Screen Readers Skip to Content

Gender-Diverse Youth in Rural Appalachia Exceeds Estimate

Author: West Virginia University
Author Contact:
Published: 8th Aug 2022 - Updated: 5th Jan 2023
Peer-Reviewed Publication: Yes
Additional References: LGBT Facts and Statistics Publications

Summary: A survey of junior high and high school students in rural Appalachia about gender identity found over 7% shared a gender identity that did not fully align with the sex they were assigned at birth.


Gender Dysphoria

Gender dysphoria is a diagnosis that refers to people whose gender at the time of their birth is contrary to the one they identify with. It constitutes a new diagnostic class in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fifth Edition. The diagnosis replaces the DSM-IV diagnosis of gender identity disorder. The DSM diagnostic criteria for gender dysphoria include intense and persistent cross-gender identification that extends beyond a desire for a perceived cultural advantage.

Main Document

The Prevalence of Gender-Diverse Youth in a Rural Appalachian Region

Gender-diverse youth are at an increased risk of suicide and depression, according to the Centers for Disease Control and Prevention (CDC). But the prevalence of gender diversity is largely unknown-especially in rural areas, where studies on the topic are rare.

To fill that knowledge gap, researchers at West Virginia University and their colleagues at the University of Washington and Boise State University surveyed junior high and high school students in rural Appalachia about their gender identity. They asked about the students' internal sense of being male, female, or having another identity, like nonbinary. They found that more than 7% of young people surveyed shared a gender identity that did not fully align with the sex they were assigned at birth.

These findings were published in JAMA Pediatrics.

Being gender diverse, including being transgender, nonbinary, or having another gender identity that doesn't match the sex assigned at birth, is not a medical concern and is considered a normal part of human experience, according to the American Academy of Pediatrics.

(Article continues below image.)

West Virginia University LGTBQ button - Image Credit: WVU Photo/Sean Hines.West Virginia University LGTBQ button - Image Credit: WVU Photo/Sean Hines.


Even though gender diversity isn't an illness, some young people who are gender diverse experience distress when their gender doesn't align with their physical characteristics or treatment in society. This distress, called "gender dysphoria," can be associated with higher rates of depression or even thoughts of self-harm, prior research suggests.

"We have a lot of studies that suggest gender-diverse youth are two to four times as likely to experience depression and thoughts of self-harm as their cisgender peers or young people whose sex assigned at birth and gender identity fully align," said WVU School of Medicine researcher Dr. Kacie Kidd, who co-authored the study. "This is an area where we need to do more research. We need to understand better how to support these young people, especially now that we increasingly recognize that they are here and would likely benefit from the support."

Other study authors include Alfgeir Kristjansson, an associate professor with the WVU School of Public Health; Brandon Benton, a nurse with WVU Medicine; Gina Sequeira of the University of Washington; and Michael Mann and Megan Smith of Boise State University.

Few studies have asked young people about their gender identity.

A 2017 study suggested that West Virginia had the country's highest per capita rate of transgender youth at just over 1%.

"Prior studies have used less inclusive questions when asking young people about their identity," said Kidd, an assistant professor of pediatrics and internal medicine. "We suspected that this underestimated the prevalence of gender-diverse youth."

She and her colleagues had previously asked these more inclusive questions to young people in Pittsburgh, a city in Appalachia. Nearly 10% of youth in that sample reported having a gender-diverse identity.

"Despite the high prevalence of gender-diverse identities found in our Pittsburgh study, information about rural areas was still unknown," Kidd said. "We suspect that many of the young people in rural Appalachia who shared their gender-diverse identities with us in this study may benefit from additional support, especially if they do not feel seen and supported at home and in their community."

This new study recognizes that researchers interested in gender diversity face a shortage of data regarding rural areas.

It's also one of many studies to recognize that gender-diverse individuals can face a scarcity of health care options, affirming social networks and other forms of support in those same rural areas.

For example, in a recent study(1) led by Megan Gandy, BSW program director and assistant professor at the WVU School of Social Work, up to 61% of participants said they had to travel out of West Virginia to access gender-related care.

Another recent study(2) by Zachary Ramsey, a doctoral candidate in the WVU School of Public Health, found that rural areas could present unique barriers to sexual and gender minorities.

Those barriers included discrimination and heteronormativity - the belief that heterosexual and cisgender identities are the only "normal" ones. They also included a lack of training for health care providers in handling LGBTQ concerns.

"Adolescent mental health is at a crisis point, according to the Centers for Disease Control," Kidd said. "We have an access concern because so many young people need mental health services nationwide, and we don't have enough mental health professionals to meet that need. It's a growing problem, and certainly, gender-diverse youth are at an even greater risk."

In CDC data, adolescents reporting poor mental health have increased, especially during the COVID-19 pandemic. Support from parents, schools, communities and health care providers has improved mental health outcomes, especially for gender-diverse youth.

"Gender-diverse youth are incredible young people, and - as our study found - many of them live in rural areas," Kidd said. "It is important that we ensure they have access to support so they can thrive."


The prevalence of gender-diverse youth in a rural Appalachian region(3)

The Research:

Research reported in this publication was supported by the Centers for Disease Control and Prevention under Award Number U48DP006391 and the Agency for Healthcare Research and Quality under Award Number 5K12HS02693-03. The content is solely the responsibility of the authors and does not necessarily represent the official views of CDC or AHRQ.

References and Source(s):

Gender-Diverse Youth in Rural Appalachia Exceeds Estimate | West Virginia University ( makes no warranties or representations in connection therewith. Content may have been edited for style, clarity or length.

Post to Twitter Add to Facebook

Latest LGBT Facts and Statistics Publications

The above information is from our reference library of resources relating to LGBT Facts and Statistics that includes:

West Virginia University LGTBQ button - Image Credit: WVU Photo/Sean Hines. thumbnail image
A survey of junior high and high school students in rural Appalachia about gender identity found over 7% shared a gender identity that did not fully align with the sex they were assigned at birth.
Publish Date: 8th Aug 2022 - Updated: 5th Jan 2023
Pathways Into Poverty for LGBTQ Adults Study thumbnail image.
Report by Williams Institute at UCLA School of Law provides exploration of common pathways into and prolonging poverty among diverse population of low-income LGBTQ people in California.
Publish Date: 30th Sep 2020
A Summary of Data on LGBT Suicide for Suicide Prevention Month thumbnail image.
Research shows that anti-LGBT discrimination and victimization contribute to an increase in the risk of suicidality and that LGBT people are at disproportionate risk of suicidal ideation, planning, and attempts.
Publish Date: 6th Sep 2020
Percent of all U.S. households reporting as same-sex couple households: 2010 Census - Image Credit: thumbnail image
Estimates of same-sex couple households in the American Community Survey including margin of errors for same-sex couple U.S. households.
Publish Date: 15th Feb 2018

1How Many Genders Are There?
Alphabetical list of gender identities.

2Transgender Reporting Guide
How to write about transgender people.

3Glossary of Sexuality Terms
Definitions of sexual terms & acronyms.

4Glossary of Sexual Identities
Definitions of gender related terms.

5Am I Gay? Questions to Ask
Think you may be gay or bisexual?

• Submissions: Send us your coming events and LGBTQ related news stories.

• Report Errors: Please report outdated or inaccurate information to us.

• (APA): West Virginia University. (2022, August 8). Gender-Diverse Youth in Rural Appalachia Exceeds Estimate. Retrieved April 19, 2024 from

• Permalink: <a href="">Gender-Diverse Youth in Rural Appalachia Exceeds Estimate</a>