In a new study, Fordham Graduate School of Education (GSE) doctoral student Hannah Sugarman and GSE professor Eric C. Chen, Ph.D., detail how much harder it can be when you’re a teenager.

In “Transgender Students’ Navigation of Gender Identity and Relationships in High School: A Phenomenological Analysis,” Sugarman interviewed three adults between 18 and 23, about how they navigated their transgender identity through the context of their relationships and high school experiences. The study, which took place in 2016 and 2017, involved two women who’d transitioned from being men and one man who’d transitioned from being a woman. All attended high schools in the New York City metro area and transitioned after they’d graduated.

Sugarman and Chen utilized a phenomenological qualitative method, which focuses on understanding a relatively small group of individuals’ own subjective experience, through the prism of the researchers’ professional and personal views. That is, both the participant and the researcher engage in the collaborative process of constructing layers of meanings underlying the phenomenon through in-depth personal interviews.

“The interviewer may have some ideas about what it means to be a transgender individual, but it’s through the process of having a dialogue with the participant that they eventually understand what it means to be transgender, and what it means to negotiate that hidden identity with others,” Chen said.

The study revealed that participants were dealing with five notable issues: early inclinations of transgender identity; denial of gender identity; school-related barriers to self-acceptance; emotional support impacting resilience; and taking on a queer identity.

Chen, whose research focuses on marginalized members of society, said that for him, the last theme was the most intriguing. Participants first identified as either gay, lesbian, or bisexual before realizing that these new labels are not sufficient.

“Transgender individuals, at least based on these participants’ experiences, seem to have a three-stage process,” Chen said. “They seem to pick up different labels to describe their own gender identity, experiment with it, and then realize, again consciously or unconsciously, that it doesn’t fit with their own transgender identity.”

Other findings that emerged from the interviews point to changes that can be made at the high school level. For instance, all three said they understood when they were very young that their psychological identity did not match their biological one. Like many in the LGTBQ community, they initially responded to this revelation with avoidance and hostility.

School administrators and teachers were sources of further tension, through policies, such as single gender bathrooms, or through the language they used.

“One [participant]indicated that she would cut school, because her teacher kept referring to her as a man. It was a source of constant stress for her,” said Chen.

On a positive side, all three participants said they were able to find adults or peers during their high school years who they could reach out to for emotional support. Those people may not have been aware of the students’ transgender identity, but because they were encouraging and empathetic, students felt OK with reaching out for comfort and found it beneficial.

The paper will form the basis of Sugarman’s doctoral dissertation. She and Chen will present their findings at the American Educational Research Association’s annual meeting, which takes place April 13 to 17 in New York.

“I have seen the impact that educated, compassionate, and empathetic adults can make on a student’s life, and my goal is to raise and showcase the voices of transgender individuals so that school personnel will be further suited to be that source of support,” Sugarman said.

“My sincere hope is that my research will contribute to the existing literature on transgender adolescents, and that my presentation will perhaps spark some interest in future research and understanding of this vulnerable community.”

Fisher was the principle investigator on a recently completed quantitative study that resulted in a paper published in the journal AIDS and Behavior titled “Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM.” In the study, Fisher found that young males who have sex with males were reticent to discuss sex with their doctors. But when doctors initiated the conversation, they were more forthcoming with vital information that could affect their health.

The nationwide study was conducted anonymously via a  questionnaire linked to from a trusted website frequented by gay teens. It surveyed 198 adolescent gay males. Several participants said they completed the survey because they wanted to help their community.

“This is the first study to ask kids about their attitudes on getting sexual health care,” said Fisher, who directs Fordham’s Center for Ethics Education. “Pediatricians and general practitioners are the gateway of youth experiences with health care, but [these patients]only go once a year, so this is an ideal time to ask [about their sexual activity].”

Fisher said there are several studies that have found that most doctors are not trained to ask questions relevant to sexual minorities, and many doctors assume the youth they treat are straight. Furthermore, the language of sexuality has evolved for young people.

“The other issue is that doctors should not use terms like ‘gay,’ or ‘LGBT,’ because for many young people the terminology is in flux,” said Fisher. “Youth no longer identify with these traditional behaviors; the question should be ‘Who are you attracted to sexually?’”

But most importantly, Fisher said, the conversation needs to be initiated by the doctors, even though doctors often have the “misperception that the kid would be uncomfortable.”

“Physicians need to be well versed in safety advice and should be able to communicate to all,” she said. “The kids don’t bring it up because they think the doctor will be prejudiced.”

Another concern among the young men was that the doctors might tell their parents, but Fisher said most states allow doctors to provide information to teens on sexual health, including HIV prevention, without parental consent. Some states, like New York, even allow doctors to prescribe PrEP, the pill that protects against HIV, to minors without getting parents involved.

“The grey area is if the child is having sex with an adult that might be considered sexual abuse and that needs to be reported,” said Fisher.

But such cases only reinforce the need for doctors need to be proactive in their conversations with youth, she said. Even if the relationship is legal and consensual, some youth lack assertiveness skills to demand a condom from an older or aggressive peer partner, she said.

“They need advice specific to males having sex with males,” said Fisher. “Giving gay males advice on sex with females is useless, but when they’re aware of those specifics they’ll be safer and healthier.”