Trans youth are twice as likely to be depressed and seven times as likely to engage in risky sexual behaviours, a new study has found.

A Minnesota study of 411 teenagers who went to the emergency department at a hospital found that rates of cis and trans teenagers having sex was not significantly different – 20.8 per cent and 23.3 per cent, respectively – but that trans youth were more likely to use drugs or alcohol before sex.

The study found that 35.7 per cent of trans youth reported that they’d drunk alcohol or used substances before sex, compared with only 4.6 per cent of cis youth. Sexually active trans youth were also more likely not to have discussed STIs before sex than cis youth – 21 per cent compared to 6.2 per cent – and 78.5 per cent of trans youth didn’t discuss pregnancy prevention before having sex, compared to 50 per cent of cis youth.

Brianna S McMichael, of Children’s Minnesota in Minneapolis, led the study and reported the findings at a virtual meeting of the American Academy of Pediatrics.

McMichael told the meeting that gender-diverse youth are also more likely to say they have been depressed for at least half of the days in the fortnight prior, with a quarter of trans youth compared with 12.6 per cent of cis youth, and trans youth are three times as likely to have tried smoking as cis youth.

“With risky sexual behaviours, smoking, and depression, the next step in our process is to figure out how we safely identify youth and provide appropriate resources around these topics,” McMichael told MedPage Today. “That is a challenge to figure out how we are going to bring it up in clinical care, how often, and in ways that are safe.”

“Gender identity and sexual orientation are still considered sensitive or taboo topics in certain communities,” McMichael said. “Because we’re a pediatric institution, parents come with their children and, depending on the reason they’re visiting the ED, parents may or may not be able to step out.”

The survey asked children about the sex they were assigned at birth and whether they were genderqueer, gender fluid or trans, which all came under the “gender diverse” category used by the researchers. If youth told the survey they were trans, they were then asked if they were trans masc or trans femme.

While most estimates put trans people at around one per cent of the population, the Minnesota study found that 15.4 per cent of youth were gender-diverse.

This could be due to the fact that the hospital where the research took place recently opened a gender clinic for trans youth, as well as being recognised as being supportive of LGBT+ patients.