Gender Nonconformity: New Suicide Risk in Teens?

F. Perry Wilson, MD, MSCE


September 25, 2018

Welcome to Impact Factor. I'm Perry Wilson. This week: a study appearing in JAMA Pediatrics which finds truly frightening rates of destructive behaviors among gender-nonconforming high-schoolers.[1] Let's define our terms.


Gender nonconformity is not the same as gender identity or sexual orientation. Gender nonconformity is when an individual's physical appearance or behaviors do not align with societal expectations. A male student can be gender nonconforming without being gay, although there are, of course, strong associations between sexual orientation and gender nonconformity.

High school is an incredibly stressful time for all kids. Add in gender nonconformity, and what is traditionally a challenging period of life can become life-threatening.

Researchers from the Centers for Disease Control and Prevention (CDC) used data from the Youth Risk Behavior Survey, which was administered to around 6000 high school students in three school districts in Florida and California.

The survey asked the teenagers to describe how other people in their school would describe them, on a scale ranging from very feminine to very masculine. The scale was then used to create a measure of gender nonconformity—ie, feminine male students and masculine female students. Twenty percent of the students reported moderate to high levels of gender nonconformity.

If you look at the total data, you get a typical picture of an American high school: 5% of the students reported smoking cigarettes and around 30% reported occasionally feeling sad or hopeless. Well, yeah; it's high school.

But all of these numbers get worse, sometimes staggeringly worse, when you look at gender nonconformity.


For example, 20% of gender-nonconforming students reported attempting suicide compared with 7% of gender-conforming students.

The data are bad for both sexes but seem to be worse for males.


Even after accounting for sexual orientation, gender-nonconforming males were three times more likely to have used cocaine, four times more likely to have used methamphetamine, and eight times more likely to have used injection drugs than their gender-conforming counterparts. These relationships were not seen in female students, underscoring that masculine traits in female students may be more socially acceptable than feminine traits in male students.

Some of you may be thinking: Is gender conformity a choice? If the students could just be more masculine or more feminine, would it alleviate these problems?

I think the important thing to realize is that to these students, conforming to gender norms that don't feel true to who they are is an even worse option than enduring the harassment and bullying that they face each day. With that in perspective, it should become clear that supporting these students and encouraging their acceptance may bring high school back to what it is supposed to be: Rough. But bearable.


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