Background: School plays an important role in transgender and non-binary (TNB) youths’ life and well-being. The aim of this study was to gain a better understanding of how the lived experiences, gender affirmation and challenges encountered by TNB youths in the school setting affect their well-being. Method: Our study was a qualitative secondary data analysis, based on the interviews of 12 Canadian TNB youths aged 15–17 years old. Results: We found that TNB students’ well-being was closely related to the acknowledgment of gender identity at school. Several factors, including school socio-cultural environment, teachers’ and peers’ attitudes and behaviours, school physical environments and the respect of confidentiality of gender identity were all found to impact TNB students’ well-being. To face adversity related to some of these factors, TNB youths used several contextually driven strategies such as compromising, educating, and sensitizing others about gender diversity and avoiding certain people or situations. Conclusion: Our results highlight the important influence of school climate and culture, as well as teachers’, school personnel’s and peers’ behaviours and attitudes on TNB youths’ well-being. Our findings can guide future interventions to help schools become more inclusive and supportive of gender diversity.

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Background According to recent population-based surveys, approximately 2% of Canadian children and adolescents identify as transgender or non-binary (TNB). Since its inception in 2016, the multidisciplinary paediatric gender diversity clinic at Sainte-Justine University Hospital Center has seen a rapid increase in the number of new referrals, which mirrors increases seen in paediatric gender diversity clinics across the country. Our clinic is the first Canadian multi-disciplinary paediatric gender diversity clinic for French-speaking youth and currently provides comprehensive affirmative medical care for approximately 350 TNB children and adolescents. TNB youths present significantly higher rates of mental health disorders and suicidal behaviours than their cis-gender peers. However, the specific needs and characteristics of French-speaking TNB youth have not yet been studied. Objectives The aim of the study is to describe the demographic and clinical characteristics of a cohort of children and adolescents who received care at the Sainte-Justine University Hospital Centre gender diversity clinic. Design/Methods De-identified data was collected retrospectively from the medical records of all 279 patients who received care at the clinic between its inception and May 31st, 2021. A research questionnaire was developed under the supervision of an adolescent medicine physician and a paediatric endocrinologist to collect data on patient socio-demographic, behavioural, psychosocial, mental health and medical characteristics. Follow-up visits were included until October 15th, 2021. All data was entered into a password-protected database. The project was approved by the CHU Sainte-Justine Research Ethics Board. Results At the time of their initial consultation, patients were on average 14.4 years old (4.1 to 18.3 years old) and 70.6% were assigned female at birth. Most of the youth had disclosed their gender identity to their families (94.3%) and nearly three-quarters (73.5%) had initiated a social transition. More than half of the patients presented with at least one mental health comorbidity (55.2%) on their first clinic visit. One in two youths reported past or current suicidal ideation at the initial consultation and 12.2% had attempted suicide. During the follow-up period, 49.5% of patients received a prescription for pubertal blockers and 40.9% received a prescription for gender-affirming hormonotherapy (testosterone or estrogen). Conclusion Children and adolescents followed at the Sainte-Justine University Hospital Center gender diversity clinic present with high rates of mental health comorbidities, including suicidal ideation and attempts, highlighting the importance of providing supportive services for these youths and their families. Future research building on these findings will help identify the specific needs, care trajectories, and impacts of gender affirming treatment on the health and well-being of French-speaking TNB youth.