Gender Expansive Youth Disclosure and Mental Health: Clinical Implications of Gender Identity Disclosure

Some health care providers work with gender expansive youth; preliminary evidence notes that many of these youth do not disclose their gender identity to all of their health care providers. No previous research focused on youth has explored gender identity disclosure to health care providers, nor linked youth disclosure to negative mental health outcomes (e.g., symptoms of depression). Data were drawn from the LGBTQ National Teen Survey to test the relationship between gender identity disclosure, symptoms of depression, and self-esteem among 13- to 17-year old (n = 5,637, M-age = 15.6) participants who identified as transgender boys, transgender girls, and nonbinary youth assigned female at birth (AFAB) or assigned male nonbinary youth assigned male at birth (AMAB). Transgender boys reported the highest symptoms of depression and the lowest levels of self-esteem in comparison with other groups. Among the full sample, 66.8% had not disclosed their gender identity health care providers-nonbinary AMAB youth were least likely to disclose (77.6%). Symptoms of depression were the highest and self-esteem was the lowest for transgender boys with mixed levels of disclosure. Transgender girls reported the lowest symptoms of depression-these youth had also disclosed their identities the most. Findings suggest that mixed disclosure to health care providers is problematic for gender expansive youth, especially transgender boys. Findings suggest a need to better prepare health professionals to understand not all gender expansive youth may feel comfortable disclosing their gender identities in medical contexts. Future research should explore gender affirmative health care as a protective factor for negative mental health outcomes.