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Gender-Affirming Care Associated With Positive Mental Health Outcomes in Adolescents
Access to gender-affirming medical interventions was associated with 60% lower odds of depression and 73% lower odds of self-harm or suicidal thoughts in transgender and nonbinary youths (TNB) over 1 year, according to an observational cohort study published in JAMA Network Open.
“This is one of the first studies to quantify a short-term transient increase in depressive symptoms experienced by TNB youths after initiating gender-affirming care, a phenomenon observed clinically by some of the authors and described in qualitative research,” Diana M. Tordoff, MPH, and co-authors wrote in the study.
Researchers aimed to investigate whether receiving gender-affirming care, including the initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs), was associated with changes in depression, anxiety, and suicidality.
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Study participants were youths seeking care at Seattle Children’s Gender Clinic, Washington, who completed the clinic’s phone intake and initial in-person appointment between August 2017 and June 2018.
To assess study variables, after their first in-person appointment, the 104 participants aged 13 to 20 years old completed baseline surveys within 24 hours. The Patient Health Questionnaire 9-item (PHQ-9) and the General Anxiety Disorder 7-item (GAD-7) scales measured mental health outcomes. Caregivers also took surveys to determine income.
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 participants (56.7%) had moderate to severe depression, 52 (50.0%) had moderate to severe anxiety, and 45 (43.3%) reported self-harm or suicidal thoughts. By the study's conclusion, 69 participants (66.3%) received PBs, GAHs, or both interventions, and 35 participants (33.7%) had not received either intervention.
Researchers found 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 youth participants who had initiated PBs or GAHs compared with participants who had not received those interventions. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51) found in the study data.
The study authors noted a few limitations, including but not limited to family support and access to care being associated with better mental health outcomes. Therefore, TNB youths who lack these resources “require particular emphasis in future research and advocacy.”
“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,” researchers concluded in the study.
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