Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Epidemiology and Biostatistics


Dr. Greta Bauer


Families often experience extrafamilial, transgender-specific social stressors as they accompany their transgender or non-binary (TGNB) youth through the gender-affirming care process. Guided by family systems theory, family life cycle perspective, and queering family perspective, we explored whether these stressor experiences were quantifiable as a latent variable, and whether such a latent stressor variable might have a relationship with family functioning. We conducted a latent class analysis using parent-report of stressor experiences in a Canadian sample of TGNB youth under 16 years of age who received gender-affirming care for the first time. Families fell into one of 4 stressor groups: “Low Disruption, Policy Advocacy”, “Social Disruption, Social Advocacy”, “Low Disruption, Low Advocacy”, and “Major Disruption, High Advocacy”. Family functioning was strong across all stressor groups, and there was no association between stressor group and family functioning score.

Summary for Lay Audience

Gender dysphoria occurs when individuals feel distress because their gender identity does not align with their sex assigned at birth. Gender affirming care involves medical procedures such as puberty blockers, hormone therapy, and surgical procedures that can help to alleviate such distress. The demand for gender affirming care is increasing among transgender and non-binary (TGNB) youth in Canada. TGNB youth and their families may experience stressful social interactions with individuals or institutions outside of their immediate family that are specific to the youth’s identity as a TGNB person; we refer to these as stressors.

Family functioning refers to how well members of a family unit work together to function through both stress and positive experiences. According to different family theories, individuals within a family unit can each influence the dynamic and experiences of the rest of the family unit, and challenges that families face differ depending on the age of the youth. It is possible that influences such as stressors outside of the family can also create stress in TGNB youth’ families and impact family functioning; however, few studies have explored this possibility.

This thesis used data from the largest study of Canadian TGNB youth and families, with youth under 16 years of age, accessing gender-affirming care for the first time. We categorized families’ experiences of stressors outside of the family into 4 different groups, with varying degrees of social disruption experienced alongside advocacy efforts. These groups generally did not differ in their experiences of family functioning, and overall, families were doing well. Stressor group was not linked to rating of family functioning, but youth age group, whether parents had a partner, and whether a co-parent was living apart from the family unit appeared to play a potential role in family functioning.

This study reaffirms that families accompanying their TGNB youth through clinical care in Canada are doing well, regardless of the challenges they face from outside the family. The discovery of distinct stressor groups affirms parents’ experiences and contributes to family functioning research in this population.

Available for download on Thursday, November 10, 2022