Importance: Lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings.Objectives: To compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes.Design, Setting, and Participants: This cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire–9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey.Exposures: The primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates.Main Outcomes and Measures: PHQ-9-M–derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt.Results: The sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P < .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P < .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P < .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P < .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth.Conclusions and Relevance: Compared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support–focused interventions to mitigate mental health inequities for LGBTQ+ youth.

Purpose: The purpose of this study was to compare the clinical acceptability of testosterone levels, time to treatment, and postinstruction questions/problems between in-person and telehealth injection teaching for adolescents and young adults (AYA) initiating gender-affirming testosterone therapy. Methods: A retrospective cohort study was conducted using electronic medical record data from a large pediatric gender health clinic. Patients who received subcutaneous testosterone prescriptions between March 15, 2018, and March 14, 2022, were included. The study compared patients receiving in-person versus telehealth injection teaching. Data were collected on demographics, testosterone levels at 3 and 6 months, time from prescription to treatment, and post-instruction contacts. Statistical analyses included t -tests, chi-square tests, logistic regression, linear regression, and zero-inflated negative binomial. Results: The study included 278 patients, with 136 (48.9%) receiving in-person teaching and 142 (51.1%) receiving telehealth teaching. There were no significant differences in baseline characteristics between groups. Clinical effectiveness, indicated by testosterone levels at 3 and 6 months, revealed no significant difference between instruction methods ( p = 0.768 and p = 0.350). Time to treatment initiation was comparable (in-person: 15.34 days; telehealth: 18.02 days), with no significant difference in adjusted analysis ( p = 0.204). Post-instruction contacts were slightly higher in the telehealth group (2.87 vs. 2.42, p = 0.040), but injection-related questions were rare and similar between groups ( p = 0.650). Conclusion: Telehealth instruction for testosterone injection is as effective as in-person teaching methods for AYA initiating gender-affirming care. The findings support the continued use of telehealth to enhance access to gender-affirming care, particularly in light of its clinical efficacy and patient acceptability.