Pathways to gender affirmation in trans youth: A qualitative and participative study with youth and their parents

Abstract

How trans youth realize about their gender identity and come out to their significant others is under-researched and very few studies include both youth and parental perspectives. This study was developed in Switzerland, a country where families with trans youth are just beginning to break invisibility. The research protocol draws on grounded theory methodology, is participative and developed in collaboration with a local trans NGO and a pan Canadian project. We conducted 20 semi-structured interviews with 10 trans youth and their caregivers/parents (10 interview). At least three developmental pathways seem to emerge: a) the affirmed children who affirm themselves very early, (b) the silent children who spend their childhood in a state of internal tension without being able to position themselves and (c) the neutral children who become aware of their gender difference at puberty following a childhood in which gender was not problematic. In all cases puberty is a crossroads, lived painfully with significant manifestations of both social and body dysphoria. A better understanding of the process of gender development in trans children and youth will help improve our interventions to better serve young people and their families, and help them overcome the different levels of oppressions they face.

Keywords

Trans youth gender affirmation qualitative identity development

Introduction: Trans youth and their families, becoming visible

The visibility of trans and non-binary people is increasing rapidly. Recent studies show that between 0.7% and 2.7% of the general population identify as trans or non-binary, with higher numbers among youth (Herman and al., 2017; Meerwijk and Sevelius, 2017; Rider et al., 2018). There are currently ideological debates about the moment where youth first know or assert they are trans, and about giving transgender youth access to gender-confirming health interventions (Leibowitz et al., 2020). It is crucial to better understand how youth experience their gender affirmation process, how they become visible to themselves and to others as trans people, what parents are aware of and how they react. This is the focus of this paper.

In the context of gender diversity, oppressions are pervasive and the development of a trans identity is a developmental process of making sense of one’s experience out of invisibility (Medico, 2019). Trans and non-binary youth are known to face significant difficulties and have much higher rates of psychological and social suffering than cisgender youth (Grossman and al. 2016; Rider et al., 2018; Rimes et al., 2017; Pullen Sansfaçon et al., 2018). These difficulties seem to result directly and indirectly from discrimination and violence, but also from non-recognition of trans identity and from the pressure to hide one’s sense of self (Connolly et al., 2016; Ehrensaft et al., 2018; Levitt and Ippolito, 2014). Some trans youth also report experiencing gender dysphoria, which manifests itself as a profound and painful discomfort with one’s body and social image of gender. This conflictual relationship with the body is correlated with mental health difficulties such as eating disorders, self-destructive behaviors, depression, and anxiety (Bouman and et al., 2016; Röder et al., 2018). It makes the passage into puberty particularly difficult. For these youth, gender-affirming treatments such as those that delay puberty dramatically improve their quality of life (Olson and et al., 2015, The Lancet, 2018), though such care is not accessible everywhere.

Literature on coming out and gender identity shows that the development of a transgender or gender diverse identity appears on average between the ages of five and eight (Olson and al., 2011). But disclosure to the family and social circle generally occurs years later (Olson and et al., 2015; Riggs, 2019; Pullen Sansfaçon et al., 2019). This huge gap produces a long period of secrecy and sometimes isolation where communication in the family is not optimal. Parental support appears to be an important protective factor for trans youth, and a growing body of literature indicates that strongly supported youth are only marginally more anxious and experience less suicidal ideation than other cisgender young people (Durwood and et al. 2017; Olson and et al. 2016; Owen-Smith et al., 2018). Family functioning has also been pointed out as a factor in the mental health of trans youth (Katz-Wise et al., 2018), so it seems particularly important to get a better sense of how youth and their parents experience the process of youth understanding themselves and coming out to others.

The concept of gender itself has many dimensions in the developmental literature (Perry et al., 2019). One major aspect must be taken into account because it is central to trans people’s identity development: the question of invisibility. Invisibility as an oppression was pointed out first by Viviane Namaste (Namaste, 2000) but has since rarely been addressed for children and youth. From a psychological and developmental perspective, the social concept of invisibility has some links to isolation and trust in relationships, so on parental support. Youth are also negociating normative « master narratives » (Bradford and Syed, 2019), some are cisgender other are transnormative, both have a powerfull influence on their identity construction. So, in order to understand their identity development we should look at as a process of unveiling and revealing, the means through which they move out of invisibility and master narratives.

Aim of the study

In some regions, like French-speaking Switzerland, these questions are only emerging, and we know little about the needs, context and challenges that youth and their families experience. This is the first study to address this population. It is community-based and was realized in partnership with a local NGO, the Agnodice Foundation, which has been active since 2006 as an information hub for trans care that also coordinates services and advocates for trans people and their families.

Based on the research protocol of a pan-Canadian qualitative research project, “Stories of gender affirming care: learning from children, youth and their families,” we adapted the data collection tools to the Swiss context to provide baseline data for future comparison (Pullen Sansfaçon et al. funded by CIHR 2016–2019). The Canadian project examines the experiences of gender diverse and transgender children and youth and their parents/caregivers who have been referred to gender affirmative clinics. Since there were not such clinics in Switzerland at the time of the study, out sample came from a peer support group of parents.

Methodology

We conducted 20 qualitative interviews with 10 youth and 10 parents/caregivers. Participants were recruited through a peer support group attending the NGO and snowball sampling. A semi-structured interview and a socio-demographic questionnaire adapted from the Canadian sister project were completed by participants. Interviews lasted 1 hour on average. We interviewed the youth and their parents separately to gain a deeper and more complete understanding of the experience of each family through two distinct sources of information. The data were collected by two psychologists, a cisgender middle-aged woman and a younger transfeminine adult, both trained in family therapy.

The interviews explored identity development, coming out, daily life, relationships with peers and families, mental and physical wellbeing, general needs, challenges and access to care, and barriers to care. Informed consent was obtained from both parents and youth. Parents and youth were reassured that no personally identifiable information would be disclosed to the other family member, nor to medical or other professionals.

Verbatim transcripts were produced from the interviews and then analyzed through inductive analysis (Braun and Clarke, 2006). An in-depth reading of the interviews and line-by-line coding was the first step in the analysis. MAXQDA software was used to organize the data. Codes were then organized into themes. Once the themes were identified in both interview groups, the data were first compared across the whole sample to reveal important themes that appeared in all interviews. Then a more individual analysis was provided by putting into dialogue each youth-parent pair. This analysis allow comparison between the youth’s narrative and their parent’s narrative. In our sample, parents and youth narrative show no major discordance. But this comparison allowed to construct a developmental narrative for each youth that was sensitive to individual/family vulnerability as thus enable us to better apprehend intersectional oppressions. Kuper et al. (2018) used an intersectional approach to conceptualize gender identity development in trans people. Our analysis will try to capture complexities in this conceptual tradition of intersectionality (Crenshaw, 1991). In line with this tradition, we focus on how diverse sources of vulnerability can intersect and induce an even more oppressive system. Our focus will be on the question of the construction of (trans)subjectivity in a context of invisibility and multiple oppressions. This research was approved by UQAM ethical committee and informed consent was provided by parents and by all youths of 14 and older.

Participant sample

The 10 families are mostly middle and upper middle class by local standards. They represent a variety of family structures: four youth lived with both parents, one with their mother and stepfather, one with their father, three with their mother, and one with other family members. Four youth were the only child in their family. Five families are from Switzerland, and the other five include at least one migrant parent. Two families reported being religious. Parents were aged between 29 and 53.

Youth participants’ ages ranged from 9 to 21, but most fell between 14 and 17 years of age. Most identified on the male spectrum (man/transman/transman/genderqueer), while three participants identified as girl/woman (see table 1). Eight participants had transitioned at school and reported a relatively high level of social acceptance by other youth. Only two trans girls were not asserting their gender in their social circle. Bullying and violence were reported by two transfeminine youth.

Table 1.

Youth participants by age and gender.

Age	Lee 9	Richard 14	John 14	Kyo 15	Alessia 15	Nina 17	Neto 17	Elio 18	Ken 19	Raphi 21
Gender	Girl	Boy	Trans man	Trans man Genderqueer	Woman	Woman	Trans man	Man	Trans man Genderqueer	Man

Results

I suffered from not being who I am

Mental health appears to be a crucial difficulty for most participants. Youth talked extensively about their psychological suffering and parents seemed to worry about it a lot. Gender dysphoria was described by every post-pubertal youth, and almost every youth had experienced at least an episode of depression, intense anxiety, self-mutilation, or suicidal ideation. Two had eating disorders and two had attempted suicide.

“I often had suicidal thoughts, I don’t know how many I had, but I’ve had a few. Around ten, something like that [. . .] There was too much pain, it was way too much pain for me, to be able to live with it, it was becoming way way too much, and I couldn’t keep going each day with this pain deep inside me. [now that I can assert my gender identity] it’s mostly dissipated, but there are still some little things sometimes. . .” (Ken, 19 ¹ )

It is noteworthy that most youth who had suicidal ideation in our sample related that they didn’t want to die. They felt they had no other choice but suicide since they were afraid of various things related to coming out and accessing care: 1. Not finding the courage to affirm themselves as trans, 2. Fear of being rejected, or 3. The impossibility of accessing gender-affirming care. They report not having the strength to bear the suffering any longer, the suffering of not being who they are.

I am trans! I felt it, now I know it

Awareness and affirmation to oneself seems to be the crucial moment in the development of self-esteem. Self-understanding originates from an embodied feeling, something which is described as an intuition, a vague impression of something being wrong. Being able to understand this and to label it as “I am trans” is recalled as a feeling of liberation and self-love. Giving meaning and putting a name to this feeling is therefore a relief.

“It liberated me. So, finally, I really really cried. And I really start to love myself while saying it. It made me realise that. . . that it was real, that it was there and that it wasn’t just something that was running through my mind.” (Elio, 18)

But the process is long, and a few months to a few years elapsed from the moment youth reached self-understanding to when they first came out to others. In this process, experiences are diverse and there is no one pathway, no single way to reach understanding and come out as trans.

Three developmental pathways of affirmation

In our data there seem to be at least three developmental pathways for youth in terms of self-understanding and affirming their (trans) gender: a) affirmed, b) silent and c) neutral. Table 2 shows key information about each participant as well as their developmental pathway.

Table 2.

Developmental process of gender affirmation.

Age	9	14	14	15	15	17	17	18	19	21
Initial moment of self-understanding	Always	Boyish girl	Always but could not find words to express	12	Always	Always but could not find words to express	11	Always but could not find words to express	10-12	12
Age at coming out to family	2-3	12	13	14	unclear	15	16	15	17	17
Developmental pattern	A	B	B	C	A	B	B	B	C	C

For the “affirmed” child (type a) there is evidence from a very early age that the assigned gender isn’t right. This is usually expressed at a very early age within the family. During childhood, the child’s gender affirmation seems to be directly met with acceptance by family members. Generally, a child’s gender expression may vary depending on the perceived expectations of emotionally significant people. If a parent for example, does not want the child to express their felt gender, the child will reassure their parent by acting in a way as to confirm this significant adult’s point of view. Children may therefore seem ambivalent about their gender while they are in fact navigating a stressful situation and managing fear of rejection. This is the case of Leon.e in our sample, who lives as a girl at home with her mother, but as a boy with her father and at school, “Because I'm too scared they'll make fun of me.” The influence of fear on gender expression was confirmed by the family.

“Leon.e wants the approval and love of his dad, he’s thinking of staying a boy because ‘Dad won’t love me anymore if I become a girl’.” (Leon.e’s stepfather)

Another girl who affirmed her gender with her mother since childhood didn’t dare to come out to her wider circle or to her father before the age of 13. She and her mother both said that fear of her father’s reaction prevented her from doing so earlier. In this case, intervention by the mother helped the father move towards acceptance, and intrafamilial ties improved:

“I was really scared of my father. I always said to my mother, he’s going to kill me. He didn’t want it. [. . .] But after a discussion with my mother, you could say that he’s understood a little, he’s accepted more and now he treats me like a girl and he tries to understand and be nice to me.” (Alessia, 15)

The “silent” child (type b) is the most common in our sample. These youth relate having had a feeling of not being cisgender since a long time but only revealing their gender identity around the onset of puberty. As a child they recalled a sense of not belonging, a felt, embodied sense of something being wrong. But this feeling was difficult to label or express for some youth, so they tried to repress and hide this feeling from others and from themselves during childhood. From a developmental perspective we can conclude that they experienced internal conflict regarding gender for many years.

“I don’t know why but I already knew it was . . . What it meant but . . . I didn’t really understand that I was . . . I didn’t make the connection of how I felt but . . . ” (John, 14)

At puberty it became impossible to continue denying their gender difference. Puberty induced overwhelming body dysphoria coupled with social dysphoria. In our sample they came out to others between the ages of 12 and 17.

“Then after he told me that he’d been questioning for more than two years, he’d looked on various websites some. Then all of a sudden one day he came across people like him and it made him feel good and he said ‘That's it, I'm transgender’. So he explored for two years before talking to me.” (Nina’s mom)

The path of the “neutral” child (type c) follows almost the same pattern in terms of coming out at puberty, but childhood is experienced with more internal congruence. They came out at puberty but in thinking back on their childhood, they didn’t question their gender or repress their gender expression as type b did. They report living either as non-gendered or in a gender that suited them. Everything was fine before puberty, but after that point, social pressure and the development of secondary sexual characteristics made gender become an issue. This pathway includes most of the youth assigned female at birth who lived a form of social masculinity during childhood, a gender that suited them and was not perceived as problematic by society or by themselves.

“When I was a child, uh . . . I think I didn’t care much because I looked like a guy, I had long hair and everything. But I mean at the level of the body I looked like men, or rather like boys. Finally, it was when my puberty started that I began to feel bad about myself and in my body. Then I was told ‘That's normal, everyone goes through that’. Lack of confidence and everything. The thing is, my chest grew really fast when I was 11 years old. As soon as I was about 12 years old, at that time, I started not feeling well, I often said that I didn’t want to be a girl, that I was not a girl, and that it was bothering me, because I was not what I felt like”

(Ken, 19)

Social pressure to conform is reported as becoming very strong at puberty for youth assigned female at birth, inducing intense distress and attempts to conform among youth who hadn’t conformed before. For example, this mother of a trans man explains how her son went through a phase of feminisation that induced depression before coming out as a trans man:

“For us it was natural to accept her how she was. And then in adolescence, when she went to high school, she completely changed her look. She had long blond hair, she was doing makeup, she was really a pretty girl, but she was very unhappy. . . She was coming home from school and she used to lock herself up in her room.” (Kyo’s mom)

Puberty was too much pain

Regardless of the developmental gender affirmation pathway (a, b or c) of the participant, puberty is a crossroads. As almost all post-pubertal youth and their parents explained to us, “There was too much pain” at puberty:

“There was too much pain, it was way too much pain for me, to be able to live with it, it was becoming way way way too much, and I couldn’t keep going each day with this pain deep inside me. I just wanted it to stop. [. . .]. And I didn’t feel at all comfortable with my body. I hated my body, I hated myself. Sometimes, I dreamed that I traded body with a guy and everything!” (Ken, 19)

At puberty, the feeling of a body that escapes and no longer belongs is overwhelming. This intense negative feeling is an undeniable cornerstone in the process of self-understanding.

“I think it’s really at the moment of puberty. . . I really started to feel this bad feeling. [. . .] And I actually understood that with the adult shapes starting to form I wouldn’t have the body that I thought.” (Neto, 17)

Neutral children face the inevitability of becoming gendered in a way they don’t feel as congruent, silent children can no longer elude or escape facing gender identification and neutral children discover how deep and embodied their gender nonconformity is.

“Growing up, I realized that there was something that didn’t work, like, I didn’t know what it was, I didn’t feel bad about it, but not good either. I felt like my body didn’t belong to me.” (Richard, 14)

The youth therefore start to label these feelings. They accept they are not like others, that they aren’t cisgender, and this process of self-understanding and meaning-making eventually alleviates the pain.

Coming out to others

Coming out to significant others is the next significative stage in gender affirmation. In our data, apart from youth who had affirmed themselves during childhood (type a), coming out to the family occurred between 2 and 7 years after the youth understood themselves as trans. Most youth came out to one family member, usually a woman. Others left clues such as chest binders or clothes to initiate a dialogue with a family member.

Once coming out is achieved, youth who had been waiting for years now often want to quickly move forward to a social gender transition. They ask to transition at school, through their official documents and, especially, through hormonal or surgical interventions. In their perception, they have overcome two of the greatest barriers, first, being able to label their experience, and second, overcoming their fear of rejection. So they are ready to move towards becoming who they feel they are and wish to be.

Parental support is reported to be crucial here, and youth who addressed the question clearly link their well-being to being supported by at least one parent. Fluctuations and ambivalence of support were noted to be distressing and creating a feeling of loneliness and abandonment:

“So, my mum, she supported me right away, she started calling me by my boy’s name and so on. She immediately helped me and then, here, after, she stopped because the psychiatrist said it wasn’t necessary, then after, she started again, then she stopped because my father didn’t want, then . . . It was really long, really hard! Every time she stopped, I felt alone! Really alone in the world! And then, it totally discouraged me.” (Kyo, 15)

The parent’s perspective

Parents participating in this research can be described as supporting their child. They report understanding that this is something serious, that they need to accept their child’s gender identity and that it is an important thing for them to do as a parent.

“It was a summer day, she came to me and she told me ‘Mum I need to talk to you’. And I turned to her, I said, ‘I know what you're going to tell me.’ It was suddenly so obvious. I asked her what steps she had taken. I think we both went to the psychiatrist at first . . . where she had made an appointment on her own. And then we informed my husband, her dad. We started this journey. For me it was obvious, I told him right away . . . I told him, he was my child, that's . . . (silence) . . . It came so much from the guts, that yeah, it doesn’t change, he’s my child. And I will not hide you. Because I said to myself, there is surely so much suffering, we cannot hide that. . .” (Raphi’s mum)

At the moment of coming out some parents report they were surprised, some expected it and some were relieved because they were anxious about their youth experiencing depression and suicidal ideation and not knowing why. As Ken’s father says: “For me, it was a relief because since he was 10, 11 years old he had started to close in on himself.”

They acknowledge that coming out is the result of a long process. But they also note that coming out was an escape from a family secret. In some cases, the coming out is accompanied by a deepening of the parent/child relationship.

“He sent me a very long text message. He explained that he had not felt good about himself for a very long time, maybe even since always, that he felt like a woman. After, what was wonderful in this message, is that he sought to reassure me too. To tell me it’s not my fault, I’m a great mom. [. . .] I think he may have been afraid of my reaction. So here I sent him a message to tell him that there are no worries, whatever he chooses for his life, I’ll support him, because I love him. I love him more than anything and I’ll support him.” (Nina’s mom)

Parents express their need to be supported in supporting their child. Knowing they are doing the right thing is identified as crucial for them because uncertainty is linked to guilt. And guilt is a major concern: guilt for not having understood before, guilt over not being supportive enough, guilt over being too supportive. Parent participants express a great degree of self-consciousness and sense of responsibility regarding their parental role.

“Let's say that what was complicated at the beginning . . . There’s always that idea, ‘But he's still so young. . . Can we really be sure?’” (Richard’father)

Parents also report being challenged by their external environment, extended family members, friends, neighbors or even co-workers. As one mother said, “I got a lot of comments,” and their decision to support their child through a transition process and/or an identity affirmation as trans is criticized.

“Many people who told me when we say ‘Raphi is not well, he’s hospitalized for depression’ ‘Oh yeah that's because he regrets, because transition has been too fast,’ and . . . Luckily I was convinced that it wasn’t that, because I think I would have been destroyed.” (Raphi’s mom)

Parents express a major need for support and the central question they have is “Are we doing the right thing?”

Discussion

Gaining an understanding of both parents and youth perspectives allows us to see that gender affirmation is a process with different pathways, and no evidence indicates that youth suddenly become trans at adolescence. It is a long way that must be processed through self-understanding and labelling. To better understand how (trans)gender identity is constructed from a psychological and developmental point of view, we conceptualize gender not as a single entity but as three-dimensional: subjective, embodied, social/identity. When asked what allowed them to understand themselves, youth responses seem to rely on the alignment of:

Gender subjectivity = Internal feeling of not being at the right place

Gender embodiment = Recognition that this subjective feeling has to do with the sexed/gendered body (usually at puberty)

Gender identity = Labelling and identification with role models.

These three dimensions are always caught in an inner/intrasubjective and intersubjective configuration. This means that emerging from invisibility and navigating master narratives (Bradford & Syed, 2019) is linked to emotional bond and recognition. These are necessary elements for self-affirmation and the youth’s narratives reveal that the process was long, sometimes over years, and complex. As stated by Burdge et al. (2018) there are nuances and complexities in coping processes. Coming out to others and affirming a gender identity is only the tip of the iceberg of a deep feeling of gender subjectivity and embodiment that requires inner work that often takes years, accompanied by intersubjective validation and recognition.

This process is long and complex because gender identity affirmation must overcome multiple levels of oppression. Invisibility, inappropriate master narratives and lack of meaning is the first level of oppression that directly affects the possibility of giving meaning to the subjective and embodied levels of gender. For these children the subjective experience is comparable to living in a parallel world, closed off and not entirely living within their lives. This particularly painful experience leads to feelings of depression and self-hatred and it forms the basis of is what is referred to as “internalised transphobia.”

The second level of oppression is relational and is linked to living in secrecy and without support, living in fear and anticipating rejection and violence. In our sample, coming out to the family occurred 2 to 7 years after the youth had understood themselves or identified as trans. Such a timespan at that age represents a considerable length of time during which the youth is alone with their secret. It is deeply present in youth that come out at puberty after a childhood of struggling with gender, especially the b pattern. As this oppression is experienced for years, it leaves its marks in the form of psychological distress that persists even after coming out. The well-known psychological concept of attachment that led to viewing intersubjectivity as a central component of child development (Stern, 1998) provides a theoretical background to help understand how living in secrecy, hiding one’s sense of truth and not being comfortable disclosing it to relatives and significant others, would likely affect the development of a positive sense of self for many trans youth.

The third level of oppression is social and structural. This means not being accepted, not being able to live in the desired gender and in the right body, being misgendered and having no or difficult access to care. A systemic and intersectional perspective should understand trans youth’s needs and identity development on subjective, relational and structural levels. To do this, it is necessary to think of oppression in a wider sense, as a psychological and developmental construct, as a basic need for recognition in intersubjective situations, and as a social and structural context of life with discriminations or possibilities.

Conclusion

We observed at least three different developmental pathways, (a) affirmed: children who affirm themselves very early, (b) silent: youth who spend their childhood in a state of internal tension without being able to position themselves, who feel that something is different for them, and (c) neutral: those who become aware at puberty following a childhood in which gender was not problematic. In all cases, puberty is a crossroads, lived painfully, with significant manifestations of both social and body dysphoria.

The young people who participated in this study are among the few who have come out in French-speaking Switzerland. They are accepted and supported by their parents. It seems, however, that it is still difficult to be a trans youth; becoming aware and understanding themselves and facing the fear of coming out remains a developmental challenge. Where access to care is limited, multiple levels of oppression overlap, it leads to poor quality of life for trans youth, as is in our sample (see forthcoming Medico et al.) and this confirm previous literature (Owen-Smith et al., 2018; Riggs et al., 2019).

In this study, we had to combine and compare the perspectives of young people and their parents, being attentive to both what was said and what was unspoken but implied to understand how the development of a trans identity occurred. Qualitative work is precious in this evolving, complex and emotional context. We believe it is urgent to understand the process of gender development in trans children and youth. This will help improve our clinical, social, medical, and educational interventions to better serve young people and their families and help them overcome the different levels of oppression they face. A comparable protocol on a larger sample would allow us to deepen this understanding.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research has been funded by Foundation Agnodice, a swiss NGO devoted to trans health.

Ethical standards

This research has been approved by the ethical commitee of University of Quebec in Montreal (certificate number: 1943_e_2017). The research protocole was developed to fit most rigorous ethical standards for research with transgender youth. Participants gave informed consent.

ORCID iD

Denise Medico

Notes

Author biographies

Denise Medico, PhD, is professor of sexology at Université du Québec à Montréal, she is also a registered psychologist working at Meraki Health Center, a transaffirmative clinic in Montreal.

Annie Pullen Sansfaçon, PhD, is professor of social work at Université de Montréal, she is also cofounder of Gender Creative Kids Canada and head of Canada research chair on transgender youth and their families.

Adèle Zufferey, MSc, is a psychologist working for the Agnodice Foundation and in private practice in Swizerland.

Gabriel Galantino, MA, is a sexologist working at Meraki Health Center and research assistant at Université du Québec in Montréal.

Morag Bosom, MA, is a sexologist and research assistant at Université du Québec in Montréal.

Frank Suerich-Gulick, PhD, is a research coordinator for Canada research chair on transgender youth and their families.

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