Background: The literature has well established that the transgender and gender diverse (TGD) population, which includes non-binary (NB) individuals, experiences significantly higher rates of psychosocial stressors and mental health concerns relative to cisgender and sexual orientation minority populations. The specific psychosocial outcomes for NB youth are understudied. This study compared the psychosocial functioning of NB youth to binary transgender peers at the time of assessment for gender-affirming hormones (GAH) according to clinically relevant youth self-report (YSR) subscale scores.

Methods: 534 patients between the ages of 14-18 seeking GAH at Boston Children’s Hospital’s Gender Multispecialty Service (GeMS) clinic were administered the YSR as part of a comprehensive psychosocial functioning assessment. Linear regression was used to determine whether and how NB and binary transgender youth differed on clinically relevant YSR T-scores. The YSR variables related to self-harm and suicidal ideation were dichotomized from “very often/sometimes/never” to “yes/no” and analyzed using logistic regression. Age- and assigned sex-adjusted logistic and linear regressions were run for all variables significant in univariate analysis. Gender was analyzed as a categorical value with affirmed male gender set as the base category.

Results: Significant differences between NB and binary transgender participants in the univariate analyses were found for: total problems (b=2.86 p<.04), internalizing problems (b=4.57 p<.003), depressive problems (b=4.52 p<.002), and self-harm (OR 2.65 p<.01), all of which were substantially increased in the NB population. When adjusted for age and assigned sex at birth, the total problems T-score was no longer significantly associated with NB gender, while the strength of the associations between NB gender and internalizing problems (b=4.40 p<.004), depressive problems (b=4.24 p<.003), and self-harm (OR 2.79 p<.008) all increased.

Conclusions: At the time of assessment for GAH, NB youth reported substantially higher levels of psychosocial distress, internalizing problems, depression, and self-harm than their binary transgender peers.