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Cited by 692LGBTQ Health, Identity, and PolicyAdolescent and Pediatric HealthcareGender, Sexuality, and Education

Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care

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Tordoff, Diana M., Wanta, Jonathon W., Collin, Arin, Stepney, Cesalie, Inwards-Breland, David J., Ahrens, Kym·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.0978PMC PMC8881768
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Abstract

Importance: Transgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care. Objective: To investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality. Design, Setting, and Participants: This prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021. Exposures: Time since enrollment and receipt of PBs or GAHs. Main Outcomes and Measures: Mental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome. Results: Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51). Conclusions and Relevance: This study found that gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.

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  • Puberty is associated with increased vulnerability to anxiety, depression, and suicidal ideation.

    “In addition to the physiological changes associated with puberty, this developmental period is also associated with dramatic shifts in mental health risk, such as increased vulnerability to anxiety, depression, and suicidal ideation (9-11)”

    From Puberty Blocker, Leuprolide, Reduces Sex Differences in Rough-and-Tumble Play and Anxiety-like Behavior in Juvenile Rats (2024) · cites this paper as [11]

    The Discussion (page unavailable) says transgender and nonbinary adolescents are at increased risk of depression, anxiety, and suicidality, and the Results (page unavailable) report high rates of these outcomes in the study cohort. The paper does not establish that puberty itself increases vulnerability, or that the finding applies to youths generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • TNB adolescents receiving gender-affirming hormone therapy had reduced anxiety and depression symptoms.

    “studies examining the effects of gender-affirming health care found that TNB adolescents receiving gender-affirming hormone therapy had reduced anxiety and depression symptoms (11).”

    From Puberty Blocker, Leuprolide, Reduces Sex Differences in Rough-and-Tumble Play and Anxiety-like Behavior in Juvenile Rats (2024) · cites this paper as [11]

    The Results (page unavailable) associate receipt of puberty blockers or gender-affirming hormones with lower odds of moderate to severe depression, but report no association with moderate to severe anxiety. The study analyzed the two interventions together, so it does not establish the stated outcomes for hormone therapy alone. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K.
Affiliations
  • University of Washington (US)
  • Seattle Children's Hospital (US)
  • University of California San Diego (US)
Corresponding author
Tordoff, Diana M.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-02-25
Volume
5
Issue
2
Pages
e220978
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.0978
PMC
PMC8881768
OpenAlex
W4214552015
Cited by
692
References
4
Citations by year
2026: 120 · 2025: 191 · 2024: 206 · 2023: 136 · 2022: 39
FWCI
135.14
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Allergy and Infectious Diseases
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
  • Social Sciences › Gender Studies › Gender, Sexuality, and Education
Keywords
transgender youth, non-binary youth, gender-affirming care, puberty blockers, gender-affirming hormones, depression, anxiety, suicidality, self-harm, mental health outcomes, adolescents and young adults, gender identity, gender-affirming hormone therapy, puberty suppression, stigma and discrimination, social support
MeSH terms
Gender Dysphoria, Adolescent, Adult, Anxiety, Depression, Female, Humans, Male, Mental Health, Prospective Studies, Treatment Outcome, Young Adult, Sex Reassignment Procedures, Gender-Affirming Procedures, Suicidal Ideation, Transgender Persons

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