Rebecca Juro remembers keeping her secret as far back as age 5. She felt different compared to other little boys in her suburban New Jersey neighborhood and, without anyone saying it, she understood being different was bad.
"I knew my parents would not be excited to hear their son wanted to wear a dress," she said.
Juro kept her secret for decades. In her teens, she lived as a boy and dated girls. In her 20s, she became a punk in the testosterone-fueled music scene of the 1970s. By the 1980s, she buckled under the weight of her double life.
At the age of 32, she decided driving off a bridge was better than living a lie.
"If I couldn’t live as myself, what’s the point?" she said, looking back on her suicide attempt. "I couldn’t see any other way out."
The trans community faces higher suicide attempt rates than almost every other demographic: 40 percent of transgender adults reported having tried to kill themselves, according to the 2015 U.S. Transgender Survey.
Ninety-two percent of those made the attempt before the age of 25.
Only white, middle-aged men have a higher suicide rate. In 2015, men between the ages of 45 and 64 accounted for seven out of 10 suicides.
Lesbian, gay and questioning youth also face a higher risk of suicide. Their attempt rate is four times greater than for heterosexual adolescents, according to the Trevor Project, a national lifeline and advocacy group.
The numbers are more difficult to count for lesbian, gay, bisexual, transgender, queer and related sexual orientation (LGBTQ+) adults because death certificates do not indicate sexual orientation and gender identity, according to the Office of the Surgeon General. But recent reports suggest gay men are six times more likely than heterosexual men to attempt suicide, and lesbians are twice as likely as straight women to attempt suicide, according to the American Association of Suicidology.
Many of the factors driving these higher suicide rates appear to be cultural. The queer community continues to face discrimination despite greater social acceptance since the Supreme Court ruled in favor of marriage equality. Rejection, bullying, homelessness, addiction and violence contribute to higher suicide rates among LGBTQ+ individuals, according to experts.
Researchers point to the minority stress theory, which posits that stigma and prejudice create a hostile and stressful social environment that can lead to mental health problems.
In young people, these external pressures become magnified.
"Kids can be made to feel unworthy and that can exacerbate feelings of depression," said Drexel University professor Dr. Guy Diamond. He helped develop a behavioral health assessment tool used by medical professionals at the Children’s Hospital of Philadelphia.
Now in her 50s, Juro still can’t point to an exact moment that defined her experience as a trans youth in hiding. Cultural cues were subtle yet clearly defined by the times. She grew up in the 1960s, when women were expected to be wives and men were expected to take care of them. As she described it, people were either from "column A or column B. There was no in between."
Juro knew she wanted to be a girl, but she didn’t have a label for what that meant. Nobody did. At school she was bullied. Teachers thought something was off with the "strange little boy" but couldn’t figure out what. She was diagnosed with ADHD and placed in special education classes.
At home Juro didn’t have role models. She and her two brothers were raised by traditional parents. Her dad was an advertising executive, her mother a homemaker. Instead of exploring what eventually became her true identity, Juro filled the role laid before her.
"I spent a lot of time trying to hypermasculinize myself," she said. "I did what was expected of me."
She dated women, played sports, got into fights and eventually dived into the punk scene. Even as an adult she only experimented with women’s clothing in private. When she was still in her 20s, living as anything other than a closeted trans woman felt like an impossibility.
"This was 1982," she said. "There was no such word as transgender. It wouldn’t exist for another 13 or 14 years."
Things turned around after Juro found a therapist near Philadelphia who encouraged her to dress as a woman in a closed gathering of trans people. Unlike previous therapists, this one did not question her sexuality or assume Juro was confused. Instead, her counselor guided Juro through a careful transition that included coming out to friends and family.
When she did, Juro’s father wanted to know if she was a drag queen who performed at clubs and wore sequins. He had recently been to one such establishment and was scandalized to think his son would be among the entertainers. Juro’s mother was initially confused but eventually became her biggest ally. When police bullied her, Juro’s mom scolded them and forced them to apologize.
Looking back at her metamorphosis, Juro laments how few resources were available to ease her transition.
"My little sister is gay and presents male," she said. "I can’t believe these kids have so much freedom now. I live vicariously through her."
But not all queer youth are supported by their loved ones. Sam Escobar, who identifies as gender fluid and uses gender-neutral pronouns, struggled with coming out. The 27-year-old went through the process twice — once at 16 and again at 25. The first time felt fruitless.
"My dad never talked about it again and my mom worried life would be harder," Escobar said. "I was worried about the stress on my parents. I felt very guilty."
This guilt was only compounded by surviving multiple sexual assaults, which contributed to post-traumatic stress disorder (PTSD), eating disorders, anxiety, depression and two suicide attempts. Added to the trauma was an ongoing internal struggle about what it meant to be truly gay. Initially, Escobar felt too shy to flirt with anyone who wasn’t a man. And when Escobar did try to explain non-binary gender, they were frequently met with disbelief or confusion.
Curvy with soft features, Escobar presents as feminine. Boys Escobar dated couldn’t understand why their girlfriend didn’t identify as a woman. They worried it would make them gay if Escobar decided to present more masculine.
"I was constantly trying to fulfill other people’s expectations of me," Escobar said. "I felt like I was never going to be happy."
It’s a familiar refrain for closeted youth.
As a teenager, James Lecense knew he was gay. He was born into a quiet, normative slice of suburbia. New York City was an hour away and Philadelphia even further. All he knew was a small New Jersey community filled with nice people who mostly resembled each other. Nothing was necessarily wrong with his childhood, but Lecense sensed something inside of him was different than the other kids at school. Like Juro, he didn’t know the word for what he was experiencing. He frequently felt isolated from family and peers.
"I grew up in another time," said the 58-year-old creator of The Trevor Project. "I didn’t even know what homosexuality was. I thought I was the only gay person that ever lived."
Moving to Manhattan and becoming involved with theater changed everything for him. He "found a tribe" that provided encouragement and support at a time when many gay men were grappling with the AIDS crisis. The epidemic killed hundreds of thousands of people, both gay and straight, but helped introduce and normalize certain aspects of queer culture.
"I was witness to an entire generation of my peers dying off," Lecense said. Still, "there was no discussion of young people being gay. It was as though you turn 21 and then suddenly turn gay."
The lack of attention to queer youth troubled Lecense, so in 1995 he created a character named Trevor as part of a larger production. Trevor, much like Lecense, was a 13-year-old boy struggling to understand and accept his sexuality. Through a series of diary entries he realized that he is gay and, distraught at what this would mean to his family and future, decides to kill himself.
Trevor’s self-realization felt familiar to Lecense, who hesitates to reveal how similar his personal experience was to his character’s. But the story of a teenager whose sexuality drove him to attempt suicide sparked the interest of two L.A. producers and eventually HBO.
The team created a longer film starring Trevor and soon realized a need that wasn’t being addressed. Who could struggling young people turn to in their darkest hours?
"There was no lifelines, no websites in those days," Lecense said. "We had to do something."
The team raised enough money in three months to fund The Trevor Project, which offers a lifeline, website and chat support for young people in need. The organization hears from an average of 52,000 people per year, according to vice president of programs David Bond. They range between the ages of 10 and 24. Some live in cities, others in small communities. The one thing they have in common is fear of rejection and a total loss of hope.
"When you’re chronically exposed to messages that your experience is less valid … that can lead to mental health problems such as suicidal thoughts or substance abuse," Bond said.
Counselors with The Trevor Project undergo extensive training and role playing sessions to prepare for what’s on the other line. The responsibility can feel heavy even to the most seasoned operator, who must be ready to help someone in crisis mode or just sit back and listen to a kid who feels there is no one else out there.
"If you have a broken leg, everyone can see your leg is broken. With depression, no one can see that from the outside," Escobar said.
"And being queer, everyone is always telling you’re wrong or trying to fix you. Sometimes, it’s better [for them] just to listen."
Like The Trevor Project, Trans Lifeline provides a safe space nearly impossible to find in the outside world. The support hotline offers suicide prevention, emotional support and a virtual community for trans people. It was founded by Greta Martela, herself a suicide attempt survivor who experienced discrimination when she reached out for help. An operator for a national suicide hotline misgendered her repeatedly and seemed uncomfortable discussing issues specific to her experience as a trans woman.
"This was in San Francisco," said Trans Lifeline spokesperson Andre Perez. "If conditions are that bad in San Francisco, then that must mean trans people across the country are facing even greater barriers."
Martela founded Trans Lifeline in 2014 to provide community members a safe space to speak with like-minded people who understand their particular concerns. Some people call in immediate distress, others just to chat. Each person is evaluated based on a loose ranking system. "One" means the person is not in immediate danger while a "four" or a "five" is in severe crisis.
"We try to talk them down. We stay on the phone as long as they need," Perez said. "Before we end the phone call, we try to make sure that there is a follow-up plan where they’re having a friend or relative come over to be with them. We really just don’t want people to be alone."
Callers are typically kids or people of color who feel doubly marginalized from society. When trans people reach out for help, many experience the same discrimination from medical professionals as they do in their private lives. Trans Lifeline seeks to remove that stigma.
Juro volunteered for the organization in 2015 because she thought she could be the person to say, "no, no, no wait a minute. There are other options." She wishes someone had said that to her when she attempted suicide.
This concept of listening and validating is at the core of Drexel’s Center for Family Intervention Science — where Diamond serves as director. In an outpatient setting just steps away from 30th Street Station, therapists treat families struggling with depression and sexual identity.
The center's approach is focused on honing in on a parent's instinctual desire to protect their child, even when they don’t understand what a young person might be experiencing or feeling. This includes talking to parents who feel homosexuality contradicts their religious beliefs or adults who think teens are merely acting out for attention.
Dr. Jody Russon, Diamond’s colleague whose practice specializes in marginalized youth, said the center’s premise is to "get the parents on board again with supporting their kid" in order to reduce the likelihood of suicide.
The first step in repairing that parent-child relationship is acknowledging that some adults might be going through a grieving process after learning their son or daughter is queer.
"It can be like a death to some," she said. "It’s a real loss if they’re not going to get that wedding or grandchild [the way] they always imagined."
Research has shown that improved relationships between parents and their children can lessen instances of depression, suicide, homelessness and addiction, yet not all parents can learn to accept certain aspects of their child’s life.
Called attachment-based therapy, the treatment happens in steps. First, therapists meet separately with parents and their children and get a sense of what each one feels is happening. Counselors then slowly and methodically start to unravel the parent’s anger, confusion or disbelief and present them with a simple concept: their child is in pain.
Somewhere along the line bonds of support have been broken, Russon said. "If we can bond and rejoin that relationship, then we’re on the right track to healing."