Transgender and gender-expansive (TGE) youth face well-documented barriers to accessing peer support: geographic distance from gender-affirming care centers, stigma that can make in-person group attendance feel risky, and the simple reality that in many areas, there aren't enough other TGE youth nearby to form a genuinely peer-matched group. A completed study from a Yale-affiliated pediatric gender program tested whether a multi-user virtual reality support group platform could meaningfully address this gap — and the results offer some of the clearest, most specific evidence yet for how VR peer support can work for this population.
The Study
Researchers conducted a mixed-methods pilot study with transgender and gender-expansive youth ages 13 to 18, recruited from a Yale pediatric gender program, using a HIPAA-compliant multi-user VR platform. Ten participants took part across two cohorts, meeting for eight weekly sessions of 50 to 60 minutes each inside customizable virtual environments, using standalone VR headsets provided to participants at no cost. Researchers measured usability with the System Usability Scale and conducted thematic analysis of qualitative survey responses gathered throughout the program.
What the Study Found
Strong, sustained engagement. Average attendance across the program reached 92.5%, and every participant completed at least five of the eight sessions — a genuinely strong retention rate for any support group intervention, let alone a novel technology-based one with a population that can be understandably wary of new institutional programs.
High usability. Eight of the ten participants rated the platform above average for usability, suggesting the technology itself wasn't a meaningful barrier to participation once youth were oriented to the format.
Avatar customization reduced a specific, real barrier. Five of the ten participants specifically noted that customizing their avatar's appearance reduced triggers related to gender dysphoria that might otherwise have made participation harder — a finding that points to something VR offers this population that neither an in-person group nor a standard video call can: meaningful control over self-presentation during a vulnerable social interaction.
Genuine peer connection. Nine of the ten participants valued the opportunity to meet other transgender and gender-expansive peers, and notably, all participants expressed interest in meeting in person afterward — a strong signal that the VR sessions were building real relationships, not just providing a technology novelty.
An important design insight: less structure, more peer leadership. Perhaps the study's most practically useful finding for programs building similar interventions: a majority of participants expressed a preference for less formally structured, more organic peer-to-peer connection, rather than a tightly therapist-directed format. This finding directly informed researchers' thinking about transitioning toward more peer-led models for future iterations of the program — a genuinely valuable, evidence-based insight for anyone designing a VR support group for this population.
Why Avatar Customization Matters So Specifically Here
The dysphoria-reduction finding deserves particular attention, because it points to something structurally different about VR compared to other remote support formats. On a video call, a transgender or gender-expansive young person is seen exactly as their camera captures them — their actual physical appearance, which for some youth, particularly earlier in a gender-affirming care journey, can itself be a source of real distress during an already vulnerable social interaction. VR avatar customization offers a form of control over self-presentation that neither an in-person group nor a video call provides, letting a young person engage in the social and emotional work of a support group without their physical appearance becoming an additional barrier to full participation.
What This Means for Gender-Affirming Care Programs
For pediatric gender programs and youth-focused behavioral health organizations, this study offers a genuinely strong, specific evidence base: the format is deliverable, engagement and retention are strong, and there's a documented, population-specific benefit (dysphoria-trigger reduction through avatar customization) that speaks directly to why this technology may be particularly well-suited to this specific population, beyond the general accessibility benefits VR support groups offer more broadly.
The finding about preferring less structured, peer-led formats is also worth taking seriously in program design — it suggests that for TGE youth specifically, the value of VR support groups may lie as much in providing a safe, low-barrier space for organic peer connection as in delivering formal therapeutic content, and programs should be open to adapting structure based on what their own participants indicate they want.
Considerations for Building a Similar Program
- Provide equipment access directly. The study’s approach of providing headsets at no cost to participants removed a real equity barrier; programs should budget for equipment access rather than assuming participants have their own.
- Prioritize avatar customization features. Given how directly this benefit showed up in the research, platforms and programs should ensure genuinely flexible avatar customization is available, not a token gesture.
- Stay open to peer-led formats. Based on this study’s findings, programs may see stronger engagement by evolving toward a more peer-led structure over time, rather than assuming a therapist-directed format is always the right fit.
The Takeaway
This completed study offers some of the strongest, most specific evidence yet for VR support groups in a distinct, historically underserved population: transgender and gender-expansive youth showed strong attendance, real engagement, and a documented, population-specific benefit in avatar-based dysphoria reduction that speaks directly to why this format may serve this community particularly well. For gender-affirming care programs looking to expand access to peer support, this research offers a genuinely solid evidence base to build from.
Foretell Reality is the HIPAA-compliant multi-user virtual reality platform used in this study, purpose-built for facilitated support groups with youth and adolescent populations. Schedule a consultation to see how it fits your gender-affirming care program.