Project Summary/Abstract This is an application for a K23 award for Dr. Stanley Vance, Jr., MD, whose research focuses on barriers to gender-affirming care for transgender youth. His research training includes an Adolescent Medicine fellowship and formal course work in quantitative approaches. Through activities proposed in this application, Dr. Vance will build skills in qualitative methodology, youth/caregiver-facing intervention development, and randomized controlled trials. The resources to foster his career development include UCSF’s Adolescent and Young Adult Medicine Division, Child and Adolescent Gender Center, Center for AIDS Prevention Studies, K- Scholars Program, and graduate coursework in qualitative methods and intervention development and trials. He has convened a mentoring team experienced in relevant disciplines of community-based research with transgender populations, pediatric transgender research, qualitative methods, and intervention implementation to guide the completion of his research and career development into an independent researcher. Informed by the Gender Affirmation and Intersectional Stigma models, this proposal focuses on Black and Latinx transgender youth (BLTY). BLTY face intersecting forces of racism and transphobia, thereby increasing their vulnerability to poor mental health outcomes. However, there is a paucity of data that document the cultural and familial factors that may contribute to these mental health disparities. Although gender affirmation—receiving social support for one’s gender identity and/or medical treatment to affirm one’s gender—improves mental health for transgender youth, cultural and parental influences on gender affirmation for BLTY have not been delineated. Exploring such factors could provide critical information to supporting BLTY and their caregivers through interventions. This career development award seeks to address these gaps in the literature through the following specific aims which will be carried out with guidance from a Community Advisory Board: Aim 1: To gather qualitative data to inform the development of a culturally informed intervention to improve mental health outcomes among BLTY. This includes conducting in-depth interviews with Black and Latinx transgender young adults about their prior experiences with gender affirmation and how their caregivers and cultures influenced such experiences. This aim also includes focus groups with Black and Latinx caregivers to understand cultural views of gender diversity. Aim 2: To develop a culturally informed intervention that promotes gender affirmation and mental health of BLTY. An intervention informant group with BLTY and caregivers will provide direct input into the development of a culturally informed intervention. Aim 3: To pilot test the intervention via a randomized controlled trial. The intervention and control condition will be administered to BLTY and their caregivers to evaluate the intervention’s acceptability, feasi...