May 30, 2017

We hope you had the opportunity to join us for this month’s PFLAG Academy Online session, Health Disparities and Risk Behaviors among Gender-Expansive Students, presented by Allison Gill. For those who missed it, not to worry: the on-demand recording is available. In the meantime, here’s more information from Allison in support of the session.


Youth whose gender expression does not fit traditional roles based on their sex assigned at birth, often referred to as gender nonconforming, gender expansive, or nonbinary youth, are at increased risk for a variety of negative health risks, including victimization (bullying, abuse, sexual harassment) and negative behavioral health outcomes (depression, suicide, drug use). Although these health risks have been studied among LGBTQ youth who are gender nonconforming, there has been very limited population-based research, particularly among heterosexual students.

The Centers for Disease Control and Prevention (CDC) has approved an optional question that allows states and municipalities to examine gender expression and gender nonconformity among students and the association to various health risks through the Youth Risk Behavior Surveillance System (YRBSS). YRBSS is the nation’s primary health survey for secondary school age youth.

Using data collected from four YRBSS sites (Broward County, Florida; Chicago, Illinois; Los Angeles, California; and San Diego, California) that used this optional question in 2013 and 2015, Advocates for Youth and the All Students Count Coalition have issued a new report analyzing this data for the first time.

An analysis of the combined data from these sites shows that gender nonconformity is associated with a wide variety of health disparities and risk behaviors. Also, the data indicate that the majority of gender-expansive youth are heterosexual and gender expression is associated with risk behaviors independent of sexual orientation. Therefore, it is important to use this question in addition to questions pertaining to sexual orientation.

This new data about gender expansive youth will help educators, policymakers, advocates, and public health practitioners to develop a greater understanding of gender expression and gender nonconformity and how they relate to health risks among students. Data from sites that have used the question show that gender expansive youth are less likely than their peers to succeed academically. By using this data about student gender expression, schools will be better situated to understand the depth and breadth of the problems faced by gender expansive students, to create or modify programs and policies to meet their particular needs, and to improve their academic success.

Feminine males are...

  • 3X more likely to miss school because they feel unsafe
  • 3X more likely to have been electronically bullied
  • 3X more likely to attempt suicide
  • 2X more likely to have had sexual intercourse before age 13
  • 4X more likely to have used amphetamines
  • 4X more likely to have been physically forced to have sexual intercourse
  • ...than masculine males

Masculine Females are...

  • 7X more likely to have carried a weapon on school property
  • 4X more likely to have used heroin
  • 4X more likely to have had sexual intercourse before age 13
  • 4X more likely to have smoked at school
  • 2X more likely to have had sexual intercourse with four or more persons
  • 5X more likely to currently use smokeless tobacco
  • ...than feminine females

Androgynous Females are...

  • 1.5X more likely to be physically forced to have sexual intercourse
  • 1.5X more likely to seriously consider attempting suicide
  • 1.5X more likely to conduct nonsuicide self-injury
  • 1.5X more likely to have had sexual intercourse with four or more persons
  • 2X more likely to be electronically bullied
  • 2X more likely to have had sexual intercourse before age 13
  • ...than feminine females


Alison Gill is an accomplished attorney and a nationally recognized expert on LGBTQ law. Alison currently works as a consultant to foundations and nonprofits focusing on advocacy strategy and systemic change. Most recently, Alison helped to found the Parallax Group, a trans-led consulting firm that supports strategic organizational change for state and local agencies, nonprofits, and other organizations. Prior her consultancy work, Alison served as Senior Legislative Counsel at the Human Rights Campaign where she managed state-level advocacy concerning conversion therapy, anti-bullying, education non-discrimination, trans issues, LGBTQ health and wellness, HIV policy, youth homelessness, and LGBTQ data collection. Prior to her work with HRC, Alison served as Government Affairs Director with The Trevor Project and as State Policy Manager with GLSEN, the Gay, Lesbian & Straight Education Network.