How School Nurses and Others Can Help Transgender Youth in Educational Settings

Recently released research from the Centers for Disease Control reinforces concerning rates of suicide attempts for transgender students in grades 9 through 12. Significant health disparities also existed in violence victimization, substance use, and sexual risk among these youth.

These troubling findings point to the importance of students’ educational and health care “homes” being accessible, supportive, and alert and aware of these disproportionate risks. They are in great need of programming to support their overall health and well-being.

Greater emphasis must be placed on safe learning environments, and school nurses and other school health personnel may play a large role in increasing wellness in the educational setting. The authors recommend providing “access to culturally competent physical and mental health care” should be considered in future prioritization of needs for these youth.

We as health care providers must explore intervention strategies that are evidence-based and that will make a real difference in the lives of these at-risk youth.

Previous evidence has shown that some health-related strategies that may assist transgender students in an educational setting include:

  • Using a student’s correct name and pronouns

  • Using trans-inclusive language in health classes and the health office

  • Showing representations of trans stories in posters and other paperwork around health offices and hallways

  • Creating or supporting trans-inclusive school and district policies, such as:

    • Inclusive restrooms

    • Inclusive locker rooms

    • Inclusive athletic policies

    • Inclusive dress codes

  • Including health lessons that center the experiences of transgender stories, both in the curriculum and also in LGBTQ+-related student activities

  • Taking time to listen to the needs of transgender students, including experiences with bullying, harassment, and/or intimidation

  • Promoting GSAs and other student efforts that have been demonstrated to increase student comfort in school

  • Remaining aware of whether a student is “out” or not to family, friends, or the school community and support their journey where they are

  • Providing related resources to students and families, and referrals to outside providers and services

What other strategies have you used to encourage your school environment towards more inclusion of transgender and gender fluid students? This extremely large study has once again demonstrated to us the importance of intervening on behalf of our most at-risk students, and health care providers within educational settings are uniquely poised to do just that.

Johns MM, Lowry R, Andrzejewski J, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students — 19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep 2019;68:67–71. DOI: