Lori* is in foster care and has been waiting for permanent housing for several years.

Why? According to her foster care agency, it’s partly because Lori decided to transition in the middle of the housing search. Lori was assigned male at birth, and if she had decided to keep presenting as a male, could have been placed in men’s-only housing. According to her foster care agency, she should’ve waited until AFTER finding housing to transition.

For many young transgender and gender non-conforming (TGNC) people, the streets may feel emotionally and physically safer than the homes they grew up in. When TGNC youth are rejected, harassed or abused by their families, remaining at home can feel impossible. Others are outright kicked out of their homes. This means that young TGNC people are more likely to be in foster care, abuse substances, engage in survival sex and become homeless. All these factors—often combined with the pain of gender dysphoria, lack of access to gender-affirming medical care and more—contribute to the astonishingly high rates of suicide among TGNC youth. Homelessness can be a deeply traumatic experience all on its own, and places young people’s lives at risk.

The foster care agency’s reaction to Lori offers a glimpse into just one reason that 1 in 5 transgender individuals have been homeless during their lifetime. These numbers get even worse when you look at youth homelessness—estimates are that 20-40% of homeless youth are LGBTQ.

As a social worker at the Mount Sinai Adolescent Health Center (MSAHC), I work with many TGNC teens and young adults. Many of them have experienced homelessness or unstable housing situations because of their gender identity.

Homeless shelters are often not equipped to provide TGNC folk a safe space—and that needs to change. When I am working to help patients find safe places to stay, they will often tell me, “I can’t go into shelter.” They know that if they do not fully “pass” as their true gender—or even if they do—they may be vulnerable to violence or ridicule when entering shelter. They also know that shelter staff will likely not use their true name or pronouns or understand their situation. Most shelters don’t have gender neutral bathrooms or rooms, and many aren’t LGBTQ friendly in other ways.

In addition to creating more shelters that are safe for TGNC young people, we need to work to prevent youth homelessness in the first place. We need to work with parents and caregivers to ensure that young TGNC people have a safe space at home. Parents face pressure from their own family, church and other communities, who may tell them that their child has an “illness.” Sometimes, parents have to choose between providing a welcoming home for their child and being accepted by their own community.

I believe that supporting families is one of the most important parts of supporting TGNC youth and youth in general. I co-facilitate a support group for the parents and caregivers of our transgender patients here at MSAHC. More than anything else, parents of TGNC young people usually need their own time and space to process their child’s transition. This may simply be a space to grieve the child they knew as they begin to move toward accepting their child in their true gender. Having a child who is transitioning is a big change, and parents need that acknowledged. Without a place to process their feelings, young TGNC people can end up having to take on their parents’ emotions—a burden they shouldn’t have to bear. Even worse, when parents don’t understand what their child is going through, they may abuse, harass, or kick their child out of the home.

Ultimately, one of the biggest barriers to care is discomfort. In order to provide empathetic care to young people, everyone needs to face and confront their own assumptions about gender. This means learning about the importance of pronouns and all aspects of transitioning. It means accepting (and assuring others) that no one is “less of a man” because they support their trans friend. It also involves EVERYONE—from friends to educators to health care providers to public officials.

To make sure my workplace remains a safe place for my patients, I routinely ask my TGNC patients whether they feel safe at the MSAHC. Overwhelmingly, they say yes. Staff and providers work hard to use the correct names and pronouns. Patients know they have access to gender-neutral restrooms. Providers understand that transitioning is not trivial or cosmetic, but a crucial, life-saving process.

Right now, the MSAHC is the exception rather than the rule. But that can (and needs to) change. Many organizations like The Center, the True Colors Fund, The Door and Ali Forney Center in NYC are doing amazing work to end TGNC youth homelessness and make the world a safer and more welcoming place for TGNC youth and their families.


If you’re unsure how to support TGNC people in your life or community, here are some good places to start.

*Not the patient’s real name. Some details have been changed to protect the patient’s identity.

Sarah McGrew, LMSW is a Primary Care Social Worker at the Mount Sinai Adolescent Health Center who works to bring holistic, client-centered, trauma-sensitive mental health care into the medical setting using various interventions including yoga, mindfulness and evidence-based practices such as TF-CBT and ARC. She coordinates services and provides counseling for many of the gender diverse youth and their families served at MSAHC.  She earned her master’s degree from Hunter’s Silberman School of Social Work and has a passion for family therapy.  

The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.