O3024: Sexual Orientation Among Gender Diverse Youth

Background: Many young people identify as gender diverse youth (GDY). Providing comprehensive sexual and reproductive healthcare to GDY remains a national focus; however, our understanding of all aspects of sexuality among GDY is limited. In the present study, we sought to compare sexual identity, attraction, and contact between cisgender youth and GDY and to describe these characteristics across GDY subgroups.

Methods: We analyzed cross-sectional data from school-based surveys administered to 4,207 high school students in Pittsburgh, PA. A two-step gender identity question was used to identify GDY. Youth indicated their sexual identity as: asexual, bisexual, gay/lesbian, heterosexual, mostly heterosexual, queer, or not sure (marking all that apply). We considered sexual minority youth (SMY) those who selected response(s) aside from only heterosexual. Sexual attraction and contact were assessed by asking respondents “Who are you sexually attracted to?” and “During your life, with whom have you had sexual contact?” Response options included boys, girls, and several gender diverse identities (marking all that apply). Participants with responses for gender identity and sexual orientation measures were included in analyses (N=3,091; 73% of all respondents). Two-sample t-tests or chi-square tests were used to compare characteristics between GDY and cisgender youth. Sexual attraction and contact were summarized with frequencies/proportions and stratified by transmasculine, transfeminine, and non-binary identities.

Results: 281 (9.1%) youth identified as GDY (Table 1). Among GDY, mean age was 15.6 years (SD: 1.4). 47.7% were assigned female sex at birth. 32.0% of GDY were non-Hispanic Black, 30.9% were non-Hispanic White, and 32.4% endorsed other racial/ethnic identities. Compared to cisgender peers, GDY were more likely to be SMY and to report attraction to other GDY. 29.9% of GDY identified as transmasculine, 36.7% as transfeminine, and 33.5% as non-binary (Table 2). Many transmasculine (45%) and transfeminine (58%) youth were heterosexual, whereas most non-binary youth (91%) identified as SMY. For heterosexual transgender youth, sexual attraction varied. For example, 53% of heterosexual transmasculine youth reported attraction to boys and 40% reported attraction to girls. Among heterosexual transfeminine youth, 18% reported attraction to boys and 40% to girls. Similar distributions were observed for sexual contact, though many heterosexual GDY reported never having sex (49%). For GDY who identified as SMY, sexual behaviors were variable. Many reported attraction to and contact with other GDY.

Conclusion: GDY in our sample endorsed diverse sexual identities, including many who were SMY; however, many transmasculine and transfeminine youth identified as heterosexual with attraction to people of the same gender identity. Our results show the complexity of sexuality among GDY and highlight the importance of an individualized approach to sexual and reproductive healthcare in this population.