Extrafamilial stressors in families of transgender adolescents referred for gender-affirming medical care: a mixed-methods analysis

Transgender and nonbinary (TNB) adolescents and their families often experience trans-specific, extrafamilial stressors, which may increase when adolescents come out and try to access gender-affirming medical care. While studies have described such stressors, it is unclear whether distinct underlying patterns of stressor experiences exist, shaping family experience. 159 adolescent–parent dyads attending an initial hormone appointment for gender-affirming medical care at any of 10 clinics in Canada reported on trans-specific, extrafamilial stressor experiences in Trans Youth CAN! Latent class analysis (LCA) assessed underlying patterns; parent and family characteristics were then described for each stressor class in the final model. LCA interpretation was supplemented with thematic analysis of qualitative interviews with 36 parents at 3 of the clinics from the Stories of Care study. The optimal model had four stressor classes: “Low Disruption, Some Advocacy” (estimated 30.4%); “Some Disruption, Some Advocacy” (9.8%); “Low Disruption, Low Advocacy” (55.7%); and “Major Disruption, High Advocacy” (4.1%). Family characteristics suggested a heterogeneous sample, with differing proportions of sociodemographic and family characteristics across stressor classes. Quotations from parent interviews in Stories of Care supported the four-class stressor model. Families of TNB adolescents accessing gender-affirming medical care may experience trans-specific, extrafamilial stressors according to four latent class groupings.