Gender-affirming care may improve mental health of transgender youths

February 28, 2022

4 minutes of reading


Disclosures: Tordoff reports receiving grants from the National Institute of Allergy and Infectious Diseases. Turban reports receiving textbook royalties from Springer Nature, expert witness payments from The American Civil Liberties Union and Lambda Legal, a pilot research award from The American Academy of Child & Adolescent Psychiatry, and its industry donors (Arbor & Pfizer) and a research grant from The Sorensen Foundation. Dolotina does not report relevant financial disclosures.

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Transgender and non-binary youth who received gender-affirming care were significantly less likely to experience moderate or severe depression and suicidality than those who did not, according to findings published in Open JAMA Network.

“Our study builds on a strong scientific evidence base that access to gender-affirming care is critically important to the mental health and well-being of trans youth.” Diana M. Tordoff, MPH, an epidemiology doctoral student at the University of Washington, told Healio. “Our findings demonstrate that puberty blockers (PBs) and gender-affirming hormones (GAHs) can mitigate depression and suicidality during the relatively short period of 1 year, and that delays in prescribing PBs and Hormones can, in fact, worsen the mental health symptoms of trans youth.”


Tordoff DM, et al. JAMA Network Open. 2022;doi:10.1001/jamannetworkopen.2022.0978.

In a prospective observational cohort study, Tordoff and colleagues investigated changes in mental health among transgender and nonbinary adolescents and young adults seeking gender-affirming care. The researchers assessed participants’ depression, anxiety, and suicidality with the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder.

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In total, 104 young people aged 13 to 20 years in an urban multidisciplinary gender clinic were followed from August 2017 to June 2018. The average age was 15.8 years and 64.4% of the young people were white. The study cohort included 63 transmasculine people (60.6%), 27 transfeminine people (26%), 10 nonbinary or genderfluid people (9.6%), and four people who did not specify their gender identity (3 .8%).

Tordoff and colleagues reported that 80.8% of the study cohort completed the surveys after 3 and 6 months of follow-up, and 62.5% completed them after 1 year of follow-up.

Prevalence of mental health problems

Overall, 56.7% of youth had moderate to severe depression, 50% had moderate to severe anxiety, and 43.3% reported thoughts of self-harm or suicidality at baseline.

After 1 year, 66.3% of the youth had received PB, SHG, or both interventions. The remaining participants received no intervention, according to the researchers.

After adjusting for confounders, Tordoff and colleagues reported a 60% lower odds of depression (adjusted OR = 0.4; 95% CI, 0.17-0.95) and a 73% lower odds of suicidality (aOR = 0.27; 95% CI, 0.11-0.65) among youth who had received gender-affirming therapy compared with youth who had not. However, there was no significant association between PB or GAH and anxiety (aOR = 1.01; 95% CI, 0.41-2.51).

“Our findings have important policy implications, suggesting that the recent wave of legislation restricting access to gender-affirming care may have significant negative outcomes on people’s well-being. [transgender and nonbinary] youth,” Tordoff and colleagues wrote.

Recently, the governor of Texas. Greg Abbott has issued a directive to report any cases of transgender minors receiving gender-affirming health care, which it says constitutes as “child abuse under existing Texas law.”

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In response, the ACP issued a statement strongly opposing “government interference in the doctor-patient relationship that prevents physicians from providing evidence-based medical services to their patients.”

Meanwhile, there are other legislative and government efforts that are aimed directly at criminalizing gender-affirming care for trans youth, Tordoff said.

“These efforts will certainly have profound immediate and long-term negative impacts on the well-being of trans youth and their families, both by increasing the stigma and discrimination these youth experience and by denying them access to critical, life-saving health services and evidence based. watch out,” she added.

In addition to addressing anti-transgender legislation, medical systems and insurance providers need to lower barriers and expand access to gender-affirming care, the researchers wrote.

Multifaceted approach to care

In a related editorial, Brett dolotinedegree, from the department of psychiatry at Massachusetts General Hospital and the Fenway Institute, and Jack L. Turban, MD, MHS, a fellow in psychiatry and behavioral sciences at Stanford University, discussed the need for a multipronged approach to address mental health disparities among transgender and gender-diverse youth.

While gender-affirming care was found to decrease the likelihood of suicidality and depression among this population, “medical intervention alone is not sufficient to address [transgender and gender-diverse] disparities in youth mental health,” they wrote.

Other steps should include implementing evidence-based experiential learning programs in medical education to properly train clinicians on how to treat these young people.

The proposed anti-transgender legislation will likely negatively impact the mental health of transgender and gender-diverse youth and prohibit their ability to use public facilities that match their gender, Dolotina and Turban wrote.

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“It is particularly important to highlight that legislation targeting sexual and gender minority youth appears to have impacts beyond the direct impact of the legislation,” they added. “Even if the anti-transgender bills don’t pass, the recent discussions around them still serve to increase the stigmatization of transgender people. [transgender and nonbinary] young people, which is expected to worsen mental health.”

References:

Dolotina B, Turbante JL. JAMA Net Opened. 2022;doi:10.1001/jamannetworkopen.2022.0926.

Governor Abbott directs DFPS to investigate gender transition procedures as child abuse. https://gov.texas.gov/news/post/governor-abbott-directs-dfps-to-investigate-gender-transitioning-procedures-as-child-abuse. Retrieved February 25, 2022.

HB 1557/SB 1834 – Harming LGBTQ+ youth and censoring discussions related to sexual orientation and gender identity in schools. https://www.aclufl.org/en/legislation/hb-1557-sb-1834-harming-lgbtq-youth-and-censoring-discussions-related-sexual-orientation. Retrieved February 24, 2022.

Internists oppose policies that interfere with the doctor-patient relationship and penalize evidence-based care. http://r.mail.acpnews.org/mk/mr/2tpx2J7087ysYBGedDSg-ZWb9oHBoWj_IAV3DIwx_UCDcZtFzj5yMyMlTCF6YoZ3QEwNwdHLpb3KSAycaiw3vTTHmnSOHVlQYRm_wyHtqY-6CsqBJ_GIMeWKlcSQwip4k. Published February 24, 2022. Retrieved February 24, 2022.

The Governor of Texas asks citizens to report parents of transgender children for abuse. https://www.nbcnews.com/nbc-out/out-politics-and-policy/texas-governor-calls-citizens-report-parents-transgender-kids-abuse-rcna17455. Published February 23, 2022. Retrieved February 24, 2022.

Tordoff DM, et al. JAMA Net Opened. 2022;doi:10.1001/jamannetworkopen.2022.0978.

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