WHAT'S KNOWN ON THIS SUBJECT: Puberty suppression has rapidly become part of the standard clinical management protocols for transgender adolescents. To date, there is only limited evidence for the long-term effectiveness of this approach after gender reassignment (cross-sex hormones and surgery). WHAT THIS STUDY ADDS:In young adulthood, gender dysphoria had resolved, psychological functioning had steadily improved, and well-being was comparable to same-age peers. The clinical protocol including puberty suppression had provided these formerly gender-dysphoric youth the opportunity to develop into well-functioning young adults. abstract BACKGROUND: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach. METHODS:A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated. RESULTS:After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Wellbeing was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. CONCLUSIONS:A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults. Pediatrics 2014;134:696-704 AUTHORS:

Transgender youth experience negative school environments and may not benefit directly from interventions defined to support Lesbian, Gay and Bisexual (LGB) youth. This study utilized a multi-method approach to consider the issues that transgender students encounter in school environments. Using data from two studies, survey data (total n = 2260, 68 transgender youth) from study 1 and focus groups (n = 35) from study 2, we examine transgender youth's experience of school harassment, school strategies implemented to reduce harassment, the protective role of supportive school personnel, and individual responses to harassment, including dropping out and changing schools. In both studies, we found that school harassment due to transgender identity was pervasive, and this harassment was negatively associated with feelings of safety. When schools took action to reduce harassment, students reported greater connections to school personnel. Those connections were associated with greater feelings of safety. The indirect effects of school strategies to reduce harassment on feelings of safety through connection to adults were also significant. Focus group data illuminate specific processes schools can engage in to benefit youth, and how the youth experience those interventions.

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Students’ perceptions of their school climates are associated with psychosocial and academic adjustment. The present study examined the role of school strategies to promote safety in predicting students’ perceptions of safety for gender nonconforming peers among 1415 students in 28 high schools. Using multilevel modeling techniques, we examined student‐ and school‐level effects on students’ perceptions of safety for gender nonconforming peers. We found that older students, bisexual youth, Latino youth, and youth who experienced school violence perceived their gender nonconforming male peers to be less safe. Similarly, we found that older students and students who experienced school violence and harassment due to gender nonconformity perceived their gender nonconforming female peers to be less safe. At the school‐level, we found that when schools included lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues in the curriculum and had a Gay‐Straight Alliance, students perceived their schools as safer for gender nonconforming male peers.

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The presence of a trans* family member can challenge existing theoretical notions about the development of gender in families. Emerging knowledge about trans* identities consolidates around 5 primary challenges to existing theoretical notions of gender: (a) non‐dimorphic sex, (b) nonbinary gender, (c) the biological and social construction of gender, (d) gender identity development, and (e) family meaning making about transgender identity. These challenges structure an examination of hetero‐ and cisnormative expectations within family theory and help unpack long‐standing tensions between essentialist and social constructionist views of gender development. This can play out in family theory through a recognition of the tension between upholding and decentering cisnormativity within families. This article pinpoints locations where current family theories require reexamination and expansion to accurately conceptualize the flexibility and variability of families with trans* members.

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Objective To explore family boundary ambiguity in the parent–child relationships of transgender youth. Background Transgender youth may perceive a lack of clarity about whether parents will accept their authentic gender expression, continue to support them physically and emotionally, and regard them as a member of the family. Uncertainty about being in or out of the family and whether family relationships endure is stressful and can lead to psychological distress, a sense of ambiguous loss, and frozen grief. Method Ethnographic content analysis was conducted based on interviews with 90 transgender youth recruited from community centers in 10 regions across 3 countries. Results Narratives revealed that transgender youth experienced family boundary ambiguity related to relational ambiguity, structural ambiguity, and identity ambiguity. Each experience of ambiguity obscured whether participants remained in the family and interpersonally connected to their parents. Conclusion Transgender youth actively navigated complex and ambiguous parent–child relationships whereby participants attempted to reconcile their need for authentic gender expression combined with their need for family connectedness and acceptance. Implications Family clinicians, educators, and policymakers are urged to consider family and transgender resilience through a lens of ambiguous loss and to promote a gender‐affirmative life‐span approach to clinical care for transgender individuals and their families.