Alcohol Use Among Transgender and Gender-Diverse Youth

Release time: 2023-09-03 09:25

Alcohol Use Among Transgender and Gender-Diverse Youth

Drinking to cope may do more harm than good.


  • Transgender and gender-diverse (TGD) youth are subjected to minority stressors, like victimization.

  • TGD youth are at risk of drinking alcohol to cope with minority stress.

  • Drinking alcohol to cope can lead to increased physical, social, and mental health harms.

Transgender and gender diverse (TGD) youth include young people whose gender identity differs from the sex they were assigned at birth. Many TGD youth, due to their minoritized status, are subjected to victimization, discrimination, invalidation of their gender, and transphobia. These experiences are referred to by researchers and clinicians as “minority stressors.” At a time when TGD youth are the target of increasing marginalization and minority stressors (see Mapping Attacks on LGBTQ Rights in the U.S.), it is critical to acknowledge that these minority stressors can have a profound impact on the mental and physical well-being of TGD youth.

TGD youth understandably develop ways to cope with these minority stressors. Some of these coping strategies can be empowering and strengthening, like seeking support from peers and TGD community members and obtaining gender-affirming interventions. Some other coping strategies, however, come with harms of their own. One concern is that TGD youth may use substances to help them cope with the distress and impacts from minority stress, such as drinking alcohol.

Drinking patterns among TGD youth

Recent research suggests that TGD youth are at risk for alcohol use and heavy drinking. In a recently published scoping review by myself and others, led by Kalina Fahey, we found that TGD youth were generally more likely to report any alcohol use than cisgender (i.e., non-transgender) young people, particularly heterosexual youth (Fahey et al., 2023). Similarly, across multiple studies, TGD youth were more likely to report drinking five or more drinks in a sitting than cisgender youth. Non-binary youth, however, may be an exception: They tended to have no difference in their drinking, or even lower drinking, compared to cisgender youth.

Minority stress and drinking to cope

It is expected that these increased rates of drinking partly result from experiencing minority stress. That is, TGD youth who experience minority stressors may rely on drinking alcohol to help them escape these painful experiences and resulting distress. In fact, several studies of TGD youth have found that experiencing minority stress is associated with increased alcohol use (Fahey et al., 2023).

Alcohol’s poisonous consequences

While alcohol use may help TGD youth in the short-term to manage this distress, alcohol use is also a leading preventable cause of injury and death. Further, alcohol intoxication can ultimately worsen the emotional and mental well-being of TGD youth. In a study of TGD university students led by myself and others, we found that they were at risk for a number of harms from drinking, including increased suicidal thinking and increased risk of being sexually assaulted (Dermody, Fahey, & Kerr, 2022). Clearly, drinking to cope can come at a great cost to TGD youth.

Taking action

There is no doubt that minority stress is prevalent and that it negatively impacts TGD youth in numerous ways, including increasing alcohol use and associated harms. Clearly, as a society, it is necessary to take steps to eliminate minority stressors and develop a gender inclusive society. It is important to halt and reverse policies and practices that harm or further marginalize TGD youth, such as bathroom bills and restricted access to health and gender-affirming care. Further, it is necessary to find ways to address the impacts that minority stressors have had and continue to have on TGD youth. Research is needed to develop individual and group support for TGD youth to bolster their well-being and promote healthy coping strategies.

Finally, allyship for TGD youth includes educating oneself about gender identity and expression and respecting gender diversity. The Trevor Project provides a helpful guide about being an ally to TGD young people.


Sarah Dermody, Ph.D., C.Psych., is the Director of the Clinical Addictions Research and Equity Lab and Associate Professor at Toronto Metropolitan University.

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