Abstract
Past and current research has often utilized a binary (i.e., man/woman) category to measure gender and/or has combined multiple transgender identities into singular groups (e.g., transgender girls and nonbinary youth as one category). Yet, transgender communities are heterogenous and encompass much more than commonly recognized labels such as only transgender boys/girls and nonbinary youth. Furthermore, the small body of research that has investigated differences within transgender communities based on gender identity have found important health and behavioral differences. Using a large, national, sample of transgender youth (N=3,570), we investigated differences in health-relevant gender-affirming school experiences (i.e., being referred to by the correct pronouns or name, authentic gender expression through clothing, and access to restrooms/locker rooms) among diverse transgender youth. Adjusted models (for outness, sexual identity, age, and caregiver education) indicated that transgender boys and transgender girls reported significantly worse gender-specific experiences in schools related to pronoun and chosen name use as well as access to restrooms/locker rooms compared to youth with nonbinary gender diverse identities (e.g., demigender, nonbinary), with some exceptions. Further, transgender boys reported greater authentic gender expression through clothing relative to most other youth with nonbinary gender diverse identities (e.g., gender nonconforming, multi-other). These findings have implications for how we might develop targeted interventions given that we pinpoint several disparities in health-relevant gender-affirming school experiences among transgender youth based on their specific gender identity. Finally, this provides stakeholders with a greater understanding of the extent of heterogeneity within transgender communities.
Keywords: transgender youth, nonbinary, gender identity, gender expression
Transgender and gender diverse (TGD) youth continue to report harassment in school despite recent social progress and more positive attitudes toward TGD people.1 Notably, school harassment has been linked to several negative outcomes for TGD youth, such as greater depressive symptoms1 and school truancy.2 Further, some TGD youth face challenges not experienced by their cisgender peers, such as being called the wrong pronouns or name at school. Gender disaffirmation denies the expression of one’s identity,3,4 which can have a substantial negative impact on mental health.5 Many TGD youth are increasingly identifying with emerging identities under the broader transgender ‘umbrella’.6 Thus, greater precision in understanding the experiences of TGD youth in school such as pronoun and chosen name use, authentic gender expression through clothing, and restroom/lock room access, is an important step in elucidating the role identity plays in everyday life.
The role of self-identification among transgender youth
Given the wide range of expressions of gender identity,7 it is unsurprising that there are many different labels with which people come to identify. TGD youth increasingly report emerging identities, such as demigender, gender nonconforming, or nonbinary among others. Distinctions across identity labels may appear as differences in everyday experiences (e.g., transgender girls perceived as violating gender norms more than genderfluid youth).8 Further, there may be discrepancies between an individual’s identity, and the identity that they are perceived to have due to stereotypes.9 While there are similarities in identities among TGD people, they may also receive differential treatment based on different characteristics such as assigned sex at birth (e.g., all transgender people assigned male at birth are treated the same regardless of identity). Thus, investigation of gender-based experiences for TGD youth can allow for a greater understanding of the ways in which specific identities and experiences do and do not overlap.
Gender affirmation and school experiences among transgender youth
Gender affirmation is a complex process in which a person receives recognition and support for their gender identity and expression.10 To affirm their own identity, many TGD youth undergo a social transition to alter their expression so that it aligns with their gender identity, which has been linked to positive health-related outcomes, such as higher self-esteem.11,12 Social transitions can include adopting gender-affirming clothing, a new name, changing pronouns, or using restrooms in line with one’s gender identity.13,14 Facilitating social transition by allowing youth to express themselves freely conveys to youth that their identities are supported.15 However, the act of transitioning is not a linear process and does not have an end point16,17 and as such occurs in different ways. For example, TGD people may start to use different names or pronouns but not change their expression.18 Other TGD youth may choose not to engage in any of these behaviors, for a number of different reasons such as not feeling ready to transition, feeling comfortable in their current expression, fearing harassment, or navigating family dynamics (e.g., slowing one’s transition to allow for greater adjustment among family members).12,19,20 Given that there are many factors that can influence a transgender person’s transition (if they choose to do so), it is likely that identity plays an important role in experiences of gender-affirmation.21 What exactly these differences are is still unclear as little research has investigated how health-relevant gender-affirming school experiences differ across TGD identities. We acknowledge that diverse forms of transition for TGD are meaningful (including chemical and surgical transitions); however, this study concerns itself with social transitions specific to TGD.22
Current Study
Youth continue to identify their gender in diverse ways,23 serving as an impetus to uncover differences in experiences among different groups of TGD youth. Investigation of these differences24 can inform the ways in which we understand gender identity and develop future research with TGD youth. In the current study, we aimed to explore transgender youth’s experiences in school among a large, national, sample of sexual and gender diverse (SGD) youth, based on gender identity. Specifically, we investigate TGD youth’s reports of being affirmed in their pronouns and chosen name use, their authentic gender expression through clothing, and access to restrooms/locker rooms, and whether these experiences differed among TGD youth who identified as boys, girls, nonbinary, gender nonconforming/genderqueer, demigender, and those who reported multiple gender diverse identities.
Methods
Procedure
Data were drawn from the 2022 LGBTQ National Teen Survey, a larger study completed in collaboration with the Human Rights Campaign that investigated the experiences of SGD youth. Of the total sample (N=17,112), slightly less than one-third of participants (n=5,635; 32.9%) reported a TGD identity, which was the group of interest for this study (i.e., cisgender participants were removed from analyses). To participate, youth needed to identify as a sexual and/or gender diverse youth, reside in the U.S. at the time of survey completion, and be between the ages of 13 to 17 years old. Participants were recruited between April and December 2017 with assistance from several community partners, many of which had a nationwide presence. A waiver of parental consent was obtained. Following assent, participants completed an anonymous, online, self-report survey via Qualtrics. After survey completion, participants were given the option to enter a raffle for gift cards and were offered wristbands from the Human Rights Campaign. This study was approved by the University of Connecticut Institutional Review Board.
Measures
Gender identity.
Youth were provided with a check-all-that-applies question to indicate their gender identity. Options included boy, girl, transgender male/transgender boy, transgender female/transgender girl, nonbinary, genderqueer/gender nonconforming, or a different identity that youth wrote in themselves.
Participants who checked only one box and selected no other gender identity options were coded as the corresponding gender identity. Youth included in the transgender boy and transgender girl categories also include youth who reported a discordant sex assigned at birth from their gender. Youth write-in responses were coded and placed into corresponding categories where applicable (e.g., “transman” would be in the transgender boy category). Additionally, a substantial number of youth reported demigender, or another identity on the agender spectrum (e.g., grey-gender), as a write-in option and thus a demigender category was created. Youth who wrote-in genderfluid or genderflux were categorized into the gender nonconforming/genderqueer group (this option was already combined in the original survey).
A new gender identity variable with seven mutually exclusive categories was created, including transgender boys, transgender girls, nonbinary (i.e., those who only selected the nonbinary option), gender nonconforming/genderqueer (GNC), demigender, nonbinary+, and an additional group of youth who selected multiple gender identities but not nonbinary (i.e., youth who selected multiple gender identity labels as part of the original check-all-that-applies question). Identity categories were developed based on past SGD youth research23,25–27 and data analytic constraints (e.g., small sample sizes), which led to the development of two additional groups (i.e., nonbinary+ and “multiple other”).28,29
Research has found that some youth use nonbinary as an umbrella term and that they characterize a unique community among transgender youth.5,30 To align with this research we separated this group as they may be distinct from youth who report multiple identities but are not necessarily under the nonbinary umbrella. Research has also distinguished a nonbinary identity as non-fluid (i.e., not genderfluid). Perhaps youth identify as nonbinary in combination with other identities to express their expansive understanding of their gender. Further, nonbinary individuals are inherently defined by an opposition to, or separation from, a gender binary. This may not be the case for genderfluid individuals who could experience shifting experiences of being a girl and a boy, rather than identifying outside of the gender binary.28 To best represent these identities, we created a category (i.e., nonbinary+) for youth who reported a nonbinary identity in addition to other gender identities, and a separate, group (i.e., “multiple other”) that included youth with multiple gender identities not including a nonbinary identity.
Sexual identity.
Youth were asked to select one sexual identity. Options included gay/lesbian, bisexual, heterosexual (heterosexual youth also had to identify as transgender to be eligible for the study), and “something else,” which provided additional options including queer, pansexual, asexual, questioning, and a write-in option.
Transgender youth’s experiences in school.
Four items were used separately to assess youth’s experiences in school related to their gender identity and expression. Youth were asked about whether “at school, do adults and students call you by the pronouns (e.g., she, her, hers) that you want to be called?” as well as similar items about chosen names and whether youth were able to dress and express themselves in a way that matches their gender identity (i.e., authentic gender expression through clothing). Finally, youth were asked whether they had access to restrooms/locker rooms that matched their gender identity. Items related to correct pronoun or name use, as well as restroom/locker room access were on a scale of 0 (Never) to 4 (Always) and being able to dress in a way that matches their gender identity was on a scale of 0 (Not at all) to 4 (Completely). Higher scores indicate more frequent gender-affirming school experiences.
Outness in school.
The degree to which transgender youth believed that they were out was assessed with the question “For each of the following groups, how many people currently do you think know that you are transgender or nonbinary?” with a list of people that they believed might know that they are transgender (e.g., parents). Five of the 12 items related to school and were used to create an average score for outness at school which included SGD friends, non-SGD friends, classmates, teachers and adults, and athletic coaches. Items were on a scale of 0 (None) to 4 (All) with a higher average score indicating that youth believed that more people were aware of their transgender identity. Average outness scores showed good reliability in our sample, α=.87.
Data Analytic Plan
We first report demographic characteristics (Table 1) and descriptive statistics (Table 2). Following, a series of generalized linear models were conducted to investigate differences in gender-affirming school experiences among youth by gender. Each individual item (i.e., pronoun use, name use, authentic gender expression through clothing, and restroom/locker room access) was used as a singular outcome variable, given the ways in which context influences each of these four outcomes.31 All adjusted models included outness, sexual identity, assigned sex at birth, age, and caregiver education attainment (a proxy for income) as covariates that may be associated with our study outcomes.32,33 We report partial η2 for all variables to indicate the contributions of each covariate relative to the overall model and gender identity (see Table 3 for all omnibus model statistics).34 We used Bonferroni corrections when analyzing all post-hoc differences between each of the different identity groups (Table 2).
Table 1.
Demographic characteristics of transgender youth
| Transgender boy (n=1315) | Transgender girl (n=146) | Nonbinary (n=506) | Gender nonconforming (n=378) | Demigender (n=92) | Nonbinary+ (n=764) | Multi-Other (n=369) | Total (N=3570) | |
|---|---|---|---|---|---|---|---|---|
| Sexual Identity | ||||||||
| Asexual | 80 (6.1%) | 10 (14.6%) | 49 (9.%) | 32 (8.4%) | 10 (10.9%) | 100 (13.1%) | 14 (3.8%) | 295 (8.3%) |
| Bisexual | 356 (27.1%) | 46 (31.5%) | 104 (20.5%) | 80 (21.1%) | 12 (13.0%) | 168 (22.0%) | 95 (25.7%) | 861 (24.1%) |
| Heterosexual | 137 (10.4%) | 19 (13.0%) | 2 (.4%) | 1 (.3%) | 1 (1.1%) | 3 (.4%) | 3 (.8%) | 166 (4.6%) |
| Lesbian/Gay | 259 (19.7%) | 31 (21.2%) | 128 (25.3%) | 93 (24.6%) | 23 (31.5%) | 147 (19.2%) | 121 (32.8%) | 802 (22.5%) |
| Pansexual | 293 (22.3%) | 27 (18.5%) | 160 (31.6%) | 111 (29.4%) | 29 (11.9%) | 190 (24.9%) | 72 (19.5%) | 882 (24.7%) |
| Queer | 94 (7.1%) | 5 (3.4%) | 34 (6.7%) | 32 (8.5%) | 11 (12.0%) | 97 (12.7%) | 45 (12.2%) | 318 (8.9%) |
| Questioning | 50 (3.8%) | 4 (2.7%) | 16 (3.2%) | 15 (4.0%) | 0 (0%) | 19 (2.5%) | 9 (2.4%) | 113 (3.2%) |
| Other | 46 (3.5%) | 4 (2.7%) | 13 (2.6%) | 14 (3.7%) | 6 (6.5%) | 40 (5.2%) | 10 (2.7%) | 133 (3.7%) |
| Assigned Sex at Birth | ||||||||
| Female | 1314 (99.92%) | 4 (2.7%) | 468 (92.5%) | 341 (90.2%) | 79 (85.9%) | 707 (92.5%) | 302 (81.8%) | 3215 (90.1%) |
| Male | 1 (.08%) | 142 (97.3%) | 38 (7.5%) | 37 (9.8%) | 13 (14.1%) | 57 (7.5%) | 67 (18.2%) | 355 (9.9%) |
| Race | ||||||||
| Asian | 29 (2.2%) | 7 (4.8%) | 13 (2.6%) | 12 (3.2%) | 2 (2.2%) | 33 (4.3%) | 11 (3.0%) | 107 (3.0%) |
| Black | 28 (2.2%) | 6 (4.1%) | 15 (3.0%) | 17 (4.5%) | 3 (3.3%) | 28 (3.7%) | 12 (3.2%) | 109 (3.0%) |
| Hispanic/Latino | 105 (8.0%) | 6 (4.1%) | 47 (9.3%) | 48 (12.7%) | 5 (5.4%) | 58 (7.6%) | 29 (7.8%) | 298 (8.3%) |
| Middle Eastern | 4 (.3%) | 0 (0%) | 3 (.6%) | 1 (.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 8 (.2%) |
| Native American | 10 (.7%) | 1 (.7%) | 1 (.2%) | 0 (0%) | 1 (1.1%) | 3 (.4%) | 2 (.5%) | 18 (.5%) |
| White | 924 (70.3%) | 106 (72.6%) | 344 (68.0%) | 236 (62.4%) | 67 (72.8%) | 492 (64.4%) | 247 (66.9%) | 2416 (67.7%) |
| Bi- or Multi-racial | 208 (15.8%) | 20 (13.7%) | 80 (15.8%) | 59 (15.6%) | 14 (15.2%) | 146 (19.1%) | 65 (17.6%) | 592 (16.6%) |
| Other | 6 (.5%) | 0 (0%) | 2 (.4%) | 3 (.8%) | 0 (0%) | 3 (.4%) | 2 (.5%) | 16 (.4%) |
| Caregiver Education | ||||||||
| Less than high school | 40 (3.0%) | 2 (1.4%) | 12 (2.4%) | 13 (3.4%) | 5 (5.4%) | 16 (2.1%) | 11 (3.0%) | 99 (2.8%) |
| High school or GED | 225 (17.1%) | 14 (9.6%) | 71 (14.0%) | 54 (14.3%) | 6 (6.5%) | 83 (10.8%) | 43 (11.6%) | 496 (13.9%) |
| Vocational or Technical | 43 (3.3%) | 4 (2.7%) | 15 (3.0%) | 13 (3.4%) | 2 (2.2%) | 21 (2.7%) | 12 (3.2%) | 110 (3.1%) |
| Some college | 249 (18.9%) | 25 (17.1%) | 81 (16.0%) | 52 (13.8%) | 11 (12.0%) | 121 (15.8%) | 49 (13.3%) | 588 (16.4%) |
| College graduate | 458 (34.8%) | 53 (36.3%) | 189 (37.3% | 137 (36.2%) | 35 (38.0%) | 266 (34.8%) | 125 (33.9%) | 1263 (35.3%) |
| Postgraduate | 300 (22.8%) | 48 (32.9%) | 138 (27.3%) | 109 (28.8%) | 33 (35.9%) | 257 (33.6%) | 129 (35.0%) | 1014 (28.4%) |
| Age | 15.55 (1.24) | 15.75 (1.22) | 15.45 (1.31) | 15.25 (1.34) | 15.16 (1.30) | 15.52 (1.34) | 15.55 (1.28) | 15.50 (1.29) |
Note. Not all columns total to 100% due to missing data
Table 2.
Adjusted models, mean scores, and post-hoc differences in gender-affirming school experiences by gender identity
| Transgender boy (n=1315)1 | Transgender girl (n=146)2 | aNB (n=506)3 | bGNC (n=378)4 | cDemi (n=92)5 | dNB+ (n=764)6 | Multi-Other (n=369)7 | Total (N=3570) | |
|---|---|---|---|---|---|---|---|---|
| Pronoun | 1.85 (1.34)3,5,7 | 1.51 (1.44)5,7 | 1.19 (1.41)1,4,5,6,7 | 1.61 (1.55)3,7 | 2.01 (1.51)1,2,3 | 1.67 (1.49)3,7 | 2.61 (1.55)1,2,3,4,6 | 1.76 (1.48) |
| Name | 2.35 (1.49)2,5,6,7 | 1.72 (1.53)ALL | 2.09 (1.70)2,5,6,7 | 2.25 (1.66)2,5,7 | 2.85 (1.45)1,2,3,4 | 2.52 (1.60)1,2,3,7 | 2.98 (1.43)1,2,3,4,6 | 2.39 (1.58) |
| Dress | 3.22 (1.04)2,3,4,6,7 | 1.64 (1.46)1,5,6,7 | 2.29 (1.19)1 | 2.23 (1.24)1,7 | 2.48 (1.10) 2 | 2.46 (1.09)1,2 | 2.44 (1.16)1,2,4 | 2.66 (1.22) |
| Rest | 1.12 (1.56)4,5,6,7 | .99 (1.53)4,5,6,7 | 1.24 (1.62)4,5,6,7 | 1.66 (1.70)1,2,3,7 | 1.86 (1.76)1,2,3 | 1.57 (1.68)1,2,3,7 | 2.51 (1.70)1,2,3,4,6 | 1.45 (1.68) |
Note.
NB = nonbinary
GNC = gender nonconforming/genderqueer
Demi = demigender
NB+ = nonbinary+.
Dress = authentic gender expression through clothing. Rest = restroom/locker room access. All post-hoc differences were significant at the level of α = .05, following Bonferroni corrections. Superscripts listed next to pronoun, name, dress, or restroom/locker room values indicate a significant difference between corresponding gender identity group for that column and the relevant reference group indicated by the superscript in the top row of the table. For example, transgender boys are significantly different from nonbinary, demigender, and multi-other youth as it relates to pronoun use. Adjusted models include sexual identity, assigned sex at birth, caregiver educational attainment, participant age, and transgender identity outness as covariates.
Table 3.
GLM results assessing differences in pronoun use, name use, gender expression through clothing, and restroom access
| Pronoun Use | Name Use | Authentic gender expression through clothing | Restroom/Locker room Access | |||||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Variable | F | Partial η2 | F | Partial η2 | F | Partial η2 | F | Partial η2 |
| Intercept | .59 | < .001 | 1.65 | < .001 | 28.05*** | .01 | .23 | < .001 |
| Gender identity | 38.08*** | .06 | 30.26*** | .05 | 25.43*** | .04 | 39.03*** | .06 |
| Sexual identity | 7.52*** | .02 | 4.26*** | .01 | 5.64*** | .01 | 7.79*** | .02 |
| Caregiver Education | 3.79** | .01 | 4.98*** | .01 | .52 | .001 | 10.20*** | .01 |
| Assigned sex at birth | 1.67 | < .001 | 6.15* | .002 | 64.61*** | .02 | .98 | < .001 |
| Age | 33.12*** | .01 | 57.27*** | .02 | 6.89** | .002 | 21.59*** | .01 |
| Outness | 111.35*** | .03 | 202.04*** | .05 | 283.59*** | .07 | 2.54 | .001 |
| Omnibus F(21,3548) | 22.30 | .12 | 22.21 | .12 | 49.62 | .23 | 18.93 | .10 |
p<.05
p<.01
p<.001.
Note: Table represents four separate generalized linear models (GLMs) to summarize overall adjusted model statistics. Gender identity, sexual identity, caregiver education, and assigned sex at birth are categorical variables, with age and transgender identity outness as continuous variables. All overall adjusted models were significant at the level of α = .001.
Of the subsample of TGD youth, between 29–39% had missing data on at least one of the study outcomes. However, most youth in the survey with missing data on study outcomes were also missing on the vast majority of other items in the study. Thus, we chose to use only data from participants with responses on all study outcomes (n=3,570) to avoid imputing missing data based solely on demographic characteristics. No consistent pattern emerged in demographic characteristics among participants based on study completion.
Results
Demographic and descriptive characteristics of gender diverse youth
On average, youth were 15.5 years old (SD=1.29). Transgender boys constituted the largest group of gender diverse youth (n=1,315; 36.8%), followed by the nonbinary+ group (n=764; 21.4%), with all other individual gender identity groups comprising 15% of the sample or less. Most youth were assigned female at birth (n=3,215; 90.1%). In terms of sexual orientation, pansexual-identified youth was the largest group of youth (n=882; 24.7%), followed closely by bisexual (n=861; 24.1%), and gay/lesbian (n=802; 22.5%), with all other individual sexual orientation groups comprising 10% or less of the sample. The two largest racial-ethnic groups were White (n=2,416; 67.7%) and multi-racial (n=592; 16.6%). As it relates to caregiver educational attainment, the most common response was having a caregiver with a college degree (n=1,263; 35.4%; see Table 1 for additional demographic information).
Pronoun use in school
There were differences in transgender youth’s reports of being called by the correct pronouns in school, F(21,3548)=22.30, p<.001, with significant post-hoc differences. Nonbinary (M=1.19; SD=1.41) youth reported significantly lower correct pronoun use in schools compared to all other groups except transgender girls (M=1.51; SD=1.44). The multi-other (M=2.61; SD=1.55) group reported significantly greater correct pronoun use than all other groups except demigender (M=2.01; SD=1.51) youth. Transgender boys (M=1.85; SD=1.34) and girls reported significantly lower correct pronoun use compared to demigender youth. Last, the nonbinary+ (M=1.67; SD=1.49) group reported significantly greater correct pronoun use compared to nonbinary youth (Table 3).
Name use in school
There were also differences in youth’s reports of being called by the correct name in school, F(21,3548)=22.21, p<.001, with significant post-hoc differences. Transgender girls (M=1.72; SD=1.53) reported being referred to by the correct name in school significantly less than all other gender identity groups. Youth in the multi-other (M=2.98; SD=1.43) group reported significantly greater correct name use in schools than all other gender identity groups except demigender (M=2.85; SD=1.45) youth. Further, demigender youth reported significantly greater correct name use compared to transgender boys (M=2.35; SD=1.49), transgender girls, nonbinary (M=2.09; SD=1.70), and GNC (M=2.25; SD=1.66) youth. Last, nonbinary+ (M=2.52; SD=1.60) youth reported significantly greater correct name use in school compared to transgender boys, transgender girls, and nonbinary youth (Table 3).
Authentic gender expression through clothing in school
There were differences in youth’s reports of authentic gender expression through clothing, F(21,3548)=49.62, p<.001, with significant post-hoc differences. Transgender boys (M=3.22; SD=1.04) reported significantly greater authentic gender expression through clothing compared to all other gender identity groups except demigender (M=2.48; SD=1.10) youth. Further, transgender girls (M=1.64; SD=1.46) reported a significantly lower degree of authentic gender expression through clothing compared to demigender, nonbinary+ (M=2.46; SD=1.09), and multi-other (M=2.44; SD=1.16) youth. Finally, multi-other youth reported significantly greater authentic gender expression through clothing compared to GNC (M=2.23; SD=1.24) youth (Table 3).
Restrooms/locker room access
There were differences in youth’s ability to use the restroom/locker rooms in school that they felt most accurately reflected their gender identity, F(21,3548)=18.93, p<.001, with significant post-hoc differences. Transgender boys (M=1.12; SD=1.56), transgender girls (M=1.64; SD=1.46), and nonbinary (M=1.24; SD=1.62) youth reported that they had access to the correct restroom/locker room in school significantly less than GNC (M=1.66; SD=1.70), demigender (M=1.86; SD=1.76), nonbinary+ (M=1.57; SD=1.68), and multi-other (M=2.51; SD=1.70) youth. Additionally, the multi-other group also reported that they had access to the correct restroom/locker room in school significantly more than GNC and nonbinary+ youth (Table 3).
Discussion
With the proliferation of unique gender diverse identities among youth there is a need to understand TGD youth’s experiences in schools and how these experiences relate to gender identity and expression.35 The role that self-identification plays in TGD youth’s gendered school experiences—particularly in the context of identifying with one or more gender identities—is still unclear. To address these shortcomings, the current study investigated chosen pronoun and chosen name use, authentic gender expression through clothing, and restroom/locker room access in a sample of TGD youth. These findings suggest that TGD youth who identify with multiple gender identities or an identity that is not binary report more frequent gender-affirming school experiences, with some exceptions.
Although youth with nonbinary gender diverse identities reported more frequent gender-affirming school experiences, no one pattern emerged across our four school outcomes. We found that transgender boys and girls reported lower incidences of being referred to by the correct pronouns by others in school than demigender and multi-other youth. Further, nonbinary youth were lower than all other groups, excluding transgender girls, which may be due to a greater likelihood in the use of singular they pronouns. This change may, inappropriately, be perceived as a more difficult adjustment in language by others relative to those who use binary pronouns.36 The differences based on chosen name use were generally the same as pronoun use with one exception. Nonbinary youth reported being referred to by their chosen name less often than most other groups, however, transgender girls were the lowest compared to all other groups. Further, the multi-other group reported being called by the correct name more often relative to all other gender identity groups in the sample. It is likely that peers and/or school authorities act more discriminatory towards transgender girls. This would align with research that, relative to assigned female at birth (AFAB) people, assigned male at birth people often experience higher levels of mistreatment.37
Unlike pronouns and chosen name, the group differences that emerged related to authentic gender expression through clothing did not hold the same pattern. Transgender boys reported greater authentic gender expression through clothing than all other groups excluding demigender youth. One interpretation is that there are more avenues through which transgender boys are able to express themselves through clothing that are not available to other TGD groups.38 Although the timing pubertal stages may be related how a TGD youth may present themselves to others (e.g., breast development), the range of clothing and gender expression that is perceived as acceptable is oftentimes wider for AFAB youth compared to those assigned male at birth.37 For instance, AFAB youth may be perceived as a tomboy and be able to wear clothing that authentically expresses their gender, at the expense of their TGD identity being invalidated.39
Youth who identified as gender nonconforming, demigender, nonbinary+, and multi-other reported greater restroom/locker room access compared to transgender boys and girls, and nonbinary youth. Multi-other, nonbinary+, demigender, or gender nonconforming youth may feel as if neither women’s nor men’s restroom/locker room label fits them, counterintuitively leading to greater restroom/locker room access. If neither label applies, youth may not feel restricted in the same way that binary transgender youth feel when confronted with restroom/locker room choice.
Our study is not without limitations. Although there was considerable variation in gender identity categories, there are still gender identities that are not represented among these groups. This is because some identities are overlapping and to avoid having individuals in multiple groups, they were excluded. For example, as transmasculine youth often straddle a line between identifying as a transgender boy and as nonbinary we were unable to place them into just one of these categories. However, the ability to have as many gender identity categories represented in our study is a notable improvement on previous work. The measure of gender identity outness in this study was not previously validated, as it was created for this study. Our data are also cross-sectional, so caution should be taken in tying causality in study outcomes based solely on gender identity. Finally, we utilized complete case analysis to address missing data given the patterns of missingness and because almost all missing data was related to participants who terminated the survey after providing only demographic data.
This work has several strengths and adds to the broader literature on the experiences of TGD youth in schools in three ways. First, there are few published studies with a large enough sample to be able to differentiate TGD youth based on gender diverse identities.23 These findings represent an important step forward in elucidating the complexities of school life among TGD youth. Second, past research has often focused singularly on specific TGD experiences such as chosen name4 or restroom use. This may be the first work to identify differences in gender identities across multiple different experiences for TGD youth. Third, these differences are rigorous and emerge even after including several contextual factors. That gender identity, in most instances, contributes a greater amount of variance than outness indicates that identity labels play a crucial role in one’s experiences.
This work also has implications for policy, practice, and the role of school authority figures (e.g., teachers; social workers) as advocates for change. These findings highlight the need to differentiate the experiences of TGD youth in schools given the growing policy concerns surrounding pronoun and name use.40 Given our findings which suggest that school policies do not address the substantial diversity of experiences TGD youth have in school settings, this work also supports school authority figures in advocating for changes to policy and affirming TGD youth. Thus, policies need to be altered to ensure that all students are treated with respect and are affirmed in their identities. Further, acknowledging that TGD youth receive differential treatment based on their gender identity is the first step in developing policies and informing clinicians to ensure support for all students. Finally, this work highlights an ongoing need to understand the ways in which youth use emerging terms to classify their gender identities. Research must continue to investigate the ever-evolving language that youth use to describe their gender identities, as our work indicates that even the act of labeling oneself is associated with differences in experiences.
Conclusion
The current study extends research on TGD youth’s gender-affirming experiences in schools by investigating differences based on multiple different gender diverse identities. Broadly, youth who identified with multiple gender diverse identities report more frequent health-relevant gender-affirming school experiences compared to those who identified with a binary identity, with some exceptions. Findings suggest that the role of self-identification should not be understated when investigating the experiences of TGD youth.
Public health significance statement:
Despite increasing numbers of transgender youth, we know little about the health-relevant, gender-affirming school experiences or heterogeneous identities of transgender youth. Binary transgender youth reported worse gender-affirming school experiences relative to nonbinary or multiple gender identity youth. These findings can inform school interventions toward specific groups of transgender youth.
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