A Therapeutic Exercise Programme for Trans and Gender Diverse Youth: An Effectiveness-Implementation Trial

Trans young people face systemic barriers to physical activity participation and experience disproportionately higher rates of physical and mental health challenges compared with their cisgender peers, yet evidence-based exercise interventions tailored to this population remain limited. This study evaluated a 12-week structured, group-based, gender-affirming exercise programme for trans youth aged 12 to 24 years in Western Australia, recruited through a specialist paediatric gender diversity service and community-based health and well-being services. Using a nonrandomised effectiveness-implementation hybrid design, the study assessed both the real-world implementation outcomes and health-related effectiveness of the programme, which was collaboratively designed with trans young people, families, and health professionals and grounded in international physical activity guidelines. Twenty participants enrolled, with 18 completing postprogramme assessments. Quantitative analysis revealed modest improvements in muscular strength, endurance, power, aerobic recovery, and well-being from baseline to 12 weeks, alongside high acceptability, appropriateness, feasibility, fidelity, and retention rates. Qualitative analysis identified themes relating to pathways to participation, connection through shared experience, supportive facilitation, and perceived physical and psychological benefits. This study adds to the limited evidence base by demonstrating that gender-affirming exercise programmes are both feasible and acceptable across clinical and community settings. Findings support the broader integration of exercise into gender-affirming health care, with implications for the design of inclusive health services and physical activity policies that address the specific needs of trans youth.