TRan and nonbinary adolescents receiving gender-affirming hormones experience less depression and anxiety and more life satisfaction than before treatment, according to a new study published Wednesday in the New England Journal of Medicine.
The researchers followed more than 300 adolescents in the United States for two years after starting hormone treatment. The findings expand a substantial body of research showing that gender-affirming care improves mental health, but most previous studies were conducted with smaller cohorts, single location, and longer follow-up windows. short. The new paper also focuses primarily on hormone therapy, whereas previous work often included a variety of treatment options, including drugs to delay the onset of puberty.
“It’s nice to have a structured analysis that supports what I and others experience in practice,” said Carl Streed Jr., a physician and research lead at Boston Medical Center’s Center for Transgender Medicine and Surgery, who was not involved in the new study. “This is another great contribution to asserting that gender-affirming care is actually evidence-based and has benefits and should be the standard of practice at this point.”
Despite mounting evidence, lawmakers in many states continue to attempt to limit or ban gender-affirming care, particularly for adolescents. Prior to 2020, no state had attempted these bans. But in 2021, such bills were introduced in nearly two dozen state legislatures. Four states — Alabama, Arkansas, Arizona and Tennessee — have since enacted bans, according to the Movement Advancement Project, a nonprofit think tank, though in Alabama and Arkansas, those bans have been temporarily blocked by state judges. Other measures, however, such as Florida’s “Don’t Say Gay” bill, which prohibits teachers from discussing sexuality or gender identity in school, can still leave many queer teens feeling insecure and unable to discuss their needs. medical.
Experts say attempts to ban gender-affirming care for adolescents misunderstand the nature of this care. The NEJM study, led by researchers at the Stanley Manne Children’s Research Institute at Lurie Children’s Hospital in Chicago, found that nearly 70 percent of participants who began the study with severe depression saw it reduced to a minimal or moderate level after two years of hormone therapy. On average, participants started the study with mild depression and ended with subclinical levels. Nearly 40% of participants who entered the trial with clinical anxiety saw it reduced to the nonclinical range after two years.
Hormone therapy radically alters one’s appearance. Among other changes, testosterone can increase body hair growth, deepen a person’s voice, and increase muscle mass; estrogen can slow the growth of body hair, increase breast growth while reducing muscle mass, and more.
The researchers met with the participants, aged 12 to 20, every six months to assess their psychosocial functioning. They found that as appearance congruence increased, meaning that as participants became more comfortable with their changing physical appearance, depression and anxiety decreased, while positive moods and life satisfaction.
Unlike previous research, the new study focuses primarily on the effects of gender-affirming hormones: Each participant received either testosterone or estradiol treatment, and the vast majority went through puberty and never received the separate treatment known as gender-affirming hormone. or puberty blockers. The researchers found that those who had not yet gone through puberty (due to their young age or because they were part of the small portion of participants who received puberty blockers) saw even higher levels of appearance congruence, positive affect, and life satisfaction, and lower scores for depression and anxiety. Researchers believe this is likely because, even with hormone therapy, the effects of puberty cannot be easily reversed, making it more difficult to achieve appearance congruence.
This reflects previous evidence, the researchers note, that the sooner children can access gender-affirming care, the better.
“The adults that I see, every single one of them is like, ‘Dude, I wish I could access this sooner,'” said Streed, who works primarily with adults in her role at BMC’s clinic. “There’s no one who says, ‘Boy, I’m glad I waited this far in my life.'”
Streed sees patients as young as teenagers transitioning from pediatric to adult care. But, she said, “you have to live to see me as an adult.” Trans and non-binary youth die by suicide at higher rates than their cisgender counterparts. In the present study, two participants died by suicide. Streed said that while every suicide is utterly tragic, he would have been surprised if there were none in the study given those higher rates.
“Transgender people disproportionately experience symptoms of poor mental health, largely as a result of living in a transphobic society,” wrote Diana Tordoff, a Stanford researcher who has done similar research on gender-affirmative care. and on mental health, in an email to STAT.
Study participants designated female at birth benefited from hormones more than those designated male at birth with regards to depression, anxiety, and life satisfaction. The authors theorize that this may be related to differences in how society accepts transfeminine and transmasculine people.
“We’re really happy and it’s really important,” said Annelou de Vries, a researcher at Amsterdam University Medical Center who co-authored a commentary on the study with colleague Sabine Hannema, also published Wednesday in NEJM. “Then comes the nuance. There are a few questions left to be answered, and some of them, this study won’t address.
The amount of research focusing on gender-affirming care has increased in recent years, in part due to increased prioritization by the National Institutes of Health. In 2016, the organization formally recognized “sexual and gender minorities” as a “population with health disparities” for research. Experts hope the increased attention will lead to more studies following trans and non-binary people long-term, in order to learn more about the potential long-term benefits and effects of treatment.
The study authors, who were unavailable for interviews, plan to continue following the same cohort to document long-term results. They’re also working on a similar study looking specifically at the effects of puberty blockers.
“Access to gender-affirming care is fundamentally a human rights issue,” Tordoff wrote. “Trans people and their families deserve high-quality science and research with which to make personal medical decisions and inform evidence-based clinical guidelines — not only for access to gender-affirming care, but also for preventive care, screening and treatment for a wide range of health problems that impact all people.”