JMIR Publications

ABSTRACT

Background:

There is a growing number of adolescents who are presenting with gender dysphoria, and these adolescents have been shown to have significantly worse health outcomes when compared with their cisgender peers. Hypotheses to explain this discrepancy are based on increased stress levels surrounding societal acceptance of gender identity. Elevated allostatic load, which demonstrates the “wear and tear” put on the body in response to repeated exposure to stress, has been associated with adverse long-term health outcomes.

Objective:

The objectives of this pilot study are to: (1) measure allostatic load amongst transgender and gender diverse (TGD) adolescents in comparison to cisgender peers; (2) assess how allostatic load varies depending on psychological stress and perceived societal acceptance.

Methods:

This will be an observational proof-of-concept pilot study. Allostatic load will be measured by assaying an array of inflammatory cytokines and cortisol in urine, saliva, and hair samples of TGD youth compared to age-matched cisgender controls. A questionnaire will assess four aspects of psychosocial wellbeing: presence and management of depression and anxiety, degree of support of gender identity by family, gender minority stress, and degree of perceived safety in surrounding community. Samples and surveys will be collected at 3 visits (baseline, 6 months, and 12 months). This study will incorporate TGD co-investigators to inform all aspects of design, data collection, and analysis and to ensure that practices are carried out in a respectful and sensitive manner.

Results:

As of September 2020, the start of data collection for this project has been postponed as a result of the COVID pandemic, which has both impacted the functioning of the clinic and delayed responses on requests for funding. We hope to begin participant recruitment and interviews of the co-investigators in the near future.

Conclusions:

We hypothesize that allostatic load will be primarily influenced by psychological well-being and perceived support and that it will be similar in TGD adolescents as in age-matched cisgender controls when acceptance and perceived support are high. The results of this study have the potential to increase our understanding of the health challenges faced by TGD individuals during adolescence, as well as to show that low levels of acceptance may have future detrimental health outcomes secondary to elevated allostatic loads. It may lead to the development of a biomarker profile to assess allostatic stress in TGD patients that can be used to guide management.