Supporting Transgender Youth During the COVID-19 Pandemic

This guest post was contributed by Huong Diep, Psy.D., ABPP.

Source: Huong Diep, used with permission

As a clinical psychologist and an ally to the transgender community, I've noted that there are particular challenges that are unique to transgender, non-binary, and gender-expansive youth. If you find yourself parenting/caregiving, providing mental health and/or medical services, or wish to serve as an ally to transgender youth, I've outlined some issues to consider in this post.

Please note: All stories have been slightly modified to protect the confidentiality of clients, and transgender will be used as an umbrella term to include all individuals who do not identify as cisgender.

1. Impact of Social Distancing and Lack of Peer Support: For our transgender youth, the impact of social distancing is significantly impactful. One youth stated, “It’s just not the same. I can Zoom and FaceTime my friends all day but I just want to hang out with them and feel ‘normal.’” Social support is important to youth, but this may be especially true for transgender youth who historically experience increased rates of bullying and harassment. Many organizations are offering gender support groups online such as Gender Spectrums and TransFamily Support Services.
2. Impact of Access to Gender-Related Services: Due to the closure of non-essential businesses, some youth are unable to access services (e.g., electrolysis) that significantly alleviate symptoms of anxiety and/or gender dysphoria. A transgender female client shared that she is nervous about the cancellation of her electrolysis appointments because facial hair and stubble are “huge” triggers for her. Suggestions for parents are to listen to their youth’s concerns about the lack of access to services and to ask open-ended questions such as, “I’m so sorry to hear that you are feeling this way. What can I do to support you during this time?”
3. Impact of Postponement on Gender-Related Appointments/Procedures: Some of my transgender clients have also expressed an understanding, but natural disappointment due to the delays in medical appointments and surgeries to help with symptoms of gender dysphoria. Some clients have waited years for these procedures; one client described it as “heartbreaking” that she is unable to get bottom surgery. Also, there are fears of losing employment which could jeopardize health insurance and coverage of the aforementioned surgeries. It is important to talk to our youth about navigating and managing multiple conflicting emotions. For example, they can be grateful for their health and also frustrated and angry at the negative impacts of the quarantine.
4. Impact of Multiple Stressors Including Previous Medical and/or Mental Health Concerns: It is crucial to recognize the unique intersection of a transgender youth's strengths, struggles, and backgrounds. For some Asian American youth, who also identify as transgender, I have been hearing unfortunate stories of the intersection of xenophobia and transphobia. One Asian American non-binary youth noted, "I have a persistent cough because of my asthma. I have been getting dirty looks because people think I have COVID-19." Another youth expressed frustration with binding because they are afraid it may worsen their respiratory issues. I would encourage parents and caregivers to remind them that transgender youth are strong and to flex their resiliency muscles. Using a strengths-based approach, I ask clients what they have done in the past to overcome previous obstacles and difficult times and how they can channel those same energies into their current struggles.
5. Impact of Questioning the Validity of Their Gender-Related Fears and Worries: Some youth shared with me they have “competing anxieties” and oscillate between a fear of the world falling apart because of COVID-19 and gender dysphoria. “Is it still fair for me to worry about my gender identity when some people are worried about not having food to eat?” Please remember that their fears may fluctuate, and acknowledge that fear is a normal response to the unknown, and help them focus on aspects they can control. I encourage all my clients to practice self-compassion during this time.
6. Impact of Pronouns and Names: Some youth are also sad and frustrated that parents and other family members are mis-gendering them and using their deadnames during this time of increased family contact. “I’m not sure if it is OK to ask my parents to use the right pronouns and names during a pandemic?! It really hurts me but I also see that they’re so stressed out because they lost their jobs.” Also, there are some concerns regarding the lack of proper identification and gender markers if courts put name change and gender marker requests on hold as “non-essential.” I typically encourage parents to have an honest conversation with their youth and discuss your potential challenges and barriers to using the correct names and pronouns.
7. Impact of Food and Body Related Concerns: For some of us, food has been a source of comfort during these uncertain times. There has been an increase in the purchasing of processed foods and an uptick in stress or emotional eating. One client said, “I’m just eating through my feelings right now. It feels better to eat chocolate than to feel sad.” The increase in processed food, lack of outdoor activities and a more sedentary lifestyle can lead to potential weight gain and potentially, body dysmorphia and gender dysphoria. A teen transmale client noticed he had gained weight around his hip areas and stated, “This is so frustrating because the weight gain goes straight to my hips which makes me look more like a girl and increases my dysphoria!” Also, for some youth who have a history of disordered eating, which could include binge eating and/or restricted eating, they may also be triggered by a limited pantry and/or lack of access to certain foods. One client stated, “I’m so freaked out that we will run out of food but then I will sneak downstairs and eat a whole block of cheese because that makes me feel better.” I would encourage parents to go for a daily walk with their youth, to help them label their emotions instead of numbing through food, and to eat mindfully (e.g., sitting down for family meals).
8. Impact on Overall Mental Health: For transgender youth, resources include Trans LifeLine, which provides a peer support hotline, and The Trevor Project, which provides access to counselors 24/7. If you are concerned about your youth's mental health, please reach out to a gender-affirming mental health provider who follows the World Professional Association of Transgender Health (WPATH) standards of care. Please know that you are not alone, and some professionals are continuing to provide services during this time via video or phone. We are all in this together.

About the guest author: Huong Diep, Psy.D., ABPP (she/her/hers) is a bilingual (English/Spanish) board-certified psychologist in clinical child and adolescent psychology who has been providing gender-affirming therapy and assessments for transgender and gender-expansive youth and their families for over ten years. She completed a two-year post-doctoral fellowship at the Center for Transyouth Health and Development at Children's Hospital Los Angeles.