New Study Finds Hormone Therapy Improves Mental Health in Transgender Young People

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

The study, published Wednesday in the New England Journal of Medicine, evaluated 315 transgender young adults aged 12 to 20, with a median age of 16, during the two years they received sex-confirming hormone therapy.

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

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

The researchers found that, on average, participants reported an increase in positive emotions, life satisfaction, and appearance congruence. This increase was associated with a decrease in symptoms of depression and anxiety.

The results, the researchers write, support the use of hormone therapy as an effective treatment for transgender and non-binary youth.

The researchers said their findings also suggest that appearance congruence is important for the well-being of transgender and non-binary youth. Differences in mental and physical health between young people who experienced significant “gender-incongruent” puberty—that is, puberty associated with their assigned sex at birth—and those who also did not support the importance of appearance congruency for well-being.

Only a small subgroup (24 participants) in the study did not undergo extensive sex-incompatible puberty, either because they started taking puberty blockers early in puberty or started taking sex-confirming hormones when puberty started later.

“Those who did not have significant gender-incongruent puberty had higher scores on appearance congruence, positive affect, and life satisfaction and lower scores on depression and anxiety at baseline than young adults who experienced significant endogenous puberty,” meaning puberty related to their assigned gender, the researchers write.

They also noted that symptoms of depression and anxiety were significantly reduced and life satisfaction increased significantly among transgender and non-binary young people who were identified as female at birth, but not among those identified as male at birth. They wrote that this difference could be explained by several factors: First, some estrogen-related physical changes, such as breast growth, can take two to five years to reach their “maximum effect.”

As a result, the researchers suggested that transgender youth might need a longer follow-up period to see an impact on mental health.

Second, they wrote that physical changes resulting from testosterone-induced puberty, such as a deeper voice, may be “more pronounced and noticeable” than those associated with estrogen-induced puberty.

Third, the researchers wrote that it is possible that differences in anxiety and life satisfaction may be due to less social acceptance of transfeminine people compared to transmasculine people.

A study published in the Journal of Adolescent Health in 2021 found that transfeminine youth may experience more minority stress—that is, the stress experienced by stigmatized minority groups such as LGBTQ people—than transmale youth.

The authors of the new study wrote that understanding the impact of gender-affirming hormones on the mental health and well-being of transgender and non-binary youth “will be critical given the documented mental health differences seen in this population, especially in the context of the increasing politicization of gender-affirming healthcare.” services”.

Over the past two years, state legislatures have considered dozens of bills aimed at limiting access to gender-affirming health care, such as puberty blockers, hormone therapy, and surgery for transgender minors.

Four state governors — Arkansas, Alabama, Tennessee and Arizona — have signed restrictions on such aid into law, but measures in Arkansas and Alabama have been blocked from taking effect by federal judges pending litigation.

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

Proponents of this law argue that care is experimental and that minors are too young to make health care decisions that could have permanent consequences.

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

These groups point to a growing body of research that has shown that caregiving has a significant positive impact on the mental and physical health of transgender youth, who have a disproportionately high suicide rate.

A national survey published last year by the Trevor Project, a national organization for suicide prevention and youth crisis intervention, found that more than half of transgender and non-binary youth (53%) had serious thoughts about suicide in the past year. Nearly one in five (19%) reported having 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 thoughts among transgender youth.

Three studies — two of which were published in 2020 and one in 2021 — have shown that earlier access to gender-affirming care is associated with improved mental health.

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

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

As a result, they stated that the results may not be applicable to youth who cannot access comprehensive gender-affirming care, or to youth who self-medicate with gender-affirming hormones.

They also noted that improvements in mental health varied greatly, and that some participants continued to report high levels of depression and anxiety and lower levels of positive emotions and life satisfaction.

According to the researchers, two participants committed suicide during the study, and six withdrew from it. They added that information collected before they died or left the study was included in the analysis.

The study did not examine other factors known to influence the psychosocial functioning of trans youth, such as parental support. The study also lacked a comparison group, which the researchers say limits their ability to establish causation. They plan to study these other factors and will continue to monitor the group to see if the improvements persist over a longer period of time.

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