“Nobody Gives You the Book for This”: How Transgender Adolescents and Parents Navigate Stress and Support Related to Adolescent Gender Affirmation Processes

We know little about how transgender adolescents and their parents perceive and experience transgender adolescents’ gender identity development, minority stress, and the parent-adolescent stress (hereafter referred to as dyadic stress), and parent support factors related to adolescent gender affirmation processes and mental health. Transgender adolescents face minority stressors related to social inequality, stigma, and inadequate social support as they navigate being transgender across multiple social environments. This qualitative study used a Life History Calendar approach to conduct separate and simultaneous interviews with 20 transgender–parent dyads to explore dyadic perspectives of adolescent minority stress, parent support, and adolescent gender affirmation processes related to adolescent gender identity development. Adolescents were between the ages of 12 and 17 and had initiated puberty blockers and/or gender affirming hormones with the last 12 months. Differences emerged related to minority stress, adolescent gender affirmation processes, adolescent mental health and parent support between adolescents who were known by parents to be transgender during childhood before puberty and adolescents who disclosed their gender to their parents after puberty. Minority stress contributed to adolescent gender affirmation processes, parent support, and adolescent mental health. While parents supported their child’s gender affirmation process, adolescent continued to experience high rates psychological distress and minority stress across salient social domains. At the same time, parents experienced their own stress related to perceived loss, disclosure decisions, and adolescent gender affirmation. Parent support and acceptance were critical to transgender adolescents’ gender identity development and gender affirmation processes both before and after adolescents disclosed that they were transgender to their parents.Evidence from the present study contributes to existing knowledge by: (1) underscoring the importance of parent support for transgender adolescents; (2) building upon previous minority stress models to understand how minority stress and parent support potentially contribute to adolescent mental health and gender affirmation processes; and (3) identifying potentially important minority stress, parent support, and gender affirmation processes related to time between adolescent gender identity disclosure to parents and puberty