PURPOSE: This systematic review was conducted to describe prevalence of substance use among transgender and nonconforming (TGNC) youth under the age of 25 in the US, identify demographic disparities at the intersection of gender, sex assigned at birth, race, ethnicity, and sexual orientation, and elucidate modifiable factors that are shown to be facilitative or mitigatory of substance use.
METHODS: This review was conducted according to the PRISMA guidelines. Searches were conducted on PubMed, LGBTQ + Source, CINAHL, and PsycINFO databases to identify peer-reviewed literature published in English examining substance use and misuse among TGNC youth and young adults (<25) since 2006.
FINDINGS: The review identified 89 eligible quantitative (n = 82), qualitative (n = 6), and mixed methods (n = 1) peer-reviewed records. Studies reported high levels of substance use among TGNC youth, with a disproportionately higher burden among transfeminine participants and youth of color. Gender minority stress factors, socio-structural vulnerabilities, and intimate partner-linked factors were among facilitators of substance use whereas social support, and community-related and socio-structural factors were among others identified as mitigatory. TGNC youth in qualitative literature described substance use as a helpful coping tool and the importance of harm reduction approaches.
CONCLUSIONS: There has been significant growth in literature over the past two decades, linking minority stressors and socio-structural vulnerabilities with substance use among TGNC youth. Notwithstanding important limitations, findings across literature suggest a multi-pronged approach that includes use of public policy to lower stressors and community based and pragmatic approaches to identify and treat substance use among TGNC youth.
Substance use among transgender and gender nonconforming youth and young adults living in the US: A systematic review
Social Science and Medicine, 383, 118330. doi: 10.1016/j.socscimed.2025.118330.