Under Pressure: Young and Figuring Out LGBTQ+ Identity – Everyday Health

September 1, 2021 Kim Martel

Emily Tressa grew up in a small New Hampshire town, the youngest of three boys who thought of herself differently. That is to say that, despite appearances, she did not feel like one of the boys. “I made it very clear to my family: I am a girl,” says Emily, now 19.

Emily was lucky. Her family affirmed and supported her. Her mother found a video of another child describing similar circumstances — Jazz Jennings — and shared it with her. Jennings, now 20, spoke to Barbara Walters at the age of 6 describing how she was a boy who felt like a girl. She went on to become one of the biggest advocates in the transgender community and star of the television show I Am Jazz.

For Emily, the video was a revelation. “I was like, ‘Finally, I had a word to describe how I feel,’” she says. And, following Jennings’s example, she realized she could transition. Before then, she says, “I never realized that was even a possibility.”

Emily socially transitioned at age 10 when she dressed as a girl and started going by the name Emily. She began the process of physically transitioning soon after, taking hormone blockers to hold off male puberty and then female hormones, followed by gender affirming surgery at 17.

She was one of the youngest people in the country to have the operation, which took place at the Mount Sinai Health System in New York City. She even appeared on I Am Jazz discussing her upcoming procedure with Jennings, who also had her surgery at Mount Sinai.

Breaking Old Boundaries Regarding Sexual Orientation and Gender Identity

Gender identity, in recent years, has increasingly been understood to be less concrete and more fluid than in past generations, where the options regarding sexual identity were limited to male or female, gay or straight.

According to the University of South Dakota (USD) Office for Diversity, gender identity and sexual orientation are understood to exist on a spectrum rather than solely as opposite endpoints.

The gender identity spectrum is a continuum that extends from men to women and masculine to feminine, USD states. For example, people who identify as transgender — someone whose gender identity does not match the sex or gender they were assigned at birth — fall toward the center of this spectrum.

Likewise, the sexual orientation spectrum ranges from attraction toward people of the same binary gender or sex to attraction toward people of the opposite binary gender or sex, USD explains. And people whose attraction to others falls somewhere in between — such as bisexual people — land somewhere in the middle of the spectrum.

This has left the current generation of adolescents and young adults with an abundance of options, but also complexity, when it comes to navigating gender identity. And of course, it all comes at one of the most challenging periods of time developmentally, says Patrice Harris, MD, a psychiatrist and Everyday Health’s medical editor in chief at large.

“Adolescence and young adulthood are times of self-exploration and development of a sense of self and identity. If you are struggling silently with gender issues, there could be even a greater burden,” Dr. Harris says.

Support Is Critical

More awareness and openness about different gender identities and sexual orientations has undoubtedly made it easier for young people in the LBGTQ+ community to both understand themselves and gain acceptance. There are role models, like the teen star JoJo Siwa and football player Carl Nassib, and celebs including Jamie Lee Curtis, who recently revealed she has a transgender daughter, as reported in the August–September 2021 issue of AARP magazine.

Emily, who is starting college at the Fashion Institute of Technology in New York City this fall, said the experience of being a transgender teen has changed in even the last few years. “Now so many more people are educated on what trans is. Now I think it’s a lot better,” she says.

But the acceptance is not universal. “There’s still a long way to go for people to understand more,” she says. Indeed, because LGBTQ+ people lack rights in the Unites States, an affirming family member, workplace, or school make a big difference in terms of safety.

Some families, like Emily’s, are supportive, as are their communities. But many teens who come out as LGBTQ+ still face bullying or experience mental health challenges as a result.

“We know young LGBTQ+ people are more prone to suicide because of their sexual orientation or gender identity — they are placed at higher risk because of the harmful rhetoric and rejection they often hear from their friends and families that can make them feel their life is worth less than their peers,” says Amit Paley, CEO and executive director of The Trevor Project, a California-based nonprofit that provides crisis intervention services to LGBTQ+ youth.

In a Trevor Project survey of 35,000 LGBTQ+ young people across the United States that was released in May 2021, 42 percent of teens and young adults ages 13 to 24 had seriously considered a suicide attempt in the last year, and nearly half of young people could not access the mental health care they wanted in their community.

“Acceptance of LGBTQ+ youth helps save lives, while rejection contributes to negative mental health outcomes,” says Paley.

Paley says The Trevor Project’s research has found that just one accepting adult can reduce the risk of a suicide attempt among LGBTQ+ young people by 40 percent. “That’s why it is so essential that acceptance starts at home.”

Even something as seemingly simple as respecting the pronouns of LGBTQ+ youth or allowing them to change their name and gender marker on legal documents is associated with lower rates of suicide attempts, says Paley.

After Acceptance at Home Comes Community and a Glossary of Respect

Having social media and the ability to connect online has been particularly helpful for LBGTQ+ youth to understand what they’re feeling, and even to put a name to it, says Phillip Hammack, PhD, a professor of social psychology at the University of California in Santa Cruz, where he also directs the sexual and gender diversity laboratory.

“When you talk to young people, what you find is that they’re very relieved and exhilarated to discover the range of language out there,” Dr. Hammack says. “It seems to be a net positive in understanding questions like: Who am I? And, is this wrong?”

“They sort of discover this language that then opens the door to a more positive mental health experience,” he says.

Terms like pansexual, meaning someone who is attracted to any possible gender identity, or gender fluidity, indicating that one’s experience of gender or sexuality can change over time, were not widely used in older generations, which had a more binary view of gender and sexuality, Hammack says. “Young people are sort of leading the way on these issues,” he says.

Primo Lagaso Goldberg, an 18-year-old from San Francisco, came out as gay in seventh grade. He now identifies as nonbinary, a term for those who don’t consider themselves exclusively male or female. Goldberg also calls himself queer. “I definitely think it’s a more inclusive and sort of overarching term that encompasses and articulates a lot of different kinds of love and attraction, and I think that’s sort of the core of what, at least I think, the LGBTQ+ community stands for,” he says.

Goldberg, who is starting his freshman year at Harvard University this fall, says growing up in progressive communities in Hawaii and California, and having an accepting family, made him feel safe to be out.

“In the places where the strain of thought is more progressive, I think it has become easier to be out and queer as a young person,” he says. “It really depends on where you are in the world.”

Medical Care, and Whether to Transition

Access to medical care for nonbinary and transgender youth is a specialized field, not universally available, and may also be limited by geography.

For some adolescents and young adults, the challenge will be limited to finding providers who are culturally inclusive, understanding, and respectful of their gender identity. For others, such as those who are trans, there’s a harder question to address: whether, and how, to transition?

“The decision to transition can be difficult for a myriad of reasons, whether social, familial, or financial reasons,” says Leif Rogers, MD, a plastic and reconstructive surgeon based in Beverly Hills, California. Dr. Rogers works with transgender people who are transitioning.

“The old-fashioned way to approach this was a lot of mental health screening (first) and making sure they’re really transgender, and it was a little bit patronizing and demeaning,” says Joshua D. Safer, MD, executive director of Mount Sinai’s Center for Transgender Medicine and Surgery in New York City. Mount Sinai is one of about six centers throughout the United States that offers comprehensive care for transgender youth.

Dr. Safer says the current thinking is to approach gender identity not as a mental health problem, but as a biological phenomenon.

“The question is: What do you do about that? The most successful strategy — for the people who are looking for it — is to do some intervention to make the body match the brain,” he says.

Safer says typically a transgender youth might enter a transition program before puberty and then be given medication to stave off the development of breasts or an Adam’s apple.

“It’s a medically conservative thing to do, so you can really be thoughtful and figure out what the next step would be without panic that puberty is happening,” he says.

Taking hormones typically comes next, followed by one or more surgeries if desired, including chest masculinization for females transitioning to male or facial feminization and vaginoplasty to create a vagina from a penis, says Safer. (There are also transgender and nonbinary people who choose never to transition medically.)

A full medical transition is the path Emily Tressa followed. She says she now feels like her body and brain match. “I’m 100 percent happy in my body now, the happiest I could be,” she says.

Additional reporting by Christina Vogt.