A Comparative Study of Health and Well-being Among Cisgender and Binary and Nonbinary Transgender Adolescents in Spain


Esther Ciria-Barreiro, Universidad de Sevilla, Spain
Concepción Moreno-Maldonado, Universidad de Sevilla, Spain
Francisco Rivera, Universidad de Sevilla, Spain
Carmen Moreno, Universidad de Sevilla, Spain


The last decade has seen growing interest in the health of transgender adolescents. Research results indicate a high prevalence of emotional distress or anxiety disorders, risk behaviors, or suicidal ideation for transgender youth. These health problems can be explained through the Minority Stress Model. According to this theory, people with diverse gender or sexual identities are exposed to a significantly cisheteronormative context, which can be a source of stress. In contrast, there is little evidence on the mental health of transgender individuals from a positive perspective.

Other methodological problems in research with transgender populations are related to the type of sampling and publication bias: many conclusions regarding the health of transgender adolescents are based on non-probability samples from studies conducted in Western, English-speaking contexts. Then, the aim of this study was to describe the wellbeing and mental health of Spanish adolescents by gender identity using a nationally representative sample.


This research is based on data collected in the 2018 Health Behaviour in School-aged Children cross-sectional survey in Spain. The sample was selected using random multi-stage sampling stratified by conglomerates, considering the age of the participants, the type of habitat, and the type of school. Of the 17,678 15-18-year-old adolescents who responded the two-step measure, which included two questions about sex and self-perceived gender identity, 303 were identified as transgender adolescents (90 binary transgender adolescents and 213 nonbinary transgender adolescents). Given the imbalanced comparison ratio between groups, resampling based on matching was used to facilitate sample equalization. The final sample was comprised of 303 transgender adolescents and 909 cisgender adolescents with a comparable profile (M = 16.41, SD = 1.07). Comparisons of frequencies and means (chisquare, t-test, and analysis of variance) were used to analyze self-reported health, life satisfaction, health-related quality of life, psychosomatic complaints, and sense of coherence as measures of well-being. Cramer’s V and Cohen’s d were estimated to test the effects size.


Nonbinary transgender adolescents reported the lowest levels of perceived excellent health, the highest frequency of psychological complaints and physical complaints, and a lower sense of coherence compared with both cisgender and binary transgender adolescents. Likewise, nonbinary transgender adolescents reported lower levels of life satisfaction and health-related quality of life than cisgender adolescents. Although these differences were statistically significant, the effect sizes were small in most of the comparisons.


To the best of our knowledge, this is the first study on the well-being of transgender adolescents based on random multi-stage sampling and in a nationally representative sample in Spain. Based on the Minority Stress Model it was expected that the transgender participants would show worse scores than their cisgender peers in health and adjustment. The differences found between binary and nonbinary transgender youth highlight the diversity within the transgender community. We hope to encourage further research with the goal of designing policies that meet the needs of the transgender community, especially in the currently turbulent times in which the rights of transgender people are in jeopardy.

Contact: eciria@us.es

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