Meaningful and minimally distressing: Trans adolescents’ perspectives on sensitive research interviews

Abstract

Qualitative research on sensitive topics (e.g. abuse, mental health difficulties, discrimination) is needed to understand lived experiences of complex issues. However, this type of research raises concerns about potential adverse effects on participants, especially with younger participants and those from marginalized populations. In this study, we conducted a reflexive thematic analysis of 20 trans adolescents’ (14–18 years of age) experiences of participating in research about their stigma experiences. Themes included: (1) lived experience in interviews matters; (2) negative effects are tolerable; and (3) sharing is important for self and others. Participants can value and even benefit from taking part in lived experience-informed sensitive research. Avenues for future research are discussed, and considerations for ethical research with marginalized populations suggested.

Introduction

Adolescents’ participation in qualitative research on sensitive topics such as abuse, mental health difficulties, and discrimination, is essential for understanding these challenging experiences. In line with human rights conventions, researchers are obliged to facilitate adolescents’ participation in issues that concern them (United Nations Convention on the Rights of the Child, 1989). Indeed, without knowing adolescents’ experiences, prevention, intervention and advocacy efforts rely on incomplete and systematically biased information from secondary or tertiary sources (Schelbe et al., 2015). Qualitative research is well suited to involving adolescents in sensitive topics because of its ability to facilitate rich and contextualized dialog on complex topics (Stutterheim and Ratcliffe, 2021), and because its participatory nature offers opportunities for adolescents to be meaningfully involved in the research process, as per their rights (Schelbe et al., 2015). We discuss these issues in the context of trans adolescents who participate in sensitive research, and in the current study we ask the question: what are trans adolescents’ perspectives on participating in stigma research?

Background

“Sensitive topics” is a broad term typically including topics considered private, stressful or sacred; issues that may cause stigmatization or fear; or political affairs which may incur controversy or social conflict (Lee, 1993), with the degree of sensitivity dependent on peoples’ contexts (Powell et al., 2018). Recounting experiences around sensitive topics can be distressing, which poses an ethical quandary for researchers: on one hand, this research is necessary to gain understanding of and work toward meeting needs, but on the other, this research must not cause harm in doing so. Ethical reviews of sensitive research topics can be challenging to navigate, with research suggesting that Human Research Ethics Committee (HREC) or Institutional Review Board (IRB) members are less likely to approve research on sensitive topics with children and adolescents (Taplin et al., 2022). This hesitancy may be in part due to overestimating participant distress (Mathews et al., 2022), and underestimating the capacity of adolescents to understand risks and give informed consent (Fisher et al., 2016), thus taking overly cautious approaches to risk management.

HRECs/IRBs may be particularly hesitant when reviewing sensitive research concerning adolescents from marginalized groups ¹ (Bracken-Roche et al., 2017) such as transgender and gender diverse (henceforth trans ² ; (Riggs et al., 2024; Zwickl et al., 2024)) adolescents, (Adams et al., 2017; Mustanski, 2011). Hesitation to approve sensitive research with marginalized young people may stem from categorizing marginalized young people as particularly “vulnerable” to distress or less capable of consenting (Mathews et al., 2022), and therefore in need of protection by HREC/IRBs from sensitive topics (Bracken-Roche et al., 2017). Further, it may be due to either project researchers who are inexperienced with regards to sensitive topics and/or marginalized young people (Barnard et al., 2021), a lack of empirical data on participant distress leading to overestimation of distress (Mustanski, 2011), lack of representation of different marginalized groups as members on HREC/IRBs (Miller, 2025), or implicit biases and heuristics (Nuttgens, 2021). HREC/IRB hesitancy creates systematic difficulties in producing a high-quality evidence base for groups already chronically underserved by academia (Adams et al., 2017; Macapagal et al., 2017), preventing the experiences of these groups from entering collective understanding, a form of injustice in itself (Clairmont et al., 2025). Furthermore, implementing procedures that are in excess of what is required to safeguard participants can be to the detriment of participant welfare (Macapagal et al., 2017; Sims and Nolen, 2021). For example, poorly-fitting risk management procedures can introduce safety and validity concerns to study results (Cwinn et al., 2021). In a study on sexuality and gender diverse adolescents’ (14–18 years) mental health and social supports, 37% of participants reported they would not have participated if caregiver consent were required (Cwinn et al., 2021). Those who would not have participated reported lower family support, and higher levels of negative affect and self-stigma (negative attitudes about their sexuality or gender identity), indicating that requiring caregiver consent would have exposed participants to risk from their caregivers, and introduced systematic biases into the data. Therefore, it is essential that researchers employ an evidence-based understanding of participant distress and commensurate strategies to manage distress.

A recent scoping review aimed to summarize qualitative research on adolescent participants’ experiences of taking part in sensitive research, and suggests that participants experience minimal distress in addition to several benefits when participating (Neelakantan et al., 2022). The review identified 17 relevant studies, and reported on participants’ benefits of participating, as well as burdens, and their motivations for taking part. Benefits included positive emotions, skills acquisition, and enhanced self-efficacy. While the review noted that distress during participation was considered a burden to participants, other burdens included concerns about breaches of confidentiality, disliking the phrasing of research questions, and boredom. Furthermore, the review highlighted that participants chose to take part for altruistic reasons, and experienced benefits such as a sense of empowerment, a space for self-reflection and catharsis, informing adults of adolescent perspectives, and the opportunity to speak on sensitive topics in an accepting space. Overall, Neelakantan et al. (2022) concluded that adolescents experienced research participation as more beneficial than burdensome and emphasized the importance of involving adolescents in sensitive research both as participants and as advisors on the design and conduct of research. Recommendations included that strategies to mitigate and manage distress must be considered in light of the benefits (Staphorst et al., 2017) so as not to “inadvertently overlook the numerous benefits that adolescent participation brings to themselves and the research as a whole” (Neelakantan et al., 2022: 16). Adolescents’ desire for inclusion and the opportunity to exercise their rights also suggests researchers should incorporate co-design principles into studies on sensitive topics with adolescents (McKercher, 2020). The need for further research with adolescents from marginalized groups was identified as their voices were underrepresented in the reviewed literature and may inform key differences in how research needs to be designed and conducted to create a respectful and responsive environment (Neelakantan et al., 2022).

The degree to which a topic is considered “sensitive” is dependent on peoples’ contexts (Powell et al., 2018). Further, each marginalized group’s context is unique, and may not be well understood by those outside the specific marginalized group. These different contexts have resulted in the broad classification of marginalized groups being more “vulnerable,” implying that marginalized groups are generally more susceptible to the negative impacts of sensitive research than their majority counterparts (Alexander et al., 2018), perhaps to the extent that any benefits would be outweighed by burdens. However, a review of sensitive research experiences of marginalized adult participants across qualitative and quantitative research concluded that when research is well-designed, potential harms are outweighed by benefits (Alexander et al., 2018). Participants in these studies included those marginalized by economic, social, psychological, and physical health factors. While studies with children were eligible for inclusion in the study, none were identified. Altruism was again the main driving force for participating, and catharsis the main benefit. Bredal et al. (2024) elaborated on altruistic reasons for participating in a study with adults who had experienced interpersonal violence, and described the motivations of telling for oneself (catharsis) and telling for others (altruism), but added a third factor: telling for the researcher. This third category represented a small portion of participants who did not describe their own personal agenda, but rather presented only with the agenda of being interviewed. Furthermore, Alexander et al. (2018) found that participants with greater marginalization, such as greater severity of mental illness, experienced more distress associated with participating, ³ but overall evaluated their experience as beneficial on-par with those who were less marginalized. In sum, this suggests that even groups that are marginalized can participate in sensitive research with minimal distress, and even benefit from the process.

Study design appears to be a crucial factor that can decide if study participation is positive or negative, with some study elements more important to some groups than others (Widom and Czaja, 2005). For example, a study with trans adults on mental health and sexual behaviors suggested that while participants found the process insightful, they found language in the survey outdated and disrespectful (Staples et al., 2018). Staples et al. (2018) recommended that distress can be partially mitigated through more inclusive and respectful language and by involving trans people in studies as fundamental facilitators of rigorous and respectful research, which aligns with the co-design principle of sharing power (McKercher, 2020). These findings can be interpreted as evidence for the context of the study being critical to participant experience, suggesting that conceptualizing “vulnerability” as a product of peoples’ context may be more accurate than “vulnerability” as an innate attribute of the individual.

The current study

To summarize, evidence from adolescents and marginalized adults suggests that adolescents from marginalized backgrounds can participate in sensitive research and experience more benefits than burdens (Alexander et al., 2018; Neelakantan et al., 2022), when the study context is adequately managed (Staples et al., 2018). However, evidence about specific groups such as trans adolescents is lacking. Trans adolescents lie at the intersection of paternalism due to developmental age, and minority stress due to gender identity; this context cannot be meaningfully understood by investigating these axes in isolation (Buchanan and Wiklund, 2021; Crenshaw, 1991). High-quality and contemporary evidence on the experiences of trans adolescents who participate in qualitative research on sensitive topics is necessary to inform evidence-based practice of research and ensure safety.

The current study asks the question: what are trans adolescents’ perspectives on participating in stigma research? This study is a secondary data analysis of data originally collected to answer questions about trans adolescents’ experiences of stigma. Secondary data analysis is the process of using existing data to answer new questions (Kelly et al., 2024). The ethics approval process for the original trans stigma study was extensive and highlighted the dearth of evidence regarding trans adolescents’ experiences of taking part in sensitive qualitative research, which hampered efforts to use an evidence-based approach to study design and consideration of benefits and burdens. Questions about participants’ experiences of the research were embedded in the existing study as part of monitoring participant wellbeing. We decided to complete a secondary analysis on the existing data, this time with the aim of understanding participants’ perspectives on taking part in the study, to begin to address this gap in the literature.

The study was conducted using the guidance of an advisory group of trans young people as suggested by ethical guidelines for the conduct of research with trans people (Adams et al., 2017), and interviews were conducted by a person with lived experience. We constructed themes of participant research participation experiences through reflexive thematic analysis (Braun and Clarke, 2022). Three themes were created: (1) lived experience in interviews matters; (2) negative effects are tolerable; and (3) sharing is important for self and others.

Methods

Participants

Participants were N = 20 trans adolescents aged 14–18 years living in Australia. Recruitment materials were distributed through social media advertising, community organizations, and word of mouth. Six participants identified as non-binary, with a further two participants identifying as non-binary man/transmasculine non-binary and genderqueer respectively; six participants identified as male, and three as transgender man, trans male, and demiboy. The remaining participants described their identity as transgender woman (n = 1), still figuring out a label (n = 1) or did not use labels (n = 1). Participants described their cultural background as Australians of Anglo-European background (n = 14); Middle Eastern (n = 2) and Asian (n = 2). Two participants did not describe their cultural background. Participants were from the following states and territories: Western Australia (n = 7), New South Wales (n = 6), Victoria (n = 2), Australian Capital Territory (n = 1), and Queensland (n = 1), with three participants not indicating a state or territory.

Procedure

The study was approved by the University of Western Australia’s Human Ethics Research Committee (2022/ET000556). The study was developed with input from a reference group of five trans young people (aged 14–25 years). The reference group drew from a larger pool of existing LGBTQA+ youth advisory group members for research conducted at The Kids Research Institute Australia. The first author met with the group remotely to introduce the study and to present the draft interview protocol for feedback. Reference group members generally considered the protocol suitable and sensitive. Reference group members were positive about the questions and general approach, and suggested minor changes such as further reminders that participants could take breaks, and to introduce both “stigma” and “transphobia” terms to participants from the beginning of the interview. Reference group members were also supportive of the first author sharing his trans identity as a way to facilitate a safe space for the interview.

Prior to being contacted by the first author for an interview, participants responded completed a short online eligibility survey including an information and consent form. Parental or caregiver consent was waived for this study to ensure that participants who had not yet disclosed their trans identity to their caregiver(s) or whose caregiver(s) were unsupportive would not be put at risk by requiring their consent (Sims and Nolen, 2021). Participants demonstrated informed consent by responding to 11 true-or-false statements about optional participation (e.g. “If I don’t want to answer a question, I don’t have to,” with a response of “true” indicating comprehension), study content (e.g. “I am unsure what this study is about,” with a response of “false” indicating comprehension), and information about data collection (e.g. “this interview will be audio recorded,” with a response of “true” indicating comprehension). Participants could only progress to consent if all responses indicated comprehension of the research content and processes. Participants then provided demographic information, advised of their preferred method of contact, and entered the details of two supportive adults that the interviewer (the first author) could follow up with in the case of distress during the interview, although no such contacts were needed. Lastly, informed consent was re-assessed verbally by the interviewer at the beginning of the interview.

Participants completed semi-structured interviews with the first author in-person (n = 3) or via videoconferencing (n = 17) between April and June 2023, and were audio recorded and transcribed verbatim by a professional transcription service that specializes in legal and medical transcription, before being anonymized by the first author.

Interview questions were designed to prompt participants to reflect on and describe stigma in their lives, with the interviewer asking follow-up questions to expand upon and clarify participants’ accounts. For context, the nature of the original interview questions is summarized below. Participants were first asked broad questions about their journey as trans young people and coming out experiences, as these experiences often bring trans people into contact with stigma. Participants were then asked questions to elicit experienced stigma, anticipated stigma, and public perceptions of trans people. Participants discussed a wide variety of experiences, including bullying and harassment, non-affirmation by others, and fears of the same, as well as stigma beliefs about trans young people that are held by the public, the impact of stigma on them personally and on their community, and people and places that they looked to for support (for results, see Hill et al., 2025). At the end of the interview, participants were asked for their perspectives about their interview experience with an open-ended question (e.g. “what was it like to talk about stigma today?”).

Several actions were taken to mitigate the power imbalance between researcher and participant. These included having the consent and information process happen online to allow the young people time and space to come to their decision regarding participation; the interviewer using his power to check in on wellbeing during the interview, which might have otherwise gone unreported due to social desirability; and through the interviewer disclosing his trans identity, reducing the “otherness” and perceived power relative to an interviewer who is assumed to be cisgender.

All participants were reminded at the start of the interview of the option to end their participation at any time. No participants elected to end the interview early. No participants left the interview suddenly and while in distress. Some participants became teary during the interview, at which point the interviewer paused the interview, asked how the participant was feeling, and explored their motivations for continuing or discontinuing. On conclusion of the interview, no participants were teary. Overall, we would describe participant distress during the interview as minimal.

Interviews lasted 18–61 minutes (M = 44 minutes). Participants were invited to review the transcripts of their interviews as part of ongoing consent. Thirteen participants opted to review their transcripts, with one participant requesting minor changes. The option to receive the results of the study was provided to all participants as per ethical guidelines (Adams et al., 2017). All participants opted to receive study results, were provided with a summary of preliminary results in December 2023, and notified of the original study’s publication and where it could be accessed in February 2025.

Analytic Approach

Data were analyzed using reflexive thematic analysis (Braun and Clarke, 2022). Thematic analysis is known for its epistemological flexibility and ease of use amongst emerging qualitative researchers (Braun and Clarke, 2022). Reflexive thematic analysis treats the various experiences that researchers bring to the table as tools to be used rather than biases to be eliminated, and a phenomenological lens was taken when analyzing the data in order to make lived experience the focal point of the study (Eatough and Smith, 2017). This lens positions participants as “experiential experts” of their own realities.

Analysis in the current study focused on responses to the final question (e.g. “what was it like to talk about stigma today?”), but also included responses from throughout the interview where participants reflected on the research experience, their emotional reactions sharing experiences, or their motivations for participating. Transcripts were coded manually in Nvivo (i.e. without use of automated coding features) and supplemented by pen and paper methods. We used the six steps of reflexive thematic analysis to guide our analysis, which includes: (1) familiarizing yourself with the data set; (2) coding (which we conducted inductively); (3) generating initial themes; (4) developing and reviewing themes; (5), refining, defining and naming themes; and (6) writing up themes. The first and second phases were predominantly conducted by the second author, with phases 3 and 4 conducted by the first, second and last author, and all authors contributing to phases 5 and 6. After selection for inclusion in the themes, the quotes were reviewed by the first and last author to check that quotes were relevant to the research question, with conflicts resolved through discussion. Interviewer responses were used as contextual information to inform selection of quotes, but only participant quotes were included in the analysis.

Positionality

A reflexive consideration of author positionality is essential to the practice of reflexive thematic analysis, as it provides context for how an author’s experiences, identities, or beliefs shaped their analytic process (Braun and Clarke, 2022, 2023). Analyses were primarily conducted by the second author NJEC, who is an Asian-Australian, neurodivergent, cisgender woman studying Honors in undergraduate psychology. The second author actively engaged with her lived experience (e.g. by reflecting on her privileges as a cisgender individual and considering how neurodivergence shapes her understanding) throughout the analysis. The second author offered a predominantly outsider perspective although with some closeness especially with respect to age. “Insider” perspectives were conceptualized as when authors shared experiences or characteristics of the participants, whereas “outsider” perspectives were when authors did not share these, and authors could have a mix of perspectives (e.g. share the characteristic of being a young person (insider perspective) and not have experienced stigma due to trans identity (outsider perspective); Court and Abbas, 2022). Analysis was supported by the first author JHLH, a trans, Aboriginal young man studying clinical psychology, and for whom this study forms part of his PhD. The first author actively engaged with his lived experience during the interviews (e.g. by letting participants know that he is trans) and throughout the theme development process. During interviews, the first author proactively considered how participants may assume his knowledge of a subject in the interview (e.g. comments such as “you know how it is”) because of his insider perspective; therefore the first author used such comments as signals to prompt participants to speak the unspoken or assumed experience out loud so that it could be recorded and considered. Analysis was supervised by the last author JLO, who is a female cisgender clinical psychologist and academic with extensive research expertise in child and youth mental health. The last author supervised the first and second authors’ engagement with the data, facilitated critical exploration of positionality, and the development of themes. The remaining co-authors, a queer cisgender female researcher in the LGBTQIA+ youth mental health field (AL), and a cisgender female researcher and clinical psychologist with expertise in trans youth mental health (YP), were part of discussions and decision-making on the construction and refinement of themes.

To acknowledge the various perspectives that all authors brought to the analysis, all members of the authorship team regularly met to discuss and touch base with different perspectives as per the notion of “critical friends” (Smith and McGannon, 2018). These meetings allowed a marriage of insider and outsider perspectives to facilitate a nuanced and reflexive consideration of the data and ensured that themes represented a meaningful interpretation of participant accounts, rather than the views of any one author.

Results

There was great variety in the degree to which people spoke about their experiences of the interview itself, with some participants responding verbosely, while others were quite brief. All participants shared openly about stigma experiences.

Our understanding of participants’ perspectives on the interview have been grouped into three themes: (1) lived experience in interviews matters; (2) negative effects are tolerable; and (3) sharing is important for self and others. Exemplar quotes are given alongside pseudonyms, gender identity, and ages.

Theme 1: Lived experience in interviews matters – “You’re trans so you understand”

Trans identity, including experiences of stigma, was discussed as possessing a unique experiential quality unattainable through second-hand expertise, with cisgender people described as having “no understanding of [being trans] ‘cause they’ve never lived it. They’ve just seen a glimpse of it.” (Asher, non-binary, 15). Participants inferred that the significance of this knowledge gap had been a barrier to interviews in the past, “It’s not like she said anything negative either but she just didn’t know anything” (Blair, male, 18), such that it could potentially limit the authenticity or validity of the research, “. . .I feel like if this was a survey done by someone who wasn’t trans, it would be not as well done as what you’re doing right now. . .” (Asher, non-binary, 15). Furthermore, by participating in the interview, their experiences were providing a perspective that could not be found elsewhere.

For other [cisgender] people, there’s just stuff that they don’t get, so when you talk about it, it’s like you’re letting them know stuff [about trans experiences] that they wouldn’t have known before and they wouldn’t have known if they read something on the internet. (Wylie, trans male, 16)

The quotes above speak to how participants positioned themselves as experiential experts and saw their perspectives as not only unattainable through other means, but invaluable to the pursuit of knowledge.

The value of lived experience was also highlighted in reports about comfort in disclosing their trans experience. Sharing their trans identity to others in general contexts typically triggered fear for personal safety and anticipation of non-acceptance: “I don’t know how they’ll react so I’m scared about coming out to people ‘cause I don’t know if it could get me bashed or if I could just get shit-talked, or if they’ll be fine with it” (Hadley, non-binary, 15). Even when others declared themselves as trans-friendly, participants had been met with disappointment, “but again she’d [a health professional] advertise as trans-friendly. If you don’t understand anything, maybe don’t advertise yourself as that.” (Blair, male, 18). These quotes exemplify how participants found it difficult to trust others with their experiences. However, participants indicated that shared community identification provided a safer experience through inherent understanding and support. Participants attributed a non-challenging experience to the interviewer’s shared trans identity, perhaps by reducing their fear of being misunderstood“. . .obviously, you’re trans so you understand a lot of it but for other people, there’s just stuff that they don’t get. . .” (Wylie, trans male, 16), which made them comfortable to share openly, “it was more comfortable talking to someone with similar experiences than talking to someone who thinks they know what happens but actually doesn’t” (Hadley, non-binary, 15). Overall, lived experience was highly valued by participants, both as a critical facilitator of sensitive research, and as an integral source of knowledge, “thank you for doing this research. It’s such important research and I’m really glad that it can be done, especially from actual trans people” (Indi, non-binary, 16).

Theme 2: Negative effects are tolerable – “There’s mixed feelings involved”

Participants described negative or uncomfortable experiences associated with participating in the interview, such as recalling memories of difficult times, anxiety around interacting with the interviewer and the self-consciousness of sharing. Negative effects of the interview were attributed to anticipatory anxiety around sharing difficult experiences, “I figured it’d be really uncomfortable for a lot of it but I wasn’t” (Lyndon, non-binary transmasculine, 18), as well as the actual sharing of challenging stigma experiences, discomfort with social situations, and personal differences.

It’s always a bit tough to talk about, but I’ve been through enough therapy that it’s fine and I’m always glad to participate in research. . . partly it’s tough because I get kind of social fatigue. Partly it’s tough because I’m sitting down and I have chronic pain and my back’s hurting. Partly it’s tough because of trauma. (Ronan, male, 18)

Participants’ stigma experiences also linked to personal and meaningful moments in their life that were ultimately positive, making for a bittersweet recounting of their experiences. One participant described personal identity and growth, “I’m happy. . . because those things used to upset me a lot.” (Calvin, male, 15), even though feelings of upset and frustration still lingered, “it still upsets me because it’s very personal to me, but. . .it’s just not who I am anymore” (Calvin, male, 15). Thus, temporal and personal contexts were influential in how discomfort was experienced.

Other factors included discomfort not directly related to the recounting of stigma experiences, such as feeling “nervous” due to being “a pretty anxious person in general” (Thomas, demiboy, 17), self-conscious about making mistakes, “I’m just a bit self-conscious ‘cause I feel like I’ve stuffed something up” (Mal, trans, 16), or oversharing, “I always accidentally overshare with people as I may have accidentally done just now. Sorry, if I did.” (Yonah, non-binary, 16). Personal discomfort was also described as a result of feeling empathetic toward the struggles of the trans community, “it just makes me emotional to think about the stigma that we go through just for being who we are” (Powell, male, 15).

Importantly, participants concluded that discomfort during the interview was tolerable, and ultimately a part of a positive interview experience. For example, Indi (non-binary, 16) admitted that it was especially tough recalling memories that were “triggering and difficult, but I mean I’m pretty happy knowing that I’m past that now and I’m doing a lot better”, while Asher (non-binary, 15) described the experience as “a little saddening but I think it’s a good thing to talk about all these experiences.”

Theme 3: Sharing is important for self and others – “Thank you for giving me a platform”

Participants described the interviews as a meaningful and often enjoyable experience, “I’ve actually really enjoyed it” (Yonah, non-binary, 16) and were generally positive, with Eleanor (transgender woman, 17) stating that she found the process “eye-opening.” This theme captures how sharing in the interview was beneficial, and important both for self and others, an idea well captured by Ode (non-binary/genderfluid, 16), who concluded the interview with “thank you for giving me a platform.” This theme discusses how the interview was thus a platform both for being understood on an emotional and reflective level, as well as furthering personal curiosity and positive social change efforts.

Although the topic of the interviews was challenging, participants wanted the chance to speak about stigma because opportunities to do so in their daily lives were rare, “I’ve been wanting to [talk] for a while because it’s hard” (Sebastian, transgender man, 16) and “[the interview was] Interesting, in that I don’t get this stuff out a lot because, as I mentioned, I don’t like mentioning that I’m trans very much.” (Lyndon, non-binary transmasculine, 18). Participants felt they could share their stories openly and authentically, “I’ve never really talked about it out loud. So, it’s been good” (Forest, non-binary, 14), which they attributed to the low-pressure environment, “I’ve enjoyed it. I appreciate how open-ended the questions are ’cause – I don’t know. It was nice. It felt like a conversation” (Jarrah, genderqueer, 17) and interviewer characteristics (as discussed in Theme 1). These quotes were interpreted as the interview reconciling an unmet need for participants to share their difficult experiences.

Participants appreciated how the interview facilitated personal insight and reflection, “It’s reflecting on things that I don’t usually think to reflect on about my journey. I remember things during the conversation that I haven’t thought of in ages.” (Yonah, non-binary, 16), and “I’ve just felt very content, I guess, because bringing up all these things and remembering how my past and my journey was, it’s just like, finally being at peace and having insight over everything” (Calvin, male, 15). Participants characterized the encounter with the interviewer as an active process which facilitated their reflections beyond what they might have achieved on their own, “You put my thoughts into words a lot more. . . not efficiently, but better” (Gabriel, male, 16), and, “I think it helps me to process everything as well” (Indi, non-binary, 16), and overall appreciated the opportunity for authentic sharing, “I find comfort in sharing how I feel and how some of my experiences are, because it takes it off my chest and I get to talk about something personal and I really like sharing how it is” (Powell, male, 15), and expressed gratitude, “I’m really thankful” (Wylie, trans male, 16).

Personal curiosity was another motivation for participating, “I never really see the results of what I’m doing and it’d be really interesting to see how this turns out” (Yonah, non-binary, 16). While all participants indicated they wanted to receive a copy of the study results, Asher (non-binary, 15) pre-emptively asked about the results, “is this gonna get published? If so, when and where? ‘Cause I wanna read about it,” demonstrating curiosity about the research process itself beyond the interview. In some cases, this curiosity appeared to be sustained beyond the novelty phase, “I like doing all the [research institute’s] stuff. I try and do a lot of it” (Nikki, no gender label, 15), perhaps reflective of an ongoing interest in research participation, “I’m always glad to participate in research and stuff” (Ronan, male, 18). Importantly, the current study was included in this interest, despite it being on a sensitive topic.

In addition to personal interest, sharing experiences was partly altruistically motivated, “knowing that it’s actually going toward something that could help or could be used in the future for other people and to help other people, I think that’s also part of the reason why I wanted to do this in the first place (Ode, non-binary/genderfluid, 16). The capacity to generate positive change was part of what shaped the interview as a worthwhile experience, “knowing that my experiences are going towards informing something better, I think that definitely makes it easier to discuss these things with you (Eleanor, transgender woman, 17). Sharing in research was characterized as a way to raise awareness about the realities that trans young people faced, “so I’m more than happy to share my experiences, if that means other people will be seen and recognized (Asher, non-binary, 15). Therefore, taking part in research was empowering because participants felt able to take meaningful action to improve their circumstances, and the circumstances of the trans community. This sentiment of empowerment is expressed in the following quote:

I wanna make the future for kids like me and kids who are like you and kids like my friends and your friends, I wanna make things easier and I want them to be able to live the best possible life they can and any means by which I can do that, I’m happy to do it. So, I’m really thankful. (Eleanor, transgender woman, 17)

Discussion

Qualitative studies on sensitive topics with adolescents are obliged to include adolescents in issues that concern them (Schelbe et al., 2015; United Nations Convention on the Rights of the Child, 1989) on balance with researchers’ responsibility to protect participants from harm. Understanding adolescents’ experiences of taking part in sensitive research, especially those of marginalized groups, is necessary for evidence-based ethical research design that meets these needs (Neelakantan et al., 2022). The current study aimed to understand trans adolescents’ perspectives on participating in interviews about their stigma experiences using qualitative interviews. We asked the question: what are trans adolescents’ perspectives on participating in stigma research? We completed a secondary data analysis (Kelly et al., 2024) of existing interviews on trans adolescents’ experiences of stigma. Overall, we found that negative experiences of the interviews were brief and outweighed by the positives, which were in part related to research design, as reflected in three themes: (1) lived experience in interviews matters; (2), negative effects are tolerable; and (3) sharing is important for self and others.

The discomfort that participants felt in disclosing their experiences was outweighed by the benefits of sharing their stories, which aligns with previous findings on sensitive research with adolescents (Mathews et al., 2022; Neelakantan et al., 2022). In this study, discomfort was reported as mild and worthwhile; for example, some participants found recalling experiences uncomfortable, but because of the setting (i.e. low pressure environment, interviewer characteristics), simultaneously enjoyable as part of a reflective exercise, which underscores the role of contextual factors in shaping a worthwhile participation experience. Benefits that adolescents in our study reported, such as the opportunity for self-reflection and sharing, and feeling empowered from engaging in a process that contributes to positive social change, have also been reported in other research on adolescents participating in sensitive research (Neelakantan et al., 2022), as well as with marginalized adults (Alexander et al., 2018). Altruistic motivation, and an opportunity to take action, may form part of a powerfully agentic experience that participants are unable to engage with in other settings, and is part of what makes recounting uncomfortable experiences worthwhile. Interestingly, of the three participant orientations described by Bredal et al. (2024), “telling for the researcher,” or those who appeared to have no strong personal motivation for participating, was not evident in this data. This may reflect that trans adolescents who participate in research are particularly conscientious about helping their community, or that due to the many barriers trans adolescents face to participating in research, those who did take part were highly motivated. Alternatively, participants may have felt pressure to report very positive motivations due to social desirability pressures, which suggests avenues for future research.

There were several study design elements that underpinned the findings of this study. In line with recommendations for conducting ethical research with trans people (Adams et al., 2017), participants reported that having an interviewer with lived experience increased their comfort to share openly in the interview, a finding shared in other studies on sensitive research with adolescents (Neelakantan et al., 2022). Input from a reference group, careful consideration of participant confidentiality and safety, the use of a waiver of caregiver consent, and dissemination of research findings to participants were also embedded as indicated by ethical guidelines (Adams et al., 2017). Inadequate sensitivity to individual groups’ contexts, preferences, and needs, such as language used to describe groups and topics (Staples et al., 2018), preferred interviewer characteristics (Neelakantan et al., 2022), and interview procedure, may partially explain why marginalized groups typically report more distress than less marginalized groups (Alexander et al., 2018), rather than a quality of “vulnerability” inherent to the individual. Thus, research ethics strategies that seek to adapt the research context to safeguard participant wellbeing are more likely to target the core social inequities that perpetuate marginalization (Link and Phelan, 2001), rather than paternalizing “vulnerable” participants (Racine and Bracken-Roche, 2019). Consequently, researchers need to understand what a given marginalized group considers sensitive (e.g. word choice, interview setting, requirements for caregiver consent), and tailor research designs to their contexts.

A strength of this study was that it documented trans adolescents’ perspectives on taking part in sensitive research, and included a reference group to review and advise on research materials. Centering the perspectives of adolescents from marginalized groups in research on sensitive topics is not inherently harmful to participant wellbeing. Ethical research can and should include adolescents in discussions of issues that concern them (Adams et al., 2017; Schelbe et al., 2015). The cisgender authors on the team provided insights in addition to the first authors’ lived experience; this mix of perspectives elicited dialog around differing perspectives that served as a resource for deeper engagement with the analytic process, as per the notion of “critical friends” (Smith and McGannon, 2018). As caregiver involvement can be a barrier to adolescent participation in sensitive research especially with trans adolescents (Sims and Nolen, 2021), it was also a strength of this study that we were able to consult adolescent perspectives without the requirement for caregiver involvement, ensuring representation from trans adolescents who are potentially at greater risk of stigma experiences.

These findings should be considered alongside some limitations. This study was a secondary analysis of data collected primarily to understand participants’ experiences of stigma. There was a single focal question which focused on participants’ internal experiences of the interview, meaning broader experiences of research participation, such as decision-making processes about engaging in the research at the recruitment stage, experience of the online eligibility survey, and post-interview experiences, including at a future follow-up time point, were out of scope and not interrogated. As these processes contextualize the interview experience as a whole, further research should consider how these factors shape trans adolescents’ experiences of sensitive research. Inclusion of participant self-report measures in future studies would provide an alternative assessment of participant research experience. Furthermore, participants were asked about their experiences at the end of the interview, which may not have allowed them time to collect their thoughts on their experience. An anonymous post-interview survey or debrief with a separate interviewer may be more apt at capturing these experiences in future. These methods may further ameliorate potential social desirability bias, which could have led to under-reporting of negative experiences. Finally, participants were required to provide the contacts of two supportive adults to participate. This requirement was not part of the original study design as it was not supported by the literature, and was included as a requirement from the ethics board in order for 14- and 15-year-olds to be allowed to participate without requiring caregiver consent. Therefore, our sample likely excluded participants with less supportive social networks, and those experiencing higher levels of stigma (Cwinn et al., 2021).

Based on these findings, and lessons learned from the broader research project, we offer some considerations for future ethical reviews of sensitive research with trans adolescents. Subject to further research, some of these considerations may also be relevant for research with other young people. Firstly, research on sensitive topics must be conducted using evidence-based strategies for ethical research, wherever possible drawing on research specific to the population of interest, as implementing adequate ethical safeguards is dependent on understanding what parts of the research context may make distress more likely, and how it can be managed effectively for the population in question. Normative procedures may have unintended consequences in marginalized groups (e.g. caregiver consent being potentially harmful, and impacting research validity in studies with trans adolescents). Secondly, that lived experience be included at all stages of the research. Lived experience can serve to advise on and pre-emptively consider sensitivities in the research specific to the population, such as through reference groups and researchers with lived experience. Ethics committees should consider including members with lived experience in their boards or, where this is not possible, consult external subject-matter experts on the topic to inform their decision-making, a consideration that becomes even more important when the literature regarding the topic or population is still emerging. Thirdly, we would urge consideration of all ethical principles of research in ethical reviews. Specifically, beneficence and justice should be considered alongside the principle of non-maleficence, as participants have the right to be involved in research concerning them. Researchers must present a clear explanation of their decision-making about risk management, inclusion of young peoples as per their rights, and a measured but meaningful presentation of likely benefits to participants, underpinned by a robust review of the literature and conveyed through the principles of science communication skills to support the deliberations of HREC/IRBs. Lastly, in managing potential distress and other risks, we suggest more emphasis on the use of robust risk management processes rather than attempts to eliminate distress entirely, aligning with findings that a degree of distress is tolerable to participants. Thus, efforts should be directed to supporting their participation, rather than excluding them altogether, including reviewing how standard research design (e.g. requirements for caregiver consent) may systematically exclude important subgroups. These considerations would be part of enabling participants to have a meaningful say in research and provide opportunities for empowerment and altruistic action, as well as begin to break the cycle of “marginalization-by-absence” in the literature (Clairmont et al., 2025).

Our findings suggest that trans adolescents who participate in sensitive research that has incorporated recommended design considerations experience minimal, tolerable distress and enjoy their participation in the research process. Centering the perspectives of adolescents from marginalized groups in research on sensitive topics need not inevitably hold negative consequences for participants’ mental health and wellbeing, and thus ethical research can and should include adolescents in research on issues that concern them. Sensitive research involves many ethical considerations, but with appropriate evidence-based research design, it is possible to conduct safe and high-quality studies that are fundamental to the promotion of adolescent health and wellbeing, including for marginalized groups on sensitive topics. Further research on the conduct of sensitive qualitative research with marginalized groups is essential for understanding risks and benefits, and furthering ethical research practice. Longitudinal or follow-up studies after the initial interview would be essential for understanding any ongoing burdens or benefits that participants may experience, which will inform future ethical research design of sensitive qualitative research.