Gender variations, generational effects, and mental health of transgender people in relation to timing and status of gender identity milestones.

Abstract

Transgender and gender diverse (TGD) people commonly report the following gender identity milestones: feeling different about their gender than expectations for their sex assigned at birth, identifying as TGD, living in their affirmed gender, and, for some, accessing gender-affirming medical care. We explored the average ages of reaching these milestones and variations across gender groups and generational cohorts. We also examined how gender groups, generational cohorts, and endorsement of reaching each of the milestones related to minority stress variables and mental health. This online study included 695 TGD individuals ages 16 -73. Boomersϩ and Generation X groups were more likely to identify as trans women compared with the younger generational cohorts, who were more varied in their identities. Trans women had later ages of starting to live in their affirmed gender and receiving gender affirming medical care compared with other gender groups. The Boomersϩ cohort reported later ages for the milestones compared with other generational cohorts. And, finally, younger generational cohorts had higher levels of internalized stigma, anxiety, and depression, compared with the older cohorts. Gender congruence emerged as a consistent predictor of mental health in the full sample and within each generational cohort. There are important generational differences across identity milestones, minority stress, and mental health that need exploration in future longitudinal research. In addition, beyond the effects of milestone timing, reporting feelings of congruence with one's gender identity is an important consideration for mental health. Public Significance StatementChallenges for gender minorities vary across generational context; younger generational cohorts of transgender individuals experienced greater challenges in relation to minority stressors and mental health, whereas older generational cohorts experienced gender identity milestones at later ages. Milestone status is especially important for more positive mental health outcomes for transgender individuals.

Gender Identity Milestones, Minority Stress and Mental Health in Three Generational Cohorts of Italian Binary and Nonbinary Transgender People

“…Indeed, the latest versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [13] and the International Classification of Diseases (ICD-11) [14] declared that the incongruence between one's perceived gender and the sex assigned at birth can no longer be considered a pathological condition. Similarly, a significant shift has been observed with respect to the perceived gender identity of TGNC individuals, with younger cohorts being more likely to self-identify within a nonbinary spectrum of gender compared with older cohorts of TGNC people [15][16][17]. These two examples could represent significant instances of detecting a socio-cultural change around attitudes and perceptions of TGNC identity, and it is plausible that TGNC individuals themselves are influenced by these changes in the ways they experience their own identity as well as in the rates of stigmatization and, therefore, of health problems.…”

“…These two examples could represent significant instances of detecting a socio-cultural change around attitudes and perceptions of TGNC identity, and it is plausible that TGNC individuals themselves are influenced by these changes in the ways they experience their own identity as well as in the rates of stigmatization and, therefore, of health problems. Indeed, the most recent research trend in the tradition of studies concerning the LGB and TGNC health consists in matching the MST with the life-course perspective (LCP)-that is, a useful framework to analyze people's health needs and experiences over the course of their life-to detect potential differences in terms of life experiences, stress, and health, and to construct a culturally sensitive picture of this population [17][18][19].…”

“…Thus, examining generational cohorts allows assessing the roles of socio-cultural context and individual differences. As the premise of the MST is that minority stress should be understood in the social context, and during the last years, many positive changes occurred in the social environment for both sexual (i.e., LGB) and gender (i.e., TGNC) minority individuals, the few studies matching the MST and LCP started from the hypothesis that younger cohorts would experience lower levels of minority stress and, as a consequence, lower mental health problems than older cohorts [17,[23][24][25]. Indeed, some research in the sociological field talked about a general decline of sexual prejudice in social contexts [26][27][28].…”

“…For instance, gender identity milestones in TGNC individuals mainly concern: (a) the age of first insights about being TGNC; (b) the age at which they self-labeled as a TGNC person; (c) the time at which they came out as TGNC; and (d) the age at which they started to live full time as a TGNC person and underwent some kind of medical gender-affirmation procedure (e.g., hormonal treatment) [15]. However, the few research in this field-conducted with U.S. samples-reported that, although sexual and gender identity milestones varied significantly among cohorts, with younger participants reporting earlier ages for the milestones compared with older cohorts, neither minority stress nor mental health resulted improved in younger cohorts both in LGB [24] and TGNC [17] samples; on the contrary, mental health was worse in the younger cohorts than the older ones. These studies concluded that changes in the social contexts would have a limited impact on stress processes and, therefore, on the mental health of minority groups, highlighting the persistence of cultural, ideological systems that perpetuate differences in identity status (e.g., homophobia, transphobia, cisgenderism, and heteronormativity) and reproduce health disparities.…”

“…Thus, within the MST and the LCP, the current study aimed to explore whether the gender identity milestones, minority stress, and mental health vary among different generational cohorts of Italian TGNC individuals. Based on the studies by Meyer et al [24] and Puckett et al [17], we hypothesized that: (1) younger generations will report higher percentages of nonbinary identity than older counterparts; (2) younger cohorts will report earlier ages for the milestones compared with older cohorts; (3) levels of minority stressors will not vary among different generational cohorts; and (4) younger cohorts will report worse levels of mental health than older counterparts. Furthermore, we also explored the role of sex assigned at birth (AMAB vs. AFAB) and gender identification (binary vs. nonbinary), as both of these variables are crucial dimensions in minority stress experiences and mental health [17].…”