Transgender teens face higher rates of health disparities and challenges in schools compared to their cisgender counterparts, according to a recent national survey from the Centers for Disease Control and Prevention (CDC), but researchers at Northwestern University said the data’s methodology could have affected its accuracy.

The CDC released results Oct. 10 for its 2023 Youth Risk Behavior Study(YRBS), a biennial surveillance system monitoring the health behaviors of American youth. For the first time, the survey included a question about transgender identity.

Its results showed 3.3% of high school students identified as transgender, with another 2.2% questioning their gender identity. Both of those populations reported higher rates of poor mental health, bullying, challenges in school and suicidal thoughts.

“It’s really heartbreaking to see a group of young people is experiencing this level of distress,” said Kathleen Ethier, director of the CDC’s Division on Adolescent and School Health. “In this case, it’s the 5% of young people that we surveyed who either said they identified as transgender or questioning, and it really calls us to action.”

Researchers at Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing who analyzed the data said its results will be useful for future research, but the survey’s phrasing of the gender identity question could have led to an underestimation of the number of trans and gender nonconforming teens.

The CDC’s survey asked students whether they identified as transgender, but assumed they are cisgender when they responded with, “No, I am not transgender.” This could have led to other gender identities, such as nonbinary or gender-nonconforming, to be left out of the data, said Gregory Phillips II, an associate professor at Northwestern University.

“It doesn’t account for anyone else who is nonbinary, genderqueer or anything else that people might not consider transgender,” Phillips said. “But it’s still great that they’re able to highlight the disparities that transgender youth face, because that data can help stimulate future research.”

Ethier said the CDC’s researchers were working with limited space in a large survey that doesn’t give room for nuanced questions about how young people might identify, but the data still shows that within the population of transgender students they did capture, major differences in health outcomes were apparent.

“The question about whether or not the data represents and over- or underestimate is interesting, but potentially not as useful as the rest of its results,” Ethier said. “The disparities between young people who identify as transgender or questioning and those who don’t is the real value of the data.”

According to the survey’s results, one in four transgender or questioning students had skipped school because they felt unsafe, compared to 8.5% of cisgender male students and 14.9% of cisgender female students. Additionally, about 40% of trans or questioning students said they were bullied at school, compared to 14.8% of cis male students and 20.3% of cis female students, according to the survey.

Trans and questioning students also reported poorer mental health outcomes, including:

  • 71.9% of trans and 68.9% of questioning students reporting persistent feelings of sadness or hopelessness, compared to 26% of cis male students and 50.5% of cis female students.
  • 52.9% of transgender and 44.9% of questioning students saying they had seriously considered suicide, compared to 12.1% of cis male students and 24% of cis female students.
  • One in four trans or questioning students having attempted suicide, compared to 5.3% of cis male students and 11% of cis female students.

“What we’re seeing in the data is that for those young people who are transgender or questioning, there are these incredibly moving disparities, and the takeaway is that we need to make school environments and community environments as safe as we possibly can for these young people,” Ethier said.

To improve these health outcomes for transgender and questioning youth, schools can implement policies or practices like creating gay-straight alliances, identifiable safe spaces, professional development on inclusivity and anti-harassment policies, Ethier said.

The CDC has done other research that shows when schools take steps to improve the health and wellbeing of LGBTQ+ youth, it improves outcomes for the entire student body, Ethier said.

“What that’s allowed us to say is when you focus on a group of incredibly vulnerable young people and make their environment safer, not only does their health and wellbeing improve, but the health and wellbeing of all young people improves,” Ethier said. “It’s not a zero-sum game.”