Gender-Affirming Care Reduces Risk for Depression, Suicidality in Trans Youth

Study data published in the Journal of Adolescent Health support the psychological benefits of gender-affirming hormone therapy (GAHT) for transgender and nonbinary youth. In a nationwide survey of transgender youth, GAHT was associated with significantly lower odds of recent depressive symptoms and past-year suicidality.

This online survey recruited youth via social media between October and December of 2020. Eligible respondents were aged 13 to 24 years, resided in the United States, and identified as lesbian, gay, bisexual, transgender, or questioning (LGBTQ).

Youth who indicated they were transgender or nonbinary were asked whether they were currently taking gender-affirming hormones. Depression levels were assessed using the Patient Health Questionnaire-2; a score of 3 or more was taken to indicate current depression. Respondents were also asked if they had experienced suicidal thoughts or actions in the past year.

Demographic covariates were also captured by self-report. Logistic regression analyses were used to assess the impact of GAHT access on the risk for depression, suicidal ideation, and suicide attempt. Models were adjusted for the following covariates: age, race/ethnicity, socioeconomic status, census region, gender identity, sexual orientation, parent support for gender identity, prior experience of gender-based victimization, gender identity conversion efforts, and history of hormone blocker use.

Data from 11,914 transgender and nonbinary youth were included in analyses. Mean age was 17.6 ± 3.2 years. The majority of respondents were non-Hispanic White (55%), followed by multiracial (21%), Latinx (12%), Asian/Pacific Islander (5%), Black (4%), and American Indian/Alaskan Native (2%). Overall, 14% reported that they were receiving GAHT; 50% said they were not using GAHT but would like to receive it; and 36% said they were not interested in receiving GAHT. Those who reported parental support for their gender identity comprised 80% of the cohort receiving GAHT. Among youth who wanted GAHT but did not receive it, just 38% reported parental support for their gender identity.

In regression models, receipt of GAHT was associated with significantly lower odds of depression (adjusted odds ratio [aOR], 0.73; 95% CI, 0.61-0.88; P <.001) compared to no receipt of GAHT. GAHT was also associated with lower odds of seriously considering suicide (OR, 0.74; 95% CI, 0.62-0.88; P <.001), though not with lower odds of suicide attempt (P =.16). When the study sample was restricted to youths aged 13 to 17 years, GAHT significantly lowered the risk for depression (OR, 0.61; 95% CI, 0.43-0.86; P <.01) and suicide attempt (OR, 0.62; 95% CI, 0.40-0.97; P =.04), though not suicide ideation.

These findings expand on prior research which suggests that access to GAHT is an important means of reducing depression in transgender and nonbinary youth. As study limitations, investigators cited the cross-sectional design and the absence of data on the duration of GAHT use among its recipients. Further study is necessary to assess the benefits of GAHT in the long term.

“Given the well-documented risks of negative mental health and suicide among transgender and nonbinary youth, it is necessary that those serving these youth provide care that is patient-centered, affirming, and evidence-based,” investigators wrote. “[Our data] support a relationship between access to GAHT and lower rates of depression and suicidality among transgender and nonbinary youth.”

Reference

Green AE, DeChants JP, Price MN, Davis CK. Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. J Adolesc Health. Published online December 12, 2021. doi:10.1016/j.jadohealth.2021.10.036