PROJECT SUMMARY
Transgender and gender diverse (TGD) youth have a gender identity different from society's expectations based
off their sex assigned at birth. Stigma, distress with pubertal changes associated with sex assigned at birth, and
societal expectations of gender and beauty, are factors that can affect a TGD youth's relationship with their body,
eating, and exercise. TGD youth are at higher risk of disordered eating behaviors (DEB) and experience unique
cognitions that contribute to DEB; however, they have historically been excluded from DEB research.
Additionally, extant DEB research with TGD youth is limited due to a lack of representation of subpopulations of
TGD youth participants, mainly non-binary youth and TGD youth of color. These gaps in research limit the field's
ability to provide culturally specific clinical care to a vulnerable group with unique health disparities associated
with DEB. To advance this care, we urgently need to extend DEB research beyond cisgender females and recruit
racially/ethnically diverse samples of TGD youth across the spectrum of age, gender identity, and access to
gender-affirming support/resources. A novel approach to address these knowledge gaps is to implement
community-engaged research methods to develop and evaluate a tailored measure of DEB in TGD youth. The
proposed research has three aims: 1. Obtain qualitative data from a diverse sample of TGD youth on facilitators
of and barriers to research participation to improve recruitment protocols for the remaining aims, 2. Use focus
groups and cognitive interviews to develop and refine a measure of DEB in TGD youth, 3. Evaluate the
psychometric properties of the DEB measure and assess correlations between DEB and TGD-specific risk and
protective factors. A TGD youth advisory board and community consultant with expertise in DEB in TGD youth
will actively participate in research protocols throughout the 4-year grant proposal. Research activities include
designing recruitment matrices, conducting qualitative interviews and analyses, and disseminating results. The
data from this innovative study will inform a longitudinal study on changes in DEB throughout: 1) eating disorder
treatment in TGD youth with DEB, 2) pubertal development in TGD youth, and 3) gender-affirming care in TGD
youth receiving gender-affirming medications such as testosterone, estrogen, and/or puberty blockers. This
proposal is highly consistent with NIMH's priority of expanding research involving sexual and gender minority
(SGM) populations to reduce the mental health disparities experienced by vulnerable SGM communities. Dr. An
Pham is an Adolescent Medicine physician with clinical expertise in gender-affirming medical care and this K23
Career Development Award will fill gaps in her training and provide her with the necessary mentorship and skills
to become an independent investigator on youth-engaged DEB research in TGD youth. Specifically, Dr. Pham
will work closely with her mentorship team and community partners to advance her knowledge and skills in
qualitative and mixed methods community-engaged research, recruitment of marginalized populations, and
advanced statistical approaches to measure development and evaluation.