For transgender people, starting gender-affirming hormone therapy in adolescence is linked to better mental health than waiting into adulthood, according to new research from Stanford University School of Medicine.
The study, published online Jan. 12 in PLOS ONE, drew on data from the largest ever survey of American transgender adults, a group of more than 27,000 people who responded in 2015. The news study found that transgender people who started hormone therapy as a teenager had fewer suicidal thoughts, were less likely to have major mental disorders, and had fewer substance abuse problems than those who started taking hormones as a teenager. ‘adulthood. The study also documented better mental health in those who received hormones at any age than those who wanted but never received the treatment.
Gender-affirming hormone therapy with estrogen or testosterone can help align a transgender person’s physical characteristics with their gender identity. As a teenager, hormone therapy can get a transgender teenager through puberty in a way that matches their gender identity.
This study is particularly relevant now because many state legislatures are introducing bills that would ban this type of care for transgender youth. We are adding to the evidence base that shows why gender care is beneficial from a mental health perspective. “
Jack Turban, MD, postdoctoral researcher in pediatric and adolescent psychiatry at Stanford Medicine
Turban is the lead author of the study. The lead author is Alex Keuroghlian, MD, associate professor of psychiatry at Harvard Medical School and director of the National LGBTQIA + Health Education Center at the Fenway Institute.
Largest survey of transgender adults
Researchers analyzed data from the 2015 US Transgender Survey, which includes survey responses from 27,715 transgender people nationwide. Participants, who were at least 18 years old when interviewed, completed detailed questionnaires about their lives.
Because some transgender people don’t want hormone therapy, the study focused on 21,598 participants who said they wanted to receive hormones. Results were analyzed according to when participants started hormone therapy: 119 started at age 14 or 15 (early adolescence), 362 started at age 16 or 17 (late adolescence), 12,257 started after their 18th birthday (adulthood) and 8,860 participants, who served as a control group, wanted but never received hormone therapy.
Participants answered several questions about their mental health, including their history of suicidal ideation and suicide attempts, and their history of excessive alcohol and illicit drug use. They filled out a questionnaire to assess whether they had experienced severe psychological distress, meaning they met criteria for a diagnosable mental illness, in the previous month.
The analysis was controlled for several factors that could influence the mental health of participants regardless of whether or not they received hormone treatment: age at time of survey; gender identity; sex assigned at birth; sexual orientation; race or ethnicity; level of family support for gender identity; Status of the relationship; level of education; employment status; household income; use of puberty suppression treatment; any attempt to force them to be cisgender; and the experience of any verbal, physical or sexual harassment based on their gender identity in grades K-12.
Compared to members of the control group, participants who took hormone therapy were less likely to experience severe psychological distress in the previous month and less likely to have suicidal thoughts in the previous year. The risks of severe psychological distress were reduced by 222%, 153%, and 81% for those who started taking hormones in early adolescence, late adolescence, and adulthood, respectively. The odds of suicidal ideation in the previous year were 135% lower in people who started taking hormones in early adolescence, 62% lower in those who started in late adolescence, and 21% lower in those who started in adulthood, compared to the control group.
Additionally, participants who started taking hormones in early or late adolescence had a lower likelihood of binge drinking and illicit drug use in the previous month than those who started taking drugs. hormones in adulthood.
But researchers found that those who started hormone therapy in adulthood were more likely to abuse alcohol and illegal substances than those who never had access to treatment. “Some people can become more confident and socially engaged when they start taking hormones,” Turban said, adding that in some cases this increased confidence and social commitment can be linked to substance use. “This finding speaks to the importance of creating culturally appropriate substance abuse counseling programs for transgender people.”
To find out whether participants’ mental health before treatment influenced their ability to access treatment, the researchers also assessed whether participants in each group had ever been suicidal but had not had suicidal feelings in the past year. .
“It was a measure of improving mental health over time,” Turban said. “People were more likely to meet these criteria if they accessed and took hormones than if they didn’t.” The finding implies that access to hormones improved mental health rather than the other way around, he said.
Establish evidence for gender-affirming medical care
Turban and his colleagues hope lawmakers across the country use the new findings 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 been passed, he said, adding that all major Medical organizations support the provision of gender-affirming medical care, including hormone therapy for patients who want it and who meet criteria defined by the Endocrine Society and the World Professional Association for Transgender Health.
“There’s no one right way to be transgender,” Turban said. Some transgender people don’t want to take hormones and feel comfortable with their bodies as they are. Young people seeking care at gender clinics are routinely offered counseling as part of their treatment to help them determine what types of care are best for their situation.
For those who desire gender-affirming hormones, being denied access to treatment can cause significant distress, Turban said.
“For some transgender youth, their negative reactions to living in bodies that develop during puberty in ways that are not what they know to be can be very damaging,” he said. For example, people who feel uncomfortable developing breasts may respond by squeezing their breasts so tightly that they develop skin infections or broken ribs.
“These results will come as no surprise to providers, but unfortunately many lawmakers have never met transgender youth,” Turban said. “It is important for lawmakers to see the numbers that underpin the experiences of transgender youth, their families and those who work in this field.