First of its Kind Study Gives New Insights into Adolescent Experiences for Transgender Women of Color

A groundbreaking study published in the most recent issue of Transgender Health finds that young transgender women of color hit several developmental milestones significantly earlier than their white peers. These milestones include outward expressions of their transfeminine identity, first consensual sexual experiences, and integration of hormone use. The study's authors caution that while reaching these external milestones earlier in life may be empowering, experiences of sex at younger ages may put young transgender women of color at elevated risk for acquiring HIV and other sexually-transmitted diseases. They conclude that trans-affirmative health interventions at earlier ages may be needed to mitigate the risk of HIV acquisition.

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The study found that, on average, participants became aware of their transfeminine identity around age nine, with some as early as four. However, Black and Latina transgender women begin disclosing their identity to others between ages 13 and 15 while White transgender women typically do not do so until age 17. "The results of this study show significant disparities by race in how early young transgender women, especially persons of color, experience these milestones," noted the study's lead author, Arjee Restar MPH, PhDc of the Department of Behavioral and Social Sciences and Epidemiology at Brown University's School of Public Health. "Racial discrimination and norms of identity concealment/disclosure may lead young transgender women of color to reach these sexual milestones earlier than their white peers."

The study, titled "Developmental Milestones in Young Transgender Women in Two American Cities: Results from a Racially and Ethnically Diverse Sample," was conducted at Boston's Fenway Health and Lurie Children's Hospital of Chicago as part of Project LifeSkills (a randomized controlled trial with the goal of reducing risk HIV acquisition and transmission). It surveyed 298 transgender women between the ages of 16 and 29 on their sexual identity developmental milestones, making it the first empirical and qualitative study of its kind on young transgender women. It included a racially mixed sample of participants with 49% Black, 26% White, 12% Latina, 11% mixed race, and 2% Asian. All participants had been assigned male sex at birth and currently identify on the transfeminine spectrum. Additionally, participants were all English speaking and self-identified as having recently engaged in risky sexual behavior.

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This, and other recent studies, indicate that young transgender women report disproportionately higher rates of mental health issues (such as suicidal behavior), bias-driven violence, sexual assault, homelessness, HIV and other STIs, and more. People of color are even more disproportionately impacted by these issues.

These results suggest that stronger support systems for young transgender women, and earlier implementation of those systems, may be needed to maintain health. Such support systems include greater acceptance of transgender people by their families as well as trans-affirmative anti-bullying policies, sexuality education, and social support organizations in schools. Additionally, health care providers need to be aware of the impact that race and ethnicity may play on the developmental milestones among their young transgender patients.

"Developmental milestones, such as the age at which youth become aware of their transgender identity or the age at which they disclose their identity to others, are important considerations in providing care," said study co-author Dr. Sari Reisner, Director of Transgender Health Research at The Fenway Institute and Assistant Professor of Pediatrics at Harvard Medical School. "Care needs to be contextualized to provide content relevant to a young person's particular developmental trajectory." More info here.

The study "Developmental Milestones in Young Transgender Women in Two American Cities: Results from a Racially and Ethnically Diverse Sample" is available online.

Since 1971, Fenway Health has been working to make life healthier for the people in our neighborhoods, the LGBT community, people living with HIV/AIDS and the broader population. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues.

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