Hormone Therapy Linked to Positive Changes in Appearance Congruence, Mental Health for Transgender and Nonbinary Youth

The largest study of its kind ever conducted in the United States is emphasizing the impact of gender-affirming hormone therapy on the psychosocial function and mental health of transgender and nonbinary youth.

A multicenter study of over 300 transgender and nonbinary youth funded by the National Institutes of Health (NIH), study results indicate that gender-affirming hormone therapy was associated with increases in appearance congruence, positive affect, and of life satisfaction, with further analysis indicating associations between increased appearance congruence and improvements in life satisfaction, as well as symptoms of depression and anxiety.

“Our findings provide a strong scientific basis that gender-affirming care is crucial to the psychological well-being of our patients,” said lead investigator Robert Garofalo, MD, MPH, co-director of Lurie Children’s Gender and Sex Development Program and professor of Pediatrics at Northwestern University Feinberg School of Medicine, in a statement, “We must ensure that access to these treatments remains available to young people with gender dysphoria.”

Called the Trans Youth Care-United States (TYCUS) Study, this study was designed as a prospective observational study with the intent to evaluate the physical and psychosocial outcomes associated with gender-affirming hormone therapy in transgender and binary youth in the United States . Participants included in the study ranged in age from 12 to 20 years old and were recruited from gender clinics at Ann and Robert H. Lurie Children’s Hospital Chicago, UCSF Benioff Children’s Hospitals, Boston Children’s Hospital, and Children’s Hospital Los Angeles from July 2016 to June 2019 .

According to the study protocol, study visits occurred at baseline and again at 6, 12, 18, and 24 months after initiation of treatment. During these visits, participants completed the Transgender Congruence Scale, the Beck Depression Inventory–II, the Revised Children’s Manifest Anxiety Scale, and the NIH Toolbox Emotion Battery’s Positive Affect and Life Satisfaction measures. The investigators noted that 2 distinct cohorts were created as part of TYCUS, one cohort evaluating the effects of gender-affirming hormone therapy and another evaluating the effects of gonadotropin-releasing hormone agonist therapy. The current study reported only the effects of gender-affirming hormone therapy.

For the purposes of the analysis, latent growth curve modeling was used to estimate trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a 2-year period. The investigators noted that further analyzes were planned to investigate how baseline levels and rates of change in appearance congruence related to each psychosocial outcome of interest.

A total of 315 participants with up to 5 follow-up visits were identified for inclusion in the study. From this cohort, a total of 6114 observations were recorded during the study period. This cohort had a mean age of 16 ± 1.9 years, 60.3% were transmasculine, 64.8% were designated female at birth, and 58.7% were non-Latino or non-Latino white. The investigators noted that 2 participants died by suicide during the study and 6 withdrew before completion, but data that had been collected prior to death or study withdrawal were included in the analyses.

During the follow-up period, scores for appearance congruence increased (annual increase on a 5-point scale, 0.48 point [95% CI, 0.42 to 0.54]; standardized β = 1.47) as well as T-scores for positive affect (annual increase on a 100-point scale, 0.80 point [95% CI, 0.08 to 1.54]; β=.19) and life satisfaction (annual increase on a 100-point scale, 2.32 points [95% CI, 1.64 to 3.00]; β=.52). In addition, the researchers observed reduced scores for depression (yearly change on a 63-point scale, -1.27 points; 95% CI, -1.98 to -0.57; standardized β=−.29) and T-scores for anxiety (yearly change on a 100-point scale, -1.46 points [95% CI, -2.13 to -0.79]; β=-.35).

Further analyzes demonstrated that increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction, and concurrent decreases in symptoms of depression and anxiety. During the study period, the most common adverse event was suicidal ideation, reported in 11 (3.5%) individuals.

“Our findings provide robust scientific evidence that improved appearance congruence secondary to hormonal treatment is strongly linked to improved mental health outcomes in transgender and nonbinary youth,” said study researcher Diane Chen, PhD, a pediatric psychologist. with the gender and sex development program at Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor at Northwestern University Feinberg School of Medicine, in the aforementioned statement. “This is critical, given that transgender youth experience more depression and anxiety and are at greater risk of suicide than cisgender youth.”

This study, “Psychosocial Functioning in Transgender Youth After 2 Years of Hormones,” was published in New England Journal of Medicine.

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