US: Developmental Milestones in Young Transgender Women in Two American Cities: Results from a Racially and Ethnically Diverse Sample

Arjee Restar, Harry Jin, Aaron Samuel Breslow, Anthony Surace, Nadav Antebi-Gruszka, Lisa Kuhns, Sari L. Reisner, Robert Garofalo, and Matthew J. Mimiaga.Transgender Health.Aug 2019.ahead of print


To understand developmental milestones among young transgender women (YTW), we mapped age estimates per milestone by race/ethnicity and cohort age using baseline data from Project Lifeskills (n=298). Compared with older and white participants, younger black, Latina, Asian, and other/mixed race transgender (trans) women reported earlier experiences of sexual debut, transfeminine identity disclosure to others, sexual debut as trans, transfeminine identity expression in public, and integration of hormone use. Findings call for increased research and utilization of gender-affirmative interventions among YTW, with incorporation of nuanced, intersecting roles of race/ethnicity and cohort age across milestones.


The findings of this study, to our knowledge, represent the first empirical quantitative account of YTW's developmental milestones. Specifically, we described age estimates when each milestone occurred, missing from previous studies.11–15 In addition, our findings indicate that while private/internal developmental milestones (e.g., self-awareness of transfeminine identity) do not significantly differ by race/ethnicity or cohort age, the social and external milestones (e.g., transfeminine identity disclosure to others,) do differ. Specifically, younger black, Latina, Asian, and other/mixed race participants experienced these social and external milestones earlier compared with older and white participants. This supports previous findings that other factors (e.g., racial discrimination, norms of concealment/disclosure) may precipitate YTW of color to meet such social/external milestones earlier relative to white YTW.20 These results suggest there is a need for integrated gender-, youth-, and race/ethnicity-affirmative early-in-life interventions, especially when YTW of color transition from more internal recognition of transfeminine identity to more social expression processes of disclosure and sexual emergence.21 That is, although reaching these external milestones early may be empowering for YTW of color, such rapid development may put such YTW at elevated risk given the dual impact of gender and racial minority marginalization.4 As such, results call for early-in-life interventions supporting YTW through these social and external milestones of development. Interventions may incorporate resilience, social support, and sexual risk reduction to better equip YTW with effective means to navigate the immense challenges they face in these periods of transition.22

Moreover, we also found that the age of first consensual oral/anal/vaginal sex among this sample is lower than the U.S. average in cisgender (non-transfeminine) women (15 vs. 17 years old),23,24 an indication for the need of early-in-life sexual health and risk prevention interventions. In particular, YTW of color, who may be particularly vulnerable to HIV/STI, reported sexual debut at roughly 13 years of age, earlier than both white YTW (18 years old) and the U.S. average for cisgender women (17 years old). As previous research has shown, age of first sexual experience is predictive of HIV/STI risk,25 and that TW of color are disproportionately impacted by HIV/STIs.9 These results underscore that early-in-life sexual health interventions that pay closer attention to the age of first sex are needed, which may be useful in reducing the risk of HIV/STI among YTW. Furthermore, it is important to situate age of first consensual sexual encounter (e.g., oral/anal/vaginal sex) within the context of internal and external gender identity milestones for YTW.

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