 16).
		Misgendering	“My friend misgendered me” (Multiracial and pansexual transgender boy, age 16).
		Reactions to Gender Presentation and Expression	“A friend of mine seemed put off by my history of wearing makeup” (Middle Eastern and pansexual cisgender boy, age 17).
		Identity Erasure	“One of my friends discounted my sexuality because I’m ‘not gay enough’” (White bisexual cisgender girl, age 17).
		Vicarious Experiences	“I talked to one of my LGBTQ friends about HIS negative experiences which made me empathetic, but otherwise I did not experience any negative situations” (White bisexual cisgender girl, age 15).
		General or Unspecified Judgment	“people being transphobic in class” (Asian and White pansexual and cisgender girl, age 15).
	Teachers Rejection perpetrated by academic instructors.	Misgendering	“My teacher still can’t get my pronouns right even though it’s almost the end of the year and it’s not like they knew me before I transitioned” (White pansexual transgender boy, age 15).
		Identity Erasure	“Biology teacher allowed another class discussion about the validity of people in LGBT communities (for example, that lesbians and gay women were leading the world to the end of the human race ect)” (Black/African American and White lesbian/queer/pansexual cisgender girl, age 17).
		General/Unspecified Judgment	“We had some presentations in our homeroom about pride, and it was obvious the teacher didn’t really care, and she was rushing through it” (White pansexual cisgender girl, age 13).
	Other or Unspecified Individual Rejection perpetrated by an unspecified or extraneous person or context (e.g., school community). This encompasses strangers, coworkers, and anyone not specified by participant.	Negative Comments	“I quit my job today partly because I couldn’t deal with some of the comments coworkers and management made about LGBT people especially like talking about women” (Black/African American and White lesbian genderqueer person, age 18).
		Jokes	“Many jokes were made that deprecated LGBT people” (White asexual biromantic cisgender girl, age 15).
		Slurs	“Being called a faggot even if it was a joke” (White bisexual cisgender girl, age 15).
		Misgendering by Others	“Being called my birthname by someone who met me long after I stopped using it” (Multiracial pansexual transgender boy, age 16).
		Reactions to Presentation and Gender Expression	“I should note first that today I was definitely presenting more masculine, just for context. Our school took us on a field trip to the zoo today and a woman in the restroom was quite rude to me. I think it came down to me not fitting how she thought I should look/act being in the girl’s room, she told me I should try and be ‘more like a lady’ and kind of pulled her kids away from me” (White pansexual genderqueer person, age 14).
		Identity Erasure	“My lows are people are not accepting to what they don’t understand. They are quick to judge or label me as ‘gay’ when I announce I’m interested [in] girls, but forget I am also attracted to boys” (Black/African American bisexual cisgender girl, age 18).
		Negative Perceptions of SGM Relationship	“Someone called my relationship ‘kinky’ because it was with a girl. Then they proceeded to call the attention of other people” (White queer cisgender girl, age 15).
		Sexual Harassment	“Being harassed by men on the streets” (Black/African American lesbian cisgender girl, age 18).
		Staring	“My school was on a trip again and I got stared down/sneered at by some Trump supporters on the mall” (White asexual biromantic cisgender girl, age 15).
		Unspecified or General Judgement	“I felt judged because of my sexuality” (Latine asexual cisgender girl, age 12).
Relationship Stressors: Distressing or stressful events that arise from a particular sexual/romantic relationship and/or attraction.	Inconvenient or Uncomfortable Romantic Interests Romantic or sexual interest by or toward the participant that causes stress or is otherwise uncomfortable.		“Confusing feelings about being a trans guy that makes out with a straight cis guy” (White bisexual/queer transgender boy, age 18).
	Rejection, Break Up, or Conflict Rejection after expression of romantic or sexual interest, ending of a relationship, inability to spend time with partner, or conflict within a relationship.		“Got into a big argument with my girlfriend” (Black/African American lesbian cisgender girl, age 17).
Stress Related to Identity Development and Disclosure: Distressing or stressful intra- and inter-personal experiences that arise from navigating and developing one’s sexual orientation or gender identity, including questioning, considering, and reflecting identity as well as the degree to which that identity is communicated to others.	Questioning Reevaluating one’s sexual orientation or gender identity and labels thereof.		Sexuality: “Sometimes I feel kinda bad that I identify as bisexual but have no experience with girls yet and do have experience with boys and this often makes me question myself and makes me feel shitty and confused” (White bisexual cisgender girl, age 17). Gender: “some general stuff around gender discomfort?? i really don’t know what is up and i really have no clarity on what the hell gender is or what the hell my gender is” (White lesbian/queer person who identifies gender as female/questioning, age 18).
	Gender Dysphoria Discomfort or distress with sex assigned at birth, secondary sex characteristics, or associated gendered traits.		“I had some dysphoria about my breasts today” (Latine and White gay genderqueer person, age 18).
	Internalized or Self-Stigma Feelings of shame or disapproval towards one’s own identity.		Sexuality: “Every day, I feel like I have to adjust the way I talk and act to pass as straight more. I don’t even know why I do it. Its like I have to justify to myself that I’m not an lgbtqi+ stereotype. I wish I was more comfortable with my sexuality. Oh well” (White bisexual cisgender girl, age 16). Gender: “Being misgendered, feeling like no one could ever love me because I’m trans” (Multiracial pansexual transgender boy, age 16).
	Discomfort with Appearance, Presentation, and Gender Expression Discomfort with aspects of physical appearance and expression, including body shape, clothing choices, or gender-affirming practices like binding.		Sexuality: “after going to the pride parade I felt as if I wasn’t expressing who I am based on my clothes and what I wore” (Latine bisexual cisgender girl, age 16). Gender: “This morning when I was getting dressed I couldn’t find anything to wear that felt ‘right’. I ended up changing my outfit and makeup multiple times only to give up and throw on the first things I could find and was really uncomfortable for the rest of the day until I could get home and change” (Black/African American genderfluid person unsure about their sexuality, age 15).
	Decision Making Around Disclosure Evaluation of whether or not to come out, internal processes prior to coming out, and/or to what extent to disclose SGM identity.		Sexuality: “I hate when my parents say that lgbt+ people are crazy and need to be ‘fixed.’ I never want to come out. I’m considering never telling them, regardless of if I ever get married. I’d like to have my parents at my wedding, but if I’m marrying a girl, they won’t come. So my parents can’t come to my wedding either way. At least this way, I’ll still have a relationship with them” (White cisgender girl questioning their sexuality, age 17). Gender: “I want to buy a binder but I need a credit card to do that so I would have to come out to my family and I’m scared” (White asexual transgender boy, age 14).
	Fears of Being Outed Anxiety, nervousness, or fear about unwanted disclosure of one’s identity by another individual.		Sexuality: “I’m going to visit my extended family for a week, and I’m worried about hiding my sexual orientation and my brother outing me without my permission” (White lesbian cisgender girl, age 18). Gender: “I had choir with GenOut and afterwards I was talking to a girl from the group”… “It also kind of sucked that I had to say I was a girl in a group like that because of how scared I am of my parents finding out I’m nb” (White pansexual genderqueer person, age 14).
	Concealment Hiding or minimizing one’s identity, whether in appearance, speech, mannerisms, or other behavior.		Gender and sexuality: “Heard a lot of really negative stuff online about LGBT people while playing a MMO [massive multiplayer online game] and I didn’t want to get kicked off the team or targeted so I couldn’t tell them to stop” (Black/African American and White lesbian genderqueer person, age 18).
	Outness Instances of coming out, navigation of the moment(s) of identity disclosure, explaining identity, or otherwise navigating others’ knowledge of one’s identity.		Sexuality: “I came out to a friend who acted like they didn’t believe in bisexual People” (Black/African American bisexual cisgender girl, age 14). Gender: “I had brought my agender flag and a bunch of people asked what it was, lots didn’t get it when I told them but they didn’t say it to my face. And I was constantly asked if it was the same thing as gender nonbianary [sic] and I hate it when people ask that cause it’s just confusing to explain” (White asexual panromantic agender person, age 14).
	Lack of Belonging Feelings of loneliness, sadness, isolation, and not “fitting in” as a result of identity.		Sexuality: “I spent no time with anyone that I can be open about my sexuality with and it felt kind of lonely” (White bisexual cisgender girl, age 17). Gender: “I worried about my gender identity because I don’t know anyone who identifies the same as me” (Multiracial and Latine pansexual demigirl, age 15).
Negative or Inadequate Representation Representation of SGM individuals and communities in media, on social media, or in the classroom that is deemed negative (or absent) by the participant.	Negative Media Representation Representation of SGM individuals and communities in film, television, news, or elsewhere that is entirely absent, stigmatizing, of low quality, extremely negative in tone, or otherwise undesirable to participant.		“I saw an anti-lgbtq commercial and it made me pretty upset” (Black/African American bisexual cisgender girl, age 14).
	Negative General Social Media (non-interpersonal) Judgment, anti-SGM sentiment, or critiques of certain identities from both within and outside of the SGM community that is directed at general audiences on social networking apps or webpages as opposed to online interactions among individuals.		Extra-community: I saw some negative posts about LGBT people from social media” (Black/African American bisexual cisgender girl, age 14). Intra-community: “Many posts by other LGBT people that perpetuated the stereotype that the community is overly sensitive and hates straight people” (White gay cisgender boy, age 16).
	Curriculum and Teaching Coursework or classroom discussion that does not represent or engage with the SGM community or does so in a judgmental, stigmatizing, or otherwise uncomfortable manner.		“I was uncomfortable in my sex Ed class that only focuses on straight sex” (Black/African American queer cisgender girl, age 16).
Structural Barriers and Cissexism- Related Stressors Barriers that prevent or otherwise negatively impact access and use of health care and bathrooms by transgender and non-binary youth.	Difficulty Accessing Gender-Affirming Health Care Struggling to receive gender-affirming services like hormone therapy, gender confirmation surgery, or culturally competent health care in general.		“Struggling to get on hormones” (Black/African American queer nonbinary person, age 18).
	Barriers and Negative Experiences with Bathrooms Lack of access to gender-affirming bathrooms, judgment surrounding bathroom use, lack of gender-neutral bathrooms, and other bathroom- related difficulties.		“I don’t like having to explain myself in the bathroom” (White asexual transgender boy, age 14).

Theme I: Social Rejection and Discomfort

Participants experienced multiple types of heterosexism, cissexism, anti-bisexual prejudice, and other anti-SGM attitudes across a variety of interpersonal relationships. The contexts for these experiences of rejection and discomfort comprised four subthemes: family, friends and peers, teachers, and other or unspecified individuals.

Subtheme I: Family

Some participants reported experiencing rejection or discomfort from immediate and extended family members, including parents, guardians, siblings, cousins, grandparents, and aunts/uncles. The six forms of family rejection included: 1) negative comments, 2) slurs, 3) misgendering, 4) identity erasure, 5) reactions to gender expression and presentation, and 6) general or unspecified judgment. In terms of negative comments, participants reported family members verbally expressing judgment of the SGM community and/or the participant’s SGM identities, whether intentionally or otherwise. These comments included some general “offensive remarks,” stereotypes, judgmental discussion of SGM people, and pathologizing of SGM identities—such as, a participant’s parent commenting that “[SGM] people need to go to a mental hospital to be ‘fixed’” (White cisgender girl unsure about her sexual orientation, age 17). While reported infrequently, participants also described hearing specific derogatory terms like “faggot,” “dyke,” and “gay” (e.g., “that’s gay”) used by family members to disparage the SGM community and/or the participant as being a member of that community. Additionally, participants reported being misgendered through family members’ purposeful or accidental use of incorrect pronouns, names, or gendered terms (e.g., “boy,” “daughter”) that misaligned with the participant’s gender identity; these experiences of misgendering were particularly prevalent and more frequent for gender minority participants. Family members also reacted negatively to participants’ appearance, clothing, hair styling, and other typically gendered facets of physical presentation; while this was reported by both cisgender and gender minority participants, such experiences were reported more frequently by gender minority participants. These reactions were sometimes also associated with misgendering. In addition to these forms of judgment, participants experienced identity erasure—or an invalidation of their identity—from their families. Lastly, participants often described very general feelings of judgment or lacking acceptance from their families.

Subtheme II: Friends and Peers

Participants experienced rejection and discomfort from friends and other peers in largely similar ways as compared to family settings; however, two additional themes emerged within this social context—particularly, insulting jokes and vicarious experiences. Participants discussed being faced with insulting jokes from their peers that demeaned the participants’ marginalized identities and the SGM community. While some participants noted that some jokes were not intentionally harmful, they still constituted an identity-based “low” for those individuals. Slur use was also reported within this context, sometimes directed at the participant, and other times overheard in a public space. Even when individual participants were not targeted by the slur, they still often noted distress at hearing the derogatory language and the conferred anti-SGM sentiment.

In addition to direct rejection from peers, participants reported being emotionally impacted by negative vicarious identity experiences, in which a fellow peer faced judgment or difficulty because of their SGM identity. For example, one participant noted, “I overheard some disparaging comments about a nonbinary kid at my school regarding their identity and it just made me kinda shitty in questioning my gender myself” (White lesbian/queer 18 year-old who identifies as female and questioning). Lastly, those participating in the study shared general instances of judgment from peers without describing specific details of the experience; for instance, one participant noted, “one of my online friends was being really rude to me about my sexuality orientation” (Multiracial and Latine and pansexual demigirl, age 15).

Subtheme III: Teachers

Rejection from teachers in academic settings followed three primary themes, consisting of: 1) misgendering, 2) identity erasure, and 3) general or unspecified judgment. Misgendering was the most prevalent form of teacher rejection, particularly in terms of incorrect pronoun and gendered language use for our gender minority participants. For many of these cases, misgendering occurred even after the teacher was informed of the participant’s pronouns and sometimes even corrected on previous occasions. Gender minority participants also reported that educators made them feel that their identities were invalid, including by allowing homophobic class discussion, or by directly dismissing participants’ SGM identities. As with peers and family members, both gender minority and cisgender participants described experiencing general anti-SGM sentiment from teachers, such as, “I found out my teacher is homophobic” (White pansexual transgender boy, age 15).

Subtheme IV: Other or Unspecified Individual

Outside of interactions with family, peers, and teachers, participants experienced rejection from other social groups including strangers, coworkers, and their overall school communities. The ten oppression-based stress categories for this context are delineated in Table 1, with negative perceptions of SGM relationships, staring, and sexual harassment emerging as additional categories unique to this social context. Participants heard and were targets of anti-SGM comments, and reported hearing offensive jokes regarding their SGM identities, without clarifying the specific content or context of the incident. Participants also described instances of hearing or being the target of derogatory terms, including around complete strangers. One participant noted, “I heard a few times people refer to girls who dress masculine and act masculine as dyke and it really irritated me” (American Indian and Black/African American bisexual genderqueer person, age 17). Gender minority participants, specifically, were subject to general experiences of being misgendered as well as negative responses to their gender expression by strangers. These reactions took the forms of “stank [negative] looks,” participants being told to make their gender “more obvious to others,” and stereotypes about the participants’ appearance. Experiences of identity erasure included assumptions that the participant was heterosexual or cisgender, as well as invalidations of specific sexual orientations and gender identities— particularly, bisexuality, queerness, and nonbinary genders—even from others within the SGM community. Participants also faced stigma in response to being in non-heterosexual relationships, usually in the form of overt staring or other negative body language, or verbal statements from strangers in public settings. Another subtheme specific to this social context was sexual harassment, which primarily included catcalling from strangers. Lastly, some participants reported experiencing general or unspecified rejection, often writing statements such as “judgment” without explaining the perpetrator or content of the stigmatizing experience.

Theme II: Relationship Stressors

In addition to identity-based rejection, participants also faced interpersonal stressors when navigating their romantic and sexual relationships. These stressors were divided among two subthemes: 1) inconvenient or uncomfortable romantic interests, and 2) rejection, break up, or conflict.

Subtheme I: Inconvenient or Uncomfortable Romantic Interests

Inconvenient and/or uncomfortable romantic and sexual interests from friends and other peers brought both general and identity-specific obstacles to participants. While these awkward, and sometimes painful, instances were not specific to SGM identity, participants described the difficulties of assessing a romantic interest’s sexual orientation, as well as falling for a heterosexual peer who had no potential of reciprocating their feelings due to their sexuality. Additionally, some participants described being interested in pursuing intimate relationships, but had difficulties meeting other SGMA. In these cases, their interests and attempts in pursuing relationships were unsuccessful. The following participant statement elucidates these identity-specific difficulties with romantic interests:

I felt kind of lonely because it is very easy for a straight person to find someone to date, but as a lesbian it can be very difficult, and I was worrying about if I would ever find someone.

(White lesbian cisgender girl, age 18)

Subtheme II: Rejection, Break Up, or Difficulties

Similar to their heterosexual peers, both cisgender and gender minority study participants experienced break ups, romantic rejection, and conflicts within relationships. Some participants described general relationship problems—such as time spent apart, arguments, awkwardness with past significant others—or discussed problems associated with partner-seeking, such as being “ghosted,” and being rejected on dating apps. While emotionally difficult, these experiences were usually not identity-specific, though closeted participants sometimes struggled through breakups and rejections without social support.

Theme III: Stress Related to Identity Development and Disclosure

Participants reported experiencing identity-specific stressors while exploring and developing their gender identities and sexual orientations. From internal questioning to external navigation of outness, this theme included nine subthemes: 1) questioning; 2) gender dysphoria, 3) internalized or self-stigma; 4) discomfort with appearance, presentation, and gender expression; 5) decision making around disclosure; 6) fears of being outed; 7) concealment; 8) outness; and 9) lack of belonging.

Subtheme I: Questioning

Both gender minority and cisgender participants described experiencing stress in relation to questioning their sexual orientations and gender identities, as well as the labels associated with these identities. For many participants, the uncertainty within this identity questioning process was stressful or uncomfortable. As one individual wrote, “I just wanna feel normal … I just wish I had everything figured out instead of question[ing] why I like this certain gender or why… I feel like this” (Latine and bisexual cisgender girl, age 14). This subtheme also overlapped somewhat with internalized or self-stigma, as participants sometimes invalidated their own identities or questioning thereof. Some adolescents also described feeling like no sexual or gender identity label fit them entirely accurately.

Subtheme II: Gender Dysphoria

Transgender, nonbinary, and gender diverse participants, as well as those questioning their gender identities, described feeling gender dysphoria, or an extreme discomfort with their sex assigned at birth in relation to their current gender identity. Gender minority participants often noted this by name, writing just “dysphoria” or “dealing with gender dysphoria in general.” Some participants described this dysphoric experience further, usually relating distress with specific, gendered aspects of their bodies (such as “breasts”); others discussed how misgendering or negative representation exacerbated their dysphoria (such as through being called the “wrong name/pronouns”).

Subtheme III: Internalized or Self-Stigma

Participants across SGM identities discussed struggles with self-stigmatization, such as through internalizing stereotypes about the SGM community and invalidating their own SGM identities. Participants described this self-stigmatization as feeling “self-conscious,” “ashamed,” or “like a failure,” because of their gender identity or sexual orientation. Many of these reported instances of internalized anti-SGM sentiments were linked to experiences of rejection from people in the participant’s life—particularly from family members. Participants’ internalized stigma was associated with concealment of identity from others, social disconnection, and feelings of anxiety. One participant’s response further illustrates these sentiments:

Honestly man (or woman) I hate being who I am. I’m always worrying about whether or not a family member knows my sexuality and I feel like I’m being judged by everyone and that just makes me more self conscious and I don’t like leaving my house because of it.

(Latine and bisexual cisgender girl, age 14)

Subtheme IV: Discomfort with Appearance, Presentation, and Gender Expression

In addition to internalized stigma, participants recounted feeling “insecure” about aspects of their personal appearance and gender expression, such as their clothing and binding choices, hair length and styling, and general body image. This discomfort was usually linked to a feeling of misalignment with the participant’s preferred gender presentation (e.g., masculine, feminine, androgynous) and their actual presentation. As a result, the majority of the participants describing such experiences in this subtheme identified as transgender or nonbinary. Other participants had different sexual orientations that they preferred to express through “traditionally queer,” and sometimes gender non-conforming, aspects of appearance. Gender minority participants also noted increased discomfort in situations where they were prevented from expressing their gender identity, or when shamed for doing so.

Subtheme V: Decision Making Around Disclosure

Participants’ responses under this theme involved deciding whether to disclose their sexual orientation and/or gender identity, as well as when, how, and to whom. Participants described the internal processes and myriad of decisions that needed to be made prior to their identity disclosure. Participants in our study reported nervousness about coming out to their loved ones, as well as uncertainty surrounding their loved ones’ perceptions of their identity disclosure. This nervousness is captured in one participant’s statement, “I was considering coming out to my mom, but I was too scared to” (Black/African American bisexual cisgender girl, age 14). Participant entries also included worries about possible awkwardness or altered treatment stemming from their identity disclosures; as a result, some participants reported being “not ready to come out.” Even for those participants with supportive social networks, the decision to disclose their identities could still be difficult, time-consuming, or nerve-wracking.

Subtheme VI: Fears of Being Outed

In addition to experiencing stress around deciding to come out, participants also reported concerns about their identities being disclosed without their consent. Examples of these fears included: worries that a sibling would out the participant to their parents, worries that someone would see an SGM pride symbol (e.g., a pride sticker on a phone case) and deduce the participant’s identity, or worries that someone would see the participant with a same-gender romantic partner. Participants were usually concerned about nonconsensual disclosures to parents or extended family members.

Subtheme VII: Concealment

Several participants reported negative experiences around concealing their SGM identities from others. Participants discussed changing their gender presentation, introducing a romantic partner as a friend, modifying their mannerisms, and not expressing dissent in response to homophobic or cissexist remarks as common forms of concealment. For many participants, identity concealment was a method to preserve individual safety and prevent intrusive questions from others. For some participants, however, identity concealment was a result of internalized shame about one’s identity or a fear of identity-based rejection. Concealment was often reported with older family members and religious loved ones, as well as in politically conservative areas, at school, or in the workplace. An example of the struggles associated with concealment follows:

I had to be a little cautious today because I was around a lot of family, and I didn’t know who knew I was gay. I didn’t want to be dropping any bombs out of carelessness, but it was annoying to have to moderate myself for that reason.

(American Indian and White, gay cisgender boy, age 17).

Subtheme VIII: Outness

Outness, for our participants, included instances of coming out, navigating specific moments of identity disclosure, or living as an openly SGM individual. Negative experiences related to outness were primarily rejection or discomfort when coming out, unwanted questions about SGM identity, or the burden of having to continuously disclose one’s identities in new environments. To this end, one participant noted that “[coming out] is also something you have to do with everyone” (White bisexual and cisgender girl, age 18).

Subtheme IX: Lack of Belonging

Whether out or closeted, participants described feelings of disconnection, loneliness, or being “out of place” in relation to their SGM identities. Adolescent participants discussed their lack of belonging in the context of not having SGM friends, being separated from their SGM friends, or dealing with internalized stigma about their own identity. One participant captured the distress associated with this lack of belonging in their response:

I don’t think I fit in anywhere – even being with friends who are lgbt feels like it drains me and I just don’t really want to have friends at all because it’s easier not feeling like an outsider all the time.

(Black/African American and White lesbian genderqueer person, age 18)

Theme IV: Negative or Inadequate Representation

An additional theme emerged regarding participants’ interactions with negative and inadequate representation of the SGM community, consisting of three subthemes: 1) negative media representation, 2) negative general social media, and 3) curriculum and teaching.

Subtheme I: Negative Media Representation

In our study context, negative media representation included participants’ reports of movies, TV shows, music, and news that portrayed SGM people in a negative light, documented hatred toward SGM people, or did not represent this population at all. Participant examples included: hearing “slurs about gay people” in radio music, not being able to relate to media character casts which were entirely cisgender and heterosexual, news coverage of homophobic or cissexist policies, erasure of canonically queer characters from film remakes, and the casting of a heterosexual and cisgender actress to play a transgender male historical figure.

Subtheme II: Negative General Social Media

Negative general social media representation comprised social media posts, videos, or comments that addressed users of a given platform and demeaned, criticized, or stereotyped the SGM community. Such content encompassed both internal and external community judgment towards people of specific gender and sexual identities, as well as demonetization of SGM content on YouTube, slur usage, and general “hate posts.” Social media content directed at a specific person was coded by perpetrator under the appropriate social rejection and discomfort subtheme.

Subtheme III: Curriculum and Teaching

Negative representation of the SGM community manifested in school curriculums through nonexistent, negative, or poorly executed teaching about SGM people. This included a lack of information about SGM sexual health in sexual education programming, overly “clinical” or othering discussions of the SGM community, presence of homophobic materials in the classroom, and allowance of anti-SGM sentiment to be expressed freely in a classroom setting.

Theme V: Structural Barriers and Cissexism-Related Stressors

Across interpersonal and intrapersonal experiences, transgender, nonbinary, and other gender diverse participants faced additional cissexist-related stressors, such as misgendering, negative reactions to gender expression, and experiences of gender dysphoria, which were not experienced by their cisgender peers. Beyond these cissexist-stressors at the inter/intrapersonal levels, transgender, nonbinary, and other gender diverse participants reported experiencing unique structural oppression-based stressors, and specific institutional barriers, that were not applicable for their cisgender peers. These structural barriers and cissexism-related stressors comprised two main subthemes: 1) difficulty accessing gender-affirming health care, and 2) barriers and negative experiences with bathrooms.

Subtheme I: Difficulty Accessing Gender-Affirming Health Care

Transgender, nonbinary, and other gender diverse adolescents in our sample described difficulties accessing health care which was affirming of their gender, in relation to both medical transition processes (i.e., hormones and gender affirming surgery) and “trans friendly” general medical care. Participants particularly emphasized the difficulties in finding medical care while transgender and discussed other institutional barriers, such as not being able to participate in sports after receiving hormone treatment. For several participants, culturally competent gender affirming care was difficult to find. Further, even for those participants who were able to access gender affirming care, additional barriers arose relating to insurance coverage and prescriptions.

Subtheme II: Barriers and Negative Experiences with Bathrooms

Participants who were transgender, nonbinary, and gender diverse reported barriers in using bathrooms that aligned with their gender identities, which included experiences such as: not having access to gender-neutral bathrooms, facing judgment when using the bathroom, and hearing negative comments about the existence of gender-neutral bathrooms. For many participants, there were no gender-neutral bathroom options in public settings or at school, with one participant noting:

The bathroom at school is always an issue because people who knew me before I came out look at me weirdly in the boys bathroom and I don’t want to go into the girls as well as girls telling me I’m wrong for enter[ing] the bathroom. The gender-neutral ones are for staff only.

(White and Latine gay genderqueer person, age 18)

Such sentiments highlight the unique barriers and lack of institutional supports that gender minority participants experienced, as separate from cisgender participants in our sample—though some cisgender participants also described frustrations with delayed opening of gender-neutral bathrooms at school.

Discussion

Given the pervasive oppression-based stress experiences of SGMA, the purpose of this study was to qualitatively examine the daily experiences of oppression-based stress and “lows” associated with identifying as an SGMA. The results of our study identified five main themes by which multi-level oppression-based stressors manifest in SGMA’s daily lives. These themes include: 1) experiences of social rejection or discomfort, 2) relationship-related stressors, 3) identity development and disclosure related stressors, 4) stressful experiences with negative representation of the SGM community, and 5) unique structural cissexism-based stressors. These themes add to existing literature on oppression-based stress and SGMA health by offering a deeper understanding of the day-to-day oppression-based stress experiences navigated by SGMA and the variety of social contexts in which they occur.

Social Rejection

Many of our participants reported experiencing social rejection from a variety of social groups, including family members, peers, teachers, and others in their lives. Experiences of oppression-based rejection ranged from being the specific target of slurs, jokes, misgendering, and negative comments, to more general experiences of judgment and identity erasure. These themes are consistent with distal minority stress as considered in minority stress models (Brooks, 1981; Hendricks & Testa, 2012; Meyer, 2003) and interpersonal oppression-based stressors (Mereish, 2024). Our findings are also consistent with prior literature on SGM youth, which has documented the varying types of family rejection, peer rejection, and school environment rejection that SGM youth experience (Russell & Fish, 2016). Additional research has shown that SGM youth are at a higher risk of bullying and social rejection than their cisgender and heterosexual peers, which ultimately has negative consequences for their mental health and wellbeing (Russell & Fish, 2016). Transgender, nonbinary, and gender diverse participants in our study were also subject to unique experiences of misgendering that differed from their cisgender peers; this is also consistent with prior gender minority stress models, which note that experiences such as misgendering and incorrect pronoun use contribute to identity nonaffirmation for gender minority individuals (Testa et al., 2015). Our analysis thus expanded upon this prior research by documenting that experiences of oppression-based social rejection for SGMA can go beyond immediate family and peers, and even including teachers, mentors, and external individuals with no prior relationship to the adolescent—thus permeating throughout an SGMA’s entire social world. It is important to consider the implications of such continuous social rejection for the health of SGMA. Specifically, daily, pervasive experiences of social rejection, as a result of oppression-based stress, may lead SGMA to evaluate themselves as having lower relational value (Cheek et al., 2020)—that is, perceiving that their relationships with others are not important—which could place SGMA at risk for poorer mental health outcomes as compared to their peers. Our study results also provide further insights into both the source of rejection and the content of this rejection. Given the ubiquitous nature of social rejection for SGMA, understanding both the rejection source and content is important for crafting familial-level and school-environmental interventions to improve the social support of SGMA (Madireddy & Madireddy, 2022).

Relationship Stressors

Discussion of relationships was common within participants’ responses, with many participants highlighting stressful events related to exploring their own romantic relationships and attractions. The most common examples of these stressors were uncomfortable romantic interests, breakups and conflict, or time spent apart from significant others. Our findings highlight relationship stressors relevant to many young people exploring romantic relationships during adolescence, which supports prior work that shows some commonalities in these relationship stressors between SGM youth and their non-SGM peers (Macapagal et al., 2015). Given the dearth of research on relationship stressors for SGMA, our findings also provide further insights into how SGMA experience and navigate stressors related to intimate relationships and the isolation they experience in finding romantic relationships. Unlike their cisgender heterosexual peers, SGMA may struggle to find a wide range of options for romantic partners, as the number of SGM youth in schools who have disclosed their identities could be fairly low (Mustanski et al., 2013). SGMA within our study experienced having to navigate the sexual orientation of their potential interests, along with other factors that could play into navigating romantic relationships as an adolescent, regardless of identity. Our participants also experienced stressors related to navigating conflict within their relationships, aligning with recent research demonstrating that sexual minority adolescents perceive themselves to have fewer romantic relationship skills as compared to their heterosexual peers (Perry et al., 2023). Given the lack of emphasis of relationship stressors for SGMA in current models of oppression-based stressors, future research should continue to examine the role of relationship stress as another avenue for oppression-based stressors to manifest within the lives of SGMA, with a particular focus on how relationship stressors intersect with the specific psychosocial needs of SGMA.

Identity Development and Disclosure

Prior literature has theorized adolescence as a key time for sexual orientation and gender identity development (Hall et al., 2021; Steensma et al., 2013). Specifically, during this time period, messages from peers, adults, and popular media serve to influence gender identity socialization and development (Brinkman et al., 2014). In similar ways, our participants’ responses also explored several themes and stressors associated with identity development and exploration among SGMA. Examples of these stressors included: SGMA questioning their sexual orientation or gender identity, reporting internalized self-stigma, navigating outness, and navigating identity concealment. Our participants’ reported experiences of internalized self-stigma, concealment, shame, and discomfort associated with their SGM identities are themes that align with proximal minority stressors as dictated by the minority stress model (Meyer, 2003), as well as internalized stigma models in oppression-based stress frameworks (Mereish, 2024). Furthermore, our findings support and build upon these oppression-based stress models by identifying additional forms of stressors that SGMA experience, specifically in relation to their identity development milestones (e.g., nonconsensual identity disclosures, discomfort with appearance and gender presentation, stressful identity-related decision making). Participants in our study expressed concerns surrounding nonconsensual identity disclosures, in which they feared having their SGM identities revealed to others in their lives without their express consent. While prior models of concealment have demonstrated its negative psychosocial impacts among SGM youth—such as reduced feelings of belonging (Newheiser & Barreto, 2014; Russell & Fish, 2016)—our findings present a novel understanding of how, beyond concealment, the fear of being outed can influence how SGMA conceptualize and develop their sexual and gender identities. Similarly, in our transgender, nonbinary, and gender diverse participants, identity development stressors specifically included experiences of dysphoria or discomfort towards their gender presentation. Such is consistent with prior research on gender dysphoria, which has noted its nature as a proximal minority stressor with relationships to internalized transphobia, self-stigma, and concealment experiences (Lindley & Galupo, 2020). As a unique intrapersonal oppression-based stressor for transgender, nonbinary, and gender diverse youth, it is important for research to continually examine how gender minority adolescents conceptualize their experiences of gender dysphoria. The experiences analyzed under this theme highlight the ways in which oppression-based stressors can converge across multiple interpersonal and intrapersonal contexts and highlight how oppressive experiences can inform the social construction and exploration of SGMAs’ social identities. Further models and frameworks of oppression-based stressors should consider, from a developmental perspective, how these fears of being outed can inform the trajectory of SGMA identity exploration and development. Continued exploration of identity development stressors as part of the broader continuum of oppression-based stressors for SGMA is warranted.

Representation

Another theme that emerged among our sample of SGMA included negative and vicarious oppression-based stress experiences surrounding a lack of SGM media, social media, and classroom representation. This theme encapsulated a range of experiences, including total absence of representation, inadequate representation, and negative representation. Previous research highlights that portrayals of SGM people in the media are often one-dimensional, stereotypical, and perpetuate homogenous narratives of the SGM community (McInroy & Craig, 2017). Participant responses also detailed a lack of representation within educational curricula, which is consistent with the 2019 National School Climate Survey, in which the majority of respondents indicated that they did not have access to lessons regarding SGM people, history, or events in school (Kosciw et al., 2020). This lack of curricular representation has only continued to decline, given the vast proliferation of anti-SGM legislation and censorship laws in recent years (Movement Advancement Project, 2023). Social media representation was also a topic of discussion for many participants, with participants noting negative experiences on social media both within and outside of the SGM community. Cyberbullying has been shown to increase risk for suicidal ideation and depression among SGM youth (Abreu & Kenny, 2018). As for intra-community experiences, previous research indicates that social media is often a safe space for identity development for SGM youth, with opportunities for social support and interaction (Craig et al., 2021). However, our findings suggest a need for further research into the potential risks associated with social media use for SGMA, specifically on an intra-community level. Considered holistically, our findings provide support for considering the lack of affirming SGM representation and vicarious exposure to stigma in this manner as oppression-based stressors, suggesting a need for future models of oppression-based stressors to incorporate these stressors as novel and salient in the lives of SGMA.

Structural Barriers and Cissexism-Specific Stressors

Gender minority adolescents in our sample reported unique stressors as compared to their cisgender sexual minority peers. Along with experiences of misgendering, gender dysphoria, discomfort with their gender presentation, and gender identity invalidation, these stressors specifically related to institutional oppression-based stressors, such as: lack of access to gender affirming healthcare and lack of access to gender-neutral bathrooms. Specifically, participants noted indecision over which bathroom to use in different circumstances, along with experiences of judgment over their choices. These stressors are consistent with extant findings, which indicate that SGM youth often must navigate uncomfortable, isolating, and unsafe bathroom environments (Porta et al., 2017). Additionally, experiencing bathroom discrimination has been found to be associated with depressive symptoms and suicidality for transgender and nonbinary youth (Price-Feeney et al., 2021). Our findings provide a further, qualitative contextualization of the phenomenological experiences of gender minority adolescents as they navigate bathroom discrimination. Participants also reported on the difficulty of accessing hormone therapy and gender affirmation surgery, along with a lack of trans-affirming experiences with healthcare providers. These experiences are aligned with previous research, which indicates that a lack of cultural competency, and delayed or limited access to hormones, are major barriers for gender minority adolescents in seeking gender affirming medical care (Gridley et al., 2016)—thus providing further evidence that advocacy is needed to dismantle structural cissexism as it manifests within access to gender affirming care. Ultimately, our findings further elucidate the unique oppression-based stress experiences of gender minority adolescents as distinct from those of cisgender sexual minority adolescents. Our findings additionally provide insights into how gender minority adolescents navigate their identity development in the context of structurally cissexist healthcare, school, and other social environments—highlighting a need for further advocacy to create more gender-affirming institutions and policies. Given that gender minority adolescents experience these stressors on top of a myriad of other oppression-based stressors, it is critical for researchers, educators, and policymakers to craft safer and more affirming spaces for transgender, nonbinary, and gender diverse youth. Further study into this area must also consider, from an intersectional perspective, how gender minority adolescents practice resilience and resistance against the continual convergence of structurally cissexist oppression-based stressors.

Limitations and Future Directions

There are several limitations of this study that have the potential to be addressed in future research. Participants were SGMA recruited from a diverse, metropolitan, mid-Atlantic region. Thus, our analyses are limited in their generalizability to other regional contexts, particularly those regions that may have more structurally heterosexist and cissexist policies and institutions. Future research should recruit a more geographically diverse sample of SGMA, in order to examine how regional contexts may impact the oppression-based stressors experienced by SGMA. Additionally, this study’s eligibility criteria (actively identifying as a sexual and or gender minority adolescent) may have excluded SGMA who have not yet solidified their identity labels; thus, our study may have excluded an SGMA subgroup with higher identity concealment and potentially more vulnerability to internalized oppression-based stressors. While the study’s use of daily diary methods allowed us to capture a robust snapshot of oppression-based stress experiences across a 21-day monitoring period, the responses of participants were limited to this short time period. Future research could employ both daily diary and longitudinal methods to accurately capture the oppression-based stress experiences of SGMA across their development. While our participant sample included a diverse range of gender identities, it is important to recognize that 90% of our sample identified as assigned female at birth. This limits our ability to extrapolate our findings to SGMA who are assigned male at birth, or who are assigned intersex at birth. Finally, we recognize that our study’s focus on negative, oppression-based experiences is limited in characterizing the unique, identity-based strengths that SGMA also experience. Strengths-based research perspectives (Mustanski & Macapagal, 2023) are necessary for a holistic understanding of how SGMA build resilience in response to oppression-based stressors.

Developing our field’s understanding of how oppression-based stressors manifest and impact the lives of SGMA is especially salient considering their critical developmental period (Blakemore & Mills, 2014; Schriber & Guyer, 2016). Given the impacts of chronic stressors in adolescence and their potential for impacting adulthood (Romeo, 2017; Soleimanpour et al., 2017), further research is needed to understand how exposure to a myriad of oppression-based stressors can impact developmental trajectories of SGMA into adulthood. As a result of existing within a significant and critical developmental stage, adolescents are highly vulnerable to the impacts of stressful events–such as oppression-based stressors–while, simultaneously, having the most to benefit from positive psychosocial interventions (Dahl et al., 2018; Sisk & Gee, 2022). While our work demonstrates how oppression-based stressors manifest in the lives of SGMA across a myriad of social contexts, it is also important to recognize how the multiplicity of social contexts that SGMA exist within also lend themselves to an abundance of domains for possible intervention and support for SGMA.

Given our findings, we suggest that several contexts exist as intervenable domains for potentially reducing the day-to-day oppression-based stress experiences of SGMA. Particularly, educational contexts serve as environments where multiple systems of social support can converge upon SGMA (i.e., parental support, peer support, curricular support, GSAs support, policy support, and climate support) (Leung et al., 2022). Positive SGM representation in educational curriculum has the potential to influence SGM identity acceptance and affirmation and reduce victimization experiences for SGM youth (Leung et al., 2022). Following this manner, positive SGM representation could also provide better frameworks and information to help SGMA navigate their identity development. In regard to the relationship stressors described by our participants, providing psychoeducation on healthy SGM romantic and sexual relationships could increase SGM relational representation, while also addressing the perceived lack of relationship skills that SGM youth experience in comparison to their peers (Perry et al., 2023).

Additionally, considering the unique cissexism-based stressors experienced by transgender, nonbinary, and gender diverse youth, future research and advocacy should aim to dismantle cissexism at the interpersonal and structural levels. Providing positive representations of diverse gender identities in educational curriculum could serve to bolster belonging and combat experiences of misgendering. Beyond educational curriculum, school leaders—such as administrators and principals—can leverage their positions of power to provide educational opportunities for staff members and parents alike, such as: including professional development training for educators on gender identity topics, and inviting broader community members to join panels on gender diversity and trans-affirming topics (Mangin, 2018). Policies at the national, state, and district levels should aim to include explicit protections against discrimination and bullying for transgender, nonbinary, and gender diverse students; indeed, research has demonstrated that specific policy protections for transgender students in antidiscrimination laws has the potential to reduce depressive symptoms for transgender adolescents (Miller-Jacobs et al., 2023). Policies should also aim to facilitate access to affordable and sustainable gender affirming care for gender minority adolescents from adolescence into adulthood. Ultimately, to maximize their efficacy, further interventions against oppression-based stressors are needed across intersecting individual, interpersonal, and structural levels to promote safe, affirming, and inclusive environments which support the well-being of SGMA.

Conclusion

Given the increasing health disparities that exist between SGMA and their cisgender and heterosexual peers, it is important for research to further understand and explore the key and unique psychosocial stressors which drive such disparities. Building upon prior oppression-based stress research, this study provides important insights into the multiple, perpetual, and intersecting ways that SGMA experience oppression-based stressors across varied social contexts in unique and nuanced ways. Future research should aim to continue to employ combinations of longitudinal, daily diary, and ecological momentary assessment techniques to capture the breadth and diversity of oppression-based stress experiences more accurately across development for SGMA. Our findings also provide support for further incorporation of identity development-related stressors and inadequate SGM representation within existing conceptualizations of oppression-based stress for SGMA. Based on the diverse experiences of SGMA, it is crucial for future research and clinical interventions to continue to formulate and utilize a more harmonized and developmental framework for understanding how oppression-based stress manifests in the lives of SGMA. Such a framework will need to examine the ways that the social contexts of SGMA influence the type, content, and different forms of oppression-based stressors they experience, in order to craft interventions and clinical treatments which successfully support the unique developmental and psychosocial needs of SGMA.

Table 2.

Negative experience percentages by gender, sexuality, and race/ethnicity.

			Total (%) (n = 696 entries)	Cisgender (%) (n = 420 entries)	Transgender & Nonbinary (%) (n = 276 entries)	Mono- sexual (%) (n = 182 entries)	Pluri- sexual (%) (n = 396 entries)	Other (%) (n = 104 entries)	White (%) (n = 444 entries)	Racial & Ethnic Minorities (%) (n = 252 entries)
Theme	Subtheme
Social Rejection and Discomfort	Family	Negative Comments	2.30	3.10	1.09	1.10	2.53	3.85	2.03	2.78
		Slurs	0.57	0.71	0.36	1.10	0.51	0.00	0.23	1.19
		Misgendering	1.72	0.24	3.99	0.55	1.77	3.85	2.25	0.79
		Identity Erasure	1.01	0.95	1.09	0.00	1.52	0.96	0.45	1.98
		Reactions to Gender Expression and Presentation	1.15	0.24	2.54	1.65	1.26	0.00	0.90	1.59
		General or Unspecified Judgment	1.58	1.43	1.81	1.10	1.52	2.88	1.58	1.59
	Friends and Peers	Negative Comments	2.59	2.14	3.26	3.30	2.27	2.88	2.70	2.38
		Insulting Jokes	3.30	3.10	3.62	2.75	4.04	1.92	4.05	1.98
		Slurs	1.72	2.38	0.72	1.10	1.77	1.92	1.80	1.59
		Misgendering	1.01	0.48	1.81	1.65	1.01	0.00	1.13	0.79
		Reactions to Gender Presentation and Expression	0.43	0.71	0.00	0.55	0.51	0.00	0.23	0.79
		Identity Erasure	1.29	1.19	1.45	0.55	1.77	0.96	1.58	0.79
		Vicarious Experiences	4.31	5.71	2.17	4.40	4.80	0.00	4.95	3.17
		General or Unspecified Judgement	2.87	3.33	2.17	3.30	2.27	3.85	2.25	3.97
	Teachers	Misgendering	1.44	0.00	3.62	0.55	1.77	1.92	1.13	1.98
		Identity Erasure	0.43	0.00	1.09	0.55	0.00	1.92	0.45	0.40
		General/Unspecified Judgement	0.86	0.48	1.45	1.10	1.01	0.00	0.90	0.79
	Other or Unspecified Individuals	Negative Comments	6.03	5.24	7.25	4.95	5.30	9.62	5.41	7.14
		Jokes	2.44	3.10	1.45	2.20	2.53	1.92	2.03	3.17
		Slurs	3.02	4.05	1.45	1.65	2.02	8.65	3.60	1.98
		Misgendering by Others	3.74	0.00	9.42	2.20	3.79	6.73	3.38	4.37
		Reactions to Presentation and Gender Expression	2.16	1.90	2.54	2.75	1.77	2.88	2.48	1.59
		Identity Erasure	2.01	1.67	2.54	1.10	2.53	1.92	1.80	2.38
		Negative Perceptions of SGM Relationship	0.57	0.95	0.00	0.00	0.76	0.96	0.68	0.40
		Sexual Harassment	1.15	1.19	1.09	2.75	0.51	0.96	0.68	1.98
		Staring	2.16	2.38	1.81	2.20	1.26	5.77	2.48	1.59
		Unspecified or General Judgement	3.02	3.33	2.54	1.65	3.03	5.77	2.70	3.57
Relationship Stressors	Inconvenient or Uncomfortable Romantic Interests		4.17	4.52	3.62	7.14	4.04	0.00	5.63	1.59
	Rejection, Break Up, or Conflict		3.59	5.48	0.72	6.59	2.27	0.96	2.70	5.16
Stress Related to Identity Development and Disclosure	Questioning		2.87	2.14	3.99	3.30	3.03	1.92	3.15	2.38
	Gender Dysphoria		3.16	0.00	7.97	2.75	4.04	0.96	3.60	2.38
	Internalized or Self-Stigma		10.92	12.86	7.97	14.29	10.35	8.65	11.49	9.92
	Discomfort with Appearance, Presentation, and Gender Expression		5.75	1.43	12.32	7.14	5.05	6.73	6.76	3.97
	Decision Making Around Disclosure		3.16	2.86	3.62	1.65	2.53	8.65	3.38	2.78
	Fears of Being Outed		1.87	1.90	1.81	1.65	1.52	3.85	2.25	1.19
	Concealment		10.20	12.86	6.16	11.54	9.85	10.58	13.06	5.16
	Outness		2.30	3.10	1.09	1.65	2.53	2.88	2.48	1.98
	Lack of Belonging		1.58	1.67	1.45	2.20	1.26	1.92	1.58	1.59
Negative or Inadequate Representation	Negative Media Representation		4.60	5.24	3.62	5.49	4.80	2.88	4.95	3.97
	Negative General Social Media		2.87	3.81	1.45	3.30	3.28	0.96	3.15	2.38
	Curriculum and Teaching		2.87	2.86	2.90	3.85	3.03	0.96	3.38	1.98
Structural Barriers and Cissexism- Related Stressors	Difficulty Accessing Gender-Affirming Health Care		1.15	0.00	2.90	1.10	1.52	0.00	0.45	2.38
	Barriers and Negative Experiences with Bathrooms		2.73	0.48	6.16	0.00	3.28	5.77	2.93	2.38

Note. Frequencies are expressed in percentage form and represent the percentage of oppression-based stress experience entries that involve the given subtheme for that demographic category. Monosexual participants include those who identified as gay or lesbian; plurisexual participants were those who identified as bisexual, pansexual, or queer; and other participants were those who identified as asexual, questioning, or unsure. Participants who identified as a racial minority or designated their ethnicity as Hispanic or Latino/a/x/e were categorized as racial and ethnic minorities.

Public Significance Statement.

The current study builds upon minority and oppression-based stress theories by providing in-depth insights and contextualization surrounding the daily oppression-based stress experiences of SGMA; several in-depth structural, interpersonal, and intrapersonal oppression-based stressors were identified. Particularly, stressors related to identity development, nonconsensual identity disclosures, romantic relationships, and inadequate SGM representation emerged as notable oppression-based stressors impacting SGMA on a daily basis. Our findings suggest that targeting these stressors could assist in the development of domain-specific interventions to build SGMAs’ resilience and resistance to experiences of oppression-based stress, in order to ultimately reduce the health disparities impacting this group.