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The necessity of including transgender adolescents in developing affirming gender identity research measures

Pediatric Research (2025)Cite this article

Abstract

Developing best practices for accurately ascertaining gender identities has become increasingly important, especially as more adolescents identify with transgender and nonbinary identities. The research community faces the challenge of creating inclusive and representative measures that effectively capture these identities. In collaboration with the Adolescent Medicine Trials Network for HIV Interventions (ATN), we present our youth-informed multi-step process for gender, gender identity and sex-assigned-at-birth ascertainment. We also highlight the critical need to involve adolescents directly in the development and testing of affirming and intersectional gender identity measures, with particular attention to ensuring how language reflects race, ethnicity, and tribal affiliation among other backgrounds. By engaging adolescents in the creation and refinement of these measures, researchers can develop methodologies that not only enhance data quality and accuracy but ensure the correct recognition of unique identities.

Impact

This article shares a newly developed, affirming, multistep process to measure gender in adolescent research while highlighting the importance of their involvement in the developmental process.

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Funding

The authors are grateful for the support from the funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH) (UM2HD111102, UM2HD111076, P2CHD041028). Dr. Restar is supported by the Research Education Institute for Diverse Scholars (REIDS) Program at Yale University School of Public Health, funded by the National Institute of Mental Health (R25MH087217), amfAR, the Foundation of AIDS Research, and the Robert Wood Johnson Foundation Health Policy Research Fellowship. This article does not represent the official view of the sponsors.

Author information

Author notes

  1. These authors contributed equally: Arjee J. Restar, Daphne C. Suen.

Authors and Affiliations

  1. Weitzman Institute, Moses/Weitzman Health System, Washington, DC, USA

    Arjee J. Restar, Max K. Morris, Peyton L. Rogers & Grace Wang

  2. Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA

    Arjee J. Restar

  3. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Daphne C. Suen

  4. Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA

    Judah Z. Dean, Adrian Williams, Dionté Gill & Kendrick Forte

  5. Office of Budgets and Financial Planning, North Carolina Central University, Durham, NC, USA

    Kendrick Forte

  6. Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Ini-Abasi A. Ubong & Kristi E. Gamarel

  7. Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Kristi E. Gamarel

Authors
  1. Arjee J. Restar
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  2. Daphne C. Suen
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  3. Max K. Morris
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  4. Peyton L. Rogers
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  5. Judah Z. Dean
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  6. Adrian Williams
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  7. Dionté Gill
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  8. Kendrick Forte
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  9. Ini-Abasi A. Ubong
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  10. Grace Wang
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  11. Kristi E. Gamarel
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Contributions

A.J.R. and D.S. conceptualized and drafted the initial manuscript and critically reviewed and revised the manuscript. G.W. and K.G. identified sources, critically reviewed and revised the manuscript, and supervised revision of the manuscript. M.M. and P.R. critically reviewed and revised the manuscript. J.Z.D., A.W., D.G., K.F., and I.U. critically revised the manuscript and were part of the ATN think tank that developed these gender measures. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Arjee J. Restar.

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The authors declare no competing interests.

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Restar, A.J., Suen, D.C., Morris, M.K. et al. The necessity of including transgender adolescents in developing affirming gender identity research measures. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04664-z

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