- A growing body of literature associates transgender and gender non-conforming (TGNC) identity with adverse mental and emotional health outcomes. Only a handful of studies have been conducted using population-based samples of adolescents to study mental health outcomes in TGNC youth (e.g., Eisenberg et al., 2017; Perez-Brumer, Day, Russell, & Hatzenbuehler, 2017; Rider, McMorris, Gower, Coleman, & Eisenberg, 2018; Toomey, Syvertsen, & Shramko, 2018) and only one has looked at outcomes that may indicate thriving (Eisenberg et al., 2017). The current study analyzes data from the 2017 Oregon Heathy Teens Survey (OHTS) (N = 26,747), a population-based biannual survey of eighth and eleventh graders. In 2017, the OHTS included three gender variables: youth report their gender identity, gender presentation (rated on a spectrum from very feminine to very masculine), and perception of others’ evaluation of their gender presentation. The current study examined associations between gender identity and four measures of thriving (emotional/mental health and wellbeing, grades, self-efficacy, and the presence of a caring adult at school) and three measures of adverse mental health outcomes
(depressive symptoms, suicidal ideation, and suicide attempt). Multiple and logistic regression were used to test two sets of models. The first set of models included only one indicator of gender identity as a predictor of thriving and adverse mental health outcomes. The second set of models included all three indicators of gender identity as well as interactions between them to provide comparison as to how a more nuanced understanding of gender relates to youth outcomes. Results showed that youth who identified with a TGNC gender identity had the most adverse scores for every outcome compared to their female and male peers. In addition, youth who identified with either a female or a male gender identity, but who reported presenting and/or believing others perceived them as presenting in a non-gender-conforming way (i.e., something other than feminine for females or something other than masculine for males) often reported more adverse outcomes than their fully gender-conforming peers. Finally, outcomes for youth who identified with a TGNC gender identity varied depending on the category of self-presentation or others’ perception that the youth reported. Those outcomes often mirrored results for the gender-conforming gender identity of the category of self-presentation or others’ perception endorsed by the youth (e.g., a TGNC youth who presents as feminine and believes others perceive them as feminine reports lower emotional and mental wellbeing than a TGNC youth who presents as masculine and believes other perceive them as masculine). On this survey, 5.48% of youth claimed a TGNC gender identity, an unprecedented rate for population-based surveys. In addition, only 57.52% of females and 56.04% of males chose the fully gender-conforming options on the self-presentation and others’ perception questions (i.e. feminine for females and masculine for males), a notable outcome given the connection between any degree of gender non-conformity and the lower levels of thriving and higher levels of mental health risk found in this study. Implications include the need for greater support of youth who identify as TGNC, as well as the need for researchers and service providers to not only ask about gender identity beyond the traditional female/male binary, but also to include items on surveys and forms that assess more than one dimension of gender.