Hormone therapy improves the mental health of transgender youth, a new study finds

Transgender youth reported more life satisfaction and fewer symptoms of depression and anxiety after receiving gender-affirming hormone therapy for two years, according to a new study.

The research, published Wednesday in the New England Journal of Medicine, tested 315 transgender youth ages 12 to 20, with an average age of 16, over the course of two years while receiving gender-affirming hormone therapy.

The researchers are a group of doctors and professors associated with universities and children’s hospitals in Chicago, Boston and Los Angeles. The study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The researchers used scales that measured depression and anxiety, positive emotions and feelings of satisfaction with life, and appearance congruence—how much a trans person feels their outward appearance aligns with their gender identity. . Participants rated each of these factors numerically.

The researchers found that, on average, the participants reported increases in positive emotions, life satisfaction, and appearance congruence. Those increases were associated with decreases in symptoms of depression and anxiety.

The findings, the researchers wrote, support the use of hormone therapy as an effective treatment for trans and non-binary youth.

The researchers said their findings they also suggest that appearance consistency is important to the well-being of trans and non-binary youth. Differences in mental and physical health between youth who had undergone substantial “gender-incongruent” puberty, which is the puberty associated with their assigned sex at birth, and those who had not undergone the importance of gender congruence. appearance for well-being.

Only a small subgroup (24 participants) in the study did not experience extensive gender-incongruent puberty, either because they started puberty blockers early in puberty or started gender-affirming hormones later in puberty. late.

“Those who had not undergone substantial gender-incongruent puberty had higher scores on appearance congruence, positive affect, and life satisfaction and lower scores on depression and anxiety at baseline than youth who had undergone substantial gender-incongruent puberty. substantial endogenous puberty,” that is, puberty associated with their assigned sex, the researchers wrote.

They also noted that symptoms of depression and anxiety decreased significantly and life satisfaction increased significantly among trans and non-binary youth designated as female at birth, but not among those designated as male at birth. This difference, they wrote, could be attributed to a few factors: First, some physical changes associated with estrogen, such as breast growth, can take two to five years to reach their “peak effect.”

As a result, the researchers speculated that a longer follow-up period might be necessary for young transfemales to see an effect on mental health.

Second, they wrote that the physical changes that result from going through testosterone-driven puberty, such as a deeper voice, might be “more pronounced and observable” than those associated with estrogen-driven puberty.

Third, the researchers wrote that differences in anxiety and life satisfaction may be related to lower social acceptance of transfeminine people, compared to transmasculine people.

Research published in the Journal of Adolescent Health in 2021 suggested that transfeminine youth may experience more minority stress, which is stress faced by stigmatized minority groups such as LGBTQ people, than transmasculine youth.

The authors of the new study wrote that understanding the effect of gender-affirming hormones on the mental health and well-being of transgender and nonbinary youth “would appear crucial, given the documented mental health disparities observed in this population, particularly in the context of increasing politicization of gender-affirming healthcare.

In the past two years, state legislatures have considered dozens of bills seeking to restrict access to gender-affirming healthcare, such as puberty blockers, hormone therapy and surgery, for transgender minors.

The governors of four states (Arkansas, Alabama, Tennessee and Arizona) have signed restrictions on such care into law, but federal judges have blocked the measures from taking effect in Arkansas and Alabama pending litigation.

So far this year, lawmakers have introduced such legislation in at least 16 states.

Supporters of this legislation argue that the care is experimental and that children are too young to make health care decisions that could have irreversible effects.

However, medical associations such as the American Medical Association and the American Academy of Pediatrics, among others, oppose efforts to restrict gender-affirming care for minors.

These groups point to the growing body of research that has found care to have significant positive effects on the physical and mental health of transgender youth, who have disproportionately high suicide rates.

A national survey released last year by the Trevor Project, a national youth suicide prevention and crisis intervention organization, found that more than half of transgender and non-binary youth (53%) had seriously considered suicide in the past year. Nearly 1 in 5 (19%) reported that they had attempted suicide in the past year.

In addition to the New England Journal of Medicine study, about half a dozen others have shown that access to puberty blockers and hormone therapy can improve mental health outcomes, including reduced suicidal ideation, among transgender youth. .

Three studies, two published in 2020 and one published in 2021, found that earlier access to gender-affirming healthcare is associated with better mental health.

And a 2021 study published in the Journal of Adolescent Health, which drew on data from The Trevor Project, found that gender-affirming hormone therapy is strongly associated with lower risk of suicide and depression for transgender youth ages 13 to 24 years. .

The researchers behind the New England Journal of Medicine Study noted that there were some limitations to their study. For example, they recruited participants from gender clinics at children’s hospitals in Chicago, Boston, and Los Angeles.

As a result, they said the findings might not apply to youth who cannot access comprehensive gender-affirming care or to youth who self-medicate with gender-affirming hormones.

They also noted that improvement in mental health varied widely, with some participants continuing to report higher levels of depression and anxiety and lower levels of positive emotions and life satisfaction.

Two participants committed suicide during the study and six withdrew, according to the researchers. Information collected before they died or dropped out of the study was included in the analyses, they added.

The study did not examine other factors known to affect psychosocial functioning among trans youth, such as parental support. The study also lacked a comparison group, which the researchers say limits their ability to establish cause-and-effect. They plan to study those other factors and will continue to follow the cohort to see if the improvements are sustained over a longer period of time.

If you or someone you know is in crisis, please call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, formerly known as the National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741, or visit SpeakingOfSuicide.com/resources for additional resources.

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