5 min read

Transgender Teens Face Stressors That Lead to Increased Substance Use

Jun 10, 2021 2:37:35 PM

Teen life is tough enough with all of its peer pressure, social media stressors, academic demands, and propensity for family discord. That's a lot for anyone to handle. Could life possibly get any tougher? Well, yes, it could. Imagine what life must be like for a transgender teen.

From Bullying to Violence, No Lack of Trouble for Transgender Teens

In addition to "typical teen traumas," transgender adolescents face the additional emotional and physical hurdles of bullying, harassment, rejection, threats, victimization, and violence directly resulting from their gender identity.  

In 2020 alone, at least 44 transgender and gender-nonconforming individuals were murdered - the most since Human Rights Campaign (HRC) began tracking this data in 2013.  There is no data to suggest how many of these murders were designated as hate crimes. But HRC, which has documented more than 200 deaths over the eight-year period from 2013 to 2020, acknowledges that the victims were killed by a combination of acquaintances, partners, and strangers and that some "involve clear anti-transgender bias." 

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In February, for example, a Pennsylvania mother killed her two children, including a 16-

year-old trans boy and his 22-year-old nonbinary sibling. These are but two of 28 transgender/gender-nonconforming murders committed less than six months into 2021 - a pace projected to easily surpass 2020's record of 44.  

HRC adds that in some cases the victims' transgender status "may have put them at risk in other ways, such as forcing them into unemployment, poverty, homelessness and/or survival sex work."

As information like this filters back to transgender teens, it contributes to their heightened sense of anxiety and fear, and begs the question: How are these individuals able to cope when exposed to so much bias, prejudice, and hate?

Trans Teens Turning to Alcohol to Cope

More than half of transgender teens - or gender minority (GM) adolescents - begin engaging in substance use as a means of enduring the stressors they face during their young lives. This conclusion is based on data from a study that was published in the open-access journal PLOS ONE.

This isn't to suggest that many teens - transgender or otherwise - don't use or experiment with tobacco, marijuana, or alcohol. Many do. But the report, written by Sabra L. Katz-Wise of Boston Children's Hospital and Harvard Medicine School and her colleagues, attributes greater emotional distress among GM youth to a higher likelihood of alcohol use than that of their cisgender (those who identify with biological birth gender) counterparts. 

Previous research indicated that substance use was 2½ to 4 times higher for GM youth than cisgender youth. 

Meanwhile, the current study examined the longitudinal effects of GM stressors in three areas:

  • Substance use in GM adolescents

  • Related risk factors such as internalized transphobia, depressive symptoms, and anxiety symptoms

  • Protective factors such as resilience, gender-related pride, family functioning, social support, and gender-related community connectedness

Participants in the study included 33 GM adolescents, ages 13-17, from the community-based longitudinal Trans Teen and Family Narratives Project. Each participant completed an online survey every six months - five in all - over a two-year period, staggered from 2015 to 2019.

At the outset of the study, 17% of the participants reported any kind of substance use: tobacco, marijuana, or alcohol. Two years later, at the conclusion of the study, the number of participants reporting any kind of substance use had more than tripled to 56%. 

Interestingly, higher exposure to GM stressors significantly increased the likelihood of trans teens engaging in alcohol use - but not tobacco or marijuana use. The study including no data regarding drug or opioid use. 

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Support from Family and Friends Can Help

Fortunately, there are factors that can mitigate the stressors that might otherwise lead to increased alcohol use. One is family functioning, which includes supportive structural, relational, and social properties associated with the family unit. The other is social support. However, these protective factors - as they relate to alcohol use - were found to be effective at lower levels of GM stress, but not at higher levels.

Researchers concluded that future interventions with GM adolescents should focus on addressing internalized transphobia while strengthening resilience, gender-related pride, and family functioning as measures to combat substance use.

"A study conducted by our team found better family functioning was associated with less self-harm and depressive/anxious symptoms, and greater self-esteem and resiliency among GM adolescents," the study's authors wrote.

Internalized transphobia, resilience, and gender-related pride were found to be the most significant mediators of associations between GM stressors and substance use. 

"Since GM adolescents appear to be using substances to cope with exposure to gender minority stressors, programs could assist adolescents in identifying adaptive coping strategies in response to such stressors," the report states. "GM adolescents should also be connected to resources where they can connect with other GM adolescents. Efforts on a macro-level to increase anti-discrimination policies and laws and decrease stigma toward GM individuals may ultimately improve the lives of GM adolescents by reducing exposure to gender minority stressors."

InSync EHR Software Relieves Stress for Mental Health Practices

The secret to relieving anxiety is to first identify stressors and pain points that are the source of the anxiety. Only then - after identifying the cause - can you begin to find solutions.

That approach certainly applies to practices with EHR systems that are less than efficient and with spotty support from their vendors. At InSync Healthcare Solutions, our software is fully supported and specialized for behavioral health practices. Providers can watch a stress-free demonstration below. The 5-minute snapshot of our software has easy-to-read callouts highlighting features. 

Mental Health EHR System Snapshot

5-minute InSync Mental Health Software Snapshot Demo

For a closer look at how our configurable, mobile-friendly software system can streamline workflows for your mental health practice, schedule a demo now with one of our experts. We're happy to answer questions and explain how our system can save you time and money. 



Human Rights Campaign: Fatal Violence Against the Transgender and Gender Non-Conforming Community is 2021

PLOS ONE: Longitudinal effects of minority stressors on substance use and related risk and protective factors among gender minority adolescents

Advocate: Trans and Nonbinary Siblings Shot to Death; Mother Charged



Andy Smith

Written by Andy Smith

Andy brings his passion for writing and editing, along with decades of experience, to research and compose stories that keep healthcare InSync. His articles take a deep dive into the trending and relevant issues of mental health, interoperability, physical therapy, speech therapy, substance abuse treatment, and CCBHC's - bringing clarity to the effects of emerging technology and Electronic Health Records on today's top healthcare stories.