Transgender and gender nonbinary youths and adults are disproportionately likely to experience sexual violence. Researchers conducted a study to determine the 12-month prevalence of sexual assault in a large, geographically diverse sample of transgender and nonbinary middle and high school students. They also assessed whether school policies that restrict students from using restrooms and locker rooms that match their gender identity were associated with sexual assault rates.

The researchers analyzed data on 3,673 students in grades seven through 12 who reported a transgender and/or nonbinary identity when they completed a Web-based survey of lesbian, gay, bisexual, transgender, and queer or questioning adolescents. During a 12-month period, the overall prevalence of sexual assault was 25.9%. The prevalence was highest among nonbinary youth who were assigned female at birth (27%) and transgender boys (26.5%).

After adjusting for potential confounders, the researchers found that students in schools with rest-room and locker-room restrictions were significantly more likely to experience sexual assault than those in schools that didn't have such restrictions. Compared with nonrestricted transgender boys, restricted transgender boys had 1.26 times the adjusted sexual assault risk. This risk was 1.42 times higher for restricted nonbinary youth who were assigned female at birth compared with nonbinary youth assigned female at birth who did not experience such restrictions. Restricted transgender girls had a 2.49 times higher risk compared with nonrestricted transgender girls. Restroom and locker-room restrictions weren't associated with risk for nonbinary youth who were assigned male at birth.

The authors couldn't determine whether restroom and locker-room restrictions caused the differences in sexual assault risk. They also note that black or African American and Hispanic or Latino participants were underrepresented. They urge pediatricians to screen transgender and nonbinary youth for a history of sexual assault and to emphasize to school officials the importance of access to safe, identity-congruent restrooms and locker rooms.

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