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Do Transgender Teens Face Greater Risk of Substance Use?

A sad couple of teens embrace, with cigarettes in hand, on colorful stairs in Istanbul.

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Key Takeaways

  • Transgender teens are at greater risk of substance use, likely to cope with the higher rates of emotional distress they report.
  • Psychosocial stressors faced by trans teens included rejection, discrimination, and threats regarding gender identity.
  • Internalized transphobia was associated with an increased risk of substance use, while personal resilience, gender pride, family functioning, and social support were protective factors.

Transphobia remains extremely prevalent in the US. A recently published study in PLoS ONE found that more than half of transgender youth engage in substance use, as linked to transphobic psychosocial stressors.

Especially as transphobia continues to dictate government policies that harm youth athletes, such research findings should come as no surprise to individuals who understand the impact of oppression on health outcomes.

While President Biden’s Executive Order on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation is encouraging, there is still a great deal of work to be done to ensure that gender-diverse youth have equitable access to opportunities and experiences in American society.

What the Research Tells Us

In this longitudinal study of mostly white youth aged 13 to 17, of whom 11 were transfeminine, 15 were transmasculine, and 4 were nonbinary, participants completed online surveys every six months for two years.

In the beginning, only 17% percent reported any use of tobacco, alcohol, and marijuana, but two years later, 56% reported substance use, with higher exposure to transphobic psychosocial stress significantly increasing the odds of alcohol use, but not tobacco or marijuana consumption.

The study was limited by a small sample population, which was disproportionately white and of higher socioeconomic status and lived only in the New England states, so findings may not be generalizable.

Transphobia Increases Substance Use Risks

A clinician at Keig Consulting, Zander Keig, MSW, LCSW, BCD, says, "Teens use substances to cope with stressors. For Gender Minority (GM) teens that is also true. However, GM teens with stable families and family social support reported lower rates of substance use."

While Keig admits that more research is needed given the small, disproportionately white sample size, and limited geographic region, he asserts that they align with findings from the Family Acceptance Project, and clarifies that GM teens are not at risk for substance use because of their minority gender identification, but due to the impact of transphobia.

Keig says, "It has been my experience that individuals who are able to embrace their authentic selves fully are less susceptible to stress associated with microaggressions directed at them throughout the day and week." His insights reinforce the importance of addressing transphobia in society so that youth can feel safe to embrace their authentic gender identity freely.

Zander Keig, MSW, LCSW, BCD

It has been my experience that individuals who are able to embrace their authentic selves fully are less susceptible to stress associated with microaggressions directed at them throughout the day and week.

— Zander Keig, MSW, LCSW, BCD

Family and Social Support Helps

Chief Clinical Officer at the Foundations Wellness Center, Justin Baksh, MS, LMHC, MCAP, says, "This study identified that those with stronger family and social supports were less likely to use substances. The saying that it takes a village resonates the loudest here."

Baksh describes how it can often take a village to have awareness, compassion, and empathy, especially for those individuals that may be deemed different, while highlighting that not all family and support systems are equipped with the necessary skills to nurture gender diversity.

Baksh says, "There may be generational bias, misconceptions, and faulty beliefs that never get addressed. If we tackle family systems, mental health, and social issues in the same manner, we will all live in a village that is capable of being present for everyone." In this way, addressing transphobia within family and support systems would be in the best interest of a particularly vulnerable group, and ultimately promote acceptance for all.

What This Means For You

As demonstrated by this research, trans teens are at greater risk of substance use, which was associated with psychosocial stressors related to transphobia. While internalized transphobia increased the risk of substance use for trans teens, personal resilience, gender pride, family functioning, and social support were protective factors.

As gender diverse youth continue to be targeted by transphobic policies in the US, greater efforts are needed at both national and grassroots levels to ensure that trans teens can access equitable outcomes in society.

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  1. Katz-Wise S, Sarda V, Austin S, Harris S. Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescentsPLoS ONE. 2021;16(6):e0250500. doi:10.1371/journal.pone.0250500