Summary: Social support, in addition to access to gender-affirming hormones and puberty blockers, helps reduce depression and suicidal ideation in young transgender people.
Source: The Conversation
Recent studies estimate that 1.8% to 2.7% – or approximately 750,000 to 1.1 million – adolescents in the U.S. identify as transgender or nonbinary. Many of these trans youth experience high levels of negative mental health symptoms due to anti-transgender stigma, discrimination and lack of family or peer support. A 2021 study found that as much as 72% of trans youth were depressed, and half had seriously considered suicide.
We are an epidemiologist and fourth-year medical student who study ways to make clinical care more inclusive for trans and nonbinary people. We conducted a study in collaboration with the Seattle Children’s Hospital Gender Clinic that found that transgender youth on puberty blockers and gender-affirming hormone therapy are less likely to report depression and suicidal thoughts.
Safe and proven treatments
Puberty blockers are medications that delay puberty. By temporarily stopping the body from making the hormones that lead to puberty-related changes, young people and their families are given time to pause and make health decisions. These medications have been used for over 30 years to treat young people with puberty that starts too early, also called precocious puberty.
Gender-affirming hormone therapy, like testosterone or estrogen, are medications that allow trans youth to experience a puberty appropriately aligned with their gender.
There is no shortage of scientific and clinical societies that have found these medications to be both safe and effective for transgender people. Numerous medical and professional societies, including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the American Medical Association, endorse access to gender-affirming care specifically for trans youth.
Social support, as well as access to gender-affirming care, is known to significantly reduce poor mental health in trans youth. In addition, several recent studies have suggested that early access to puberty blockers and hormones during adolescence can have long-term positive effects that last into adulthood. Despite these benefits, many young people face significant barriers in accessing gender-affirming care. Only 1 in 5 youth who need hormones have been able to access them.
To further examine the mental health effects of puberty blockers and hormone therapy, we followed 104 trans and nonbinary youth ages 13 to 20 during their first year of gender-affirming care. After one year, we found that young people who began puberty blockers or gender-affirming hormones were 60% less likely to be depressed and 73% less likely to have thoughts about self-harm or suicide compared to youth who hadn’t started these medications.
In addition, young people who were unable to start these medications within three to six months of their first appointment with a medical provider had a two- to threefold increase in depression and suicidal thoughts. Our findings suggest that delays in prescribing hormones and puberty blockers may worsen mental health symptoms for trans youth.
What this means for anti-transgender legislation
2021 and 2022 have been record-breaking years for anti-transgender legislation, including attempts to criminalize gender-affirming care for trans youth.
Banning gender-affirming care will have immediate and long-term negative effects on the well-being of trans youth and their families, both by increasing the stigma and discrimination these young people face and by denying them access to critical life-saving and evidence-based health care. Our study builds on existing scientific evidence and underscores that timely access to gender-affirming care saves trans youth lives.
Funding: Diana Tordoff receives funding from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, the American Sexually Transmitted Diseases Association (ASTDA), and the Northwest Center for Public Health Practice at the University of Washington’s School of Public Health.
About this psychology research news
Author: Diana Tordoff and Arin Collin
Source: The Conversation
Contact: Diana Tordoff and Arin Collin – The Conversation
Image: The image is in the public domain
Original Research: Open access.
“Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care” by Diana Tordoff, Arin Collin et al. JAMA Network Open
Abstract
Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care
Importance
Transgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care.
Objective
To investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality.
Design, Setting, and Participants
This prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021.
Exposures
Time since enrollment and receipt of PBs or GAHs.
Main Outcomes and Measures
Mental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome.
Results
Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded “I don’t know” or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51).
Conclusions and Relevance
This study found that gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.
