The Power of Social Transition

Jessica Tomaszewski, MD

The majority of studies on the mental health of transgender people focus on adolescents and adults in whom considerably elevated rates of anxiety, depression, and suicidality are noted. Along with this, research states that stronger social support is linked to better mental health outcomes among these individuals. 

There is significantly less data on younger, prepubescent transgender children, especially those who have socially transitioned (ie, being raised and presented as the child’s gender identity rather than the child’s natal sex). Despite the heated ongoing conversations regarding transgendered persons in society and increased appearances of patients at gender clinics, there is still limited information regarding the mental health of prepubescent transgender children.

With all of this in mind, Olson and colleagues examined parental reports of anxiety and depression among a cohort of prepubescent transgender children who have socially transitioned with the support of their families. These rates were compared with those of nontransgender siblings and typically developing nontransgender children.

The 73 (22 natal girls and 51 natal boys) transgender children in the study were recruited via support groups, conferences, and websites. The control group of nontransgender siblings included 49 children. Seventy-three typically developing children were also included as the other control group. 

All of the children were all recruited as part of the TransYouth project and were matched in demographics as much as possible. Symptoms of anxiety and depression were reported using the National Institutes of Health Patient Reported Outcomes Measurement Information System parental proxy short forms for anxiety and depression. These scales are nationally normed.

Results indicated that socially transitioned, prepubescent transgender children showed typical rates of depression and slightly elevated rates of anxiety symptoms when compared with population averages. The rates of depression in the transgender group did not differ from the population average. Mean anxiety rates were elevated when compared with the population average, but they were not in the range that would be considered clinically significant.

The authors of this study suggest that these findings support the decision to allow prepubescent transgender children to socially transition, because that decision may be associated with better mental health outcomes and a better support system. That being said, the authors also examine several facets of the study that warrant further study. As these early transitions are often seen as controversial, there is some thought that there may be specific characteristics within families who allow these children to transition that may play a role in the mental health of their children. 

Conversely, there may be specific personality aspects within the children themselves that allow these children to transition with confidence. These aspects may be protective in other areas, such as mental health. It is important to note that the study focuses on children with binary identities, which limits the applicability for children whose identities may be more complex in nature. 

The most important aspect of this study is that these socially transitioned prepubescent children are doing well from a mental health standpoint. Further studies will have to examine if these measures are protective as these patients enter adolescence, a particularly challenging time period in the life of a transgender child. Health care providers will have to continue to educate and aid our families as we work to support the mental health of our patients.  

Jessica Tomaszewski, MD, is an assistant clinical professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and a hospitalist pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware. 

Charles A. Pohl, MD—Series Editor, is a professor of pediatrics, senior associate dean of student affairs and career counseling, and associate provost for student affairs at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.


Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137(3):1-8.