Good mental health is a priority for everyone and can have a significant impact on a person’s general health and wellbeing. Risks in mental health can be influenced by gender and age and, along with societal attitudes, can shape a person’s experience when accessing health and other care services than their cisgender peers. This is the case particularly for trans young people. Listening to the experiences of those affected is critical, but having an evidence-driven approach is critical to supporting improvements to existing barriers to accessing care services.

Whilst international studies have been done that show trans young people have higher rates of poor mental health and problems accessing care services, there was limited data on this from the Australian context.

Listening to trans young people is critical to supporting improved services

Trans Pathways

Trans Pathways was published in 2017 and was the largest study conducted of mental health and care pathways in trans youth in Australia. It included 859 trans and gender diverse young people aged 14-25 as well as the views of parents and guardians of this marginalised population.

It considered experiences that might have impacted their mental health, both positive and negative and looked at their experiences in accessing health services, which is generally unsupported for trans young people. Its focus on trans young people highlighted that their needs around service access can be quite different, as some will be accessing gender affirming hormones.

“There is still a lot more stigma associated with being trans than there is with being lesbian or gay. We should consider that someone’s own experiences can have a huge impact on them, even if they have little impact on you.”

Prof. Ashleigh Lin, UWA

The landmark study was published by The Kids Research Institute Australia (The Kids) and led by Dr Penelope Strauss, who was then a PhD candidate in Public Health at The University of Western Australia (UWA). Dr Strauss is currently a Research Fellow at The Kids and an Adjunct Research Fellow at UWA. The study team included her supervisor Professor Ashleigh Lin, UWA School of Global Health, Population and Public Health, as well as partners from The Kids, UWA, Curtin University, YouthLink, and Freedom.

The purpose of the study was to:

• examine the mental health and wellbeing of young trans and gender diverse people;
• provide insight into what was driving poor mental health in this group and the associations with poor mental health and daily life, including school experiences, sport and social rejection and stigma;
• identify areas where better support is needed; and
• improve the understanding of the issues and needs of young trans and gender diverse people across Australia.

“The findings from Trans Pathways have brought to light many different areas in which trans young people in Australia can be better supported by services, peers, families and society as a whole.”

Dr Penelope Strauss, The Kids Research Institute Australia

Trans Pathways Report

Setting standards for social change

The study brought to the forefront the need for equitable care, showing that the rates of mental ill health were very high in trans and gender diverse young people. It showed that 75% of trans young people had either anxiety and/or depression, and that one in two (48.1%) had attempted suicide at some point in their life.

It has significant social impacts and has become valuable in raising awareness of some of the problems that trans young people face, promoting equity in care services, and in supporting the development of initiatives to improve the mental health of trans and gender diverse young people.

For advocacy groups, it has become a useful tool to encourage gender affirming care for young people, which is vital for good mental health. And for parents, it provides information to help them better understand their young people, and the challenges they face, and the need for change.

The impact of Trans Pathways has been felt locally, nationally and internationally and continues to be cited as evidence in a number of health policy and strategy documents, including:

• Children’s Rights Report, National Children’s Commissioner (2017)
• Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (2017)
• Western Australian Commissioner for Children and Young People’s Issue Paper: ‘Lesbian, Gay, Bisexual, Trans and Intersex (LGBTI) children and young people’ (2017)
• Report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, United Nations Human Rights Council (2018)
• Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand, Professional Association for Transgender Health Aotearoa (2018)
• Western Australian Lesbian, Gay, Bisexual, Transgender, Intersex Health Strategy 2019-2024, Government of Western Australia (2019)

A strong advocate of the rights of trans people, Professor Lin has also sat on state and federal working groups to develop policy and was previously a member of the Department of Health and Aged Care LGBTIQA+ Health and Wellbeing 10-year National Action Plan Expert Advisory Group (EAG). This expert advisory group informs the Australian Government about the health needs of people in the LGBTIQA+ community.

“If we just find it in our hearts to be kind and to be compassionate, I think that will go a long way to improving the lives of trans young people and the trans community more generally.”

Prof. Ashleigh Lin, UWA

Raising awareness of the problems faced by trans young people

Recognising the importance of a healthy mental space

The work around Trans Pathways has solidified both Professor Ashleigh Lin and Dr Penelope Strauss as leaders in trans health across Australia. Professor Lin is currently the President of the Australian Professional Association for Trans Health, the peak organisation of people who work and support trans people. She has presented the research at national and international research conferences, and to government agencies, organisations, and educators.

Professor Lin has also been formally recognised for her contribution to youth mental health research in Western Australia (WA), with a primary focus on the mental health of marginalised young people, including trans young people.

• 2023 WA Mental Health Awards, Minister’s Award
• 2023 Premiers Science Awards, Mid-Career Scientist of the Year finalist

Professor Lin has become a leader in trans mental health in Australia

Toward a brighter future

The team’s research is now focused on using their findings to inform interventions that could be provided. Now that they know of the scope of the issues faced by trans youth, it is important to ensure interventions are safe and effective.

Professor Lin’s UWA PhD student Felicity Austin, School of Human Sciences, is also currently researching how best to engage trans young people in sports and exercise, supporting their right to play and be part of a team, which is integral to reducing overall stigma and discrimination.

This year, Professor Lin and Dr Strauss, along with colleagues at the Perth Children’s Hospital, received a $5 million grant from the Medical Research Future Fund. This funding will allow them to examine the longitudinal trajectories of young people who attend the Gender Diversity Service at Perth Children’s Hospital to better understand the mental and physical health outcomes of trans youth. They will also combine their data with similar data across Australia (making it the largest worldwide) to allow them to ask important questions about medical intervention for trans youth.

“We’ve raised awareness and provided strong data, and now we’re looking for solutions. But there will always be a section of the community that we can’t convince. I think it’s just about being kind, and imagining yourself in that position and how you would do anything to protect your child.”

Prof. Ashleigh Lin, UWA

A brighter future for trans young people.