Better mental health in transgender people who started using hormones as teenagers | Message center

The analysis controlled for several factors that could affect participants’ mental health independent of hormone treatment: age at the time of the survey; gender identity; gender assigned at birth; sexual orientation; race or ethnicity; degree of family support of gender identity; Relationship status; level of education; employment relationship; household income; use of puberty suppression treatment; any attempts to force them to be cisgender; and experience of verbal, physical, or sexual harassment because of their gender identity in grades K-12.

Compared to the control group members, participants who had undergone hormone treatment had a lower likelihood of experiencing severe mental distress in the previous month and a lower likelihood of having suicidal thoughts in the previous year. The likelihood of severe psychological distress was reduced by 222%, 153%, and 81% in those who started using hormones in early adolescence, late adolescence, and adulthood, respectively. The odds of having suicidal thoughts in the prior year were 135% lower in people who started using hormones in early adolescence, 62% lower in those who started in late adolescence, and 21% lower in those who started as adults compared to the control group.

Additionally, participants who started using hormones in early or late adolescence had a lower risk of binge drinking and lifelong illicit drug use than those who started using hormones in adulthood.

However, the researchers found that those who started hormone treatment in adulthood were more likely to binge drink and use illicit substances than those who had never resorted to treatment. “Some individuals may become more self-confident and socially engaged when they start taking hormones,” Turban said, adding that in some cases, this increased self-confidence and social engagement may be related to substance use. “This finding highlights the importance of creating culturally appropriate drug use counseling programs for transgender people.”

To get a sense of whether the participants’ mental health prior to treatment affected their ability to access treatment, the researchers also looked at whether participants in each group had ever had suicidal tendencies but had not had suicidal feelings in the previous year.

“This was a measure of improvement in mental health over time,” Turban said. “People were more likely to meet these criteria if they had access to hormones and were taking them than if they didn’t.” The finding implies that access to hormones improves mental health and not the other way around, he said.

Evidence building for gender-affirming medical care

Turban and his colleagues hope lawmakers across the country will use the new evidence to inform their policy decisions. Although several bills banning gender-affirming medical care for transgender youth have been introduced in state legislatures in recent years, almost all have not passed, he said, adding that all major medical organizations support the provision of gender-affirming medical care , including hormone therapy for patients who so desire and who meet Endocrine Society and World Professional Association for Transgender Health criteria.

“There is no one right way to be transgender,” Turban said. Some transgender people don’t want to take hormones and want to be comfortable with their bodies the way they are. Young people who seek treatment in gender clinics routinely receive counseling as part of their treatment to identify what types of care best suit their circumstances.

For those who want sex-affirming hormones, being denied access to treatment can cause significant distress, Turban said.

“For some transgender youth, their negative responses to life in bodies that develop during puberty in ways that are inconsistent with what they know themselves to be can be very damaging,” he said. For example, individuals who are uncomfortable developing breasts may respond by binding their breasts so tightly that they develop skin infections or broken ribs.

“These results will not surprise providers, but unfortunately many lawmakers have never met a transgender youth,” Turban said. “It’s important for lawmakers to see the numbers that support the experiences of transgender youth, their families and the people who work in this field.”

Researchers from the Fenway Institute, Brigham and Women’s Hospital, Harvard Medical School and Harvard TH Chan School of Public Health contributed to the study.

The research was funded by the American Academy of Child & Adolescent Psychiatry (supported by industry sponsors Arbor and Pfizer), the Harvey L. and Maud C. Sorensen Foundation, the National Institute of Mental Health (Grant MH094612), and Health Resources and Services Administration (grant U30CS22742).

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