REVIEW OF: Turban et al, PLoS ONE 2022;17(1):e0261039

STUDY TYPE: Secondary analysis of data from a cross-sectional nonprobability study

Approximately 2% of adolescents in the US identify as transgender. Social stigma and mistreatment negatively impact their mental health, and they are at high risk for depression and suicidality. While many transgender adolescents seek hormonal treatment to bring their bodies in line with their gender identities, several state legislatures have banned gender-affirming hormones (GAH) for youths (for a list of states that have restricted gender-­affirming care for transgender youth as of September 2023, see: www.tinyurl.com/mudwmtvy). 

Does the initiation of GAH in adolescence improve or worsen mental health outcomes in transgender youth? A recent study used data from the 2015 Transgender Survey—the largest-ever survey on transgender people in the US (n=21,715)—to answer this important question. The study compared mental health outcomes among individuals who initiated GAH with those of individuals who desired but never accessed GAH. 

Notably, 78% of respondents reported wanting GAH, but only 0.6% and 1.7% reported having access to GAH in early (ages 14–15) and late (ages 16–17) adolescence, respectively. In contrast, 57% of respondents accessed GAH in adulthood. 

After adjustments for potential confounders (including age, race, gender assigned at birth, sexual orientation, employment status, and previous pubertal suppression treatment), access to GAH during early or late adolescence was associated with significantly lower likelihood of past-month severe psychological distress (p<0.0001) or suicidal ideation (p=0.0007) compared with access to GAH in adulthood. Also, access to GAH in adolescence or adulthood was associated with significantly lower risk of suicidal ideation (p<0.001) compared to those who wanted but never accessed GAH.

CARLAT TAKE

Access to GAH in adolescence or adulthood is associated with improved mental health outcomes among transgender individuals, including lower rates of severe psychological distress and suicidal ideation. The results of this study support the Endocrine Society’s recommendation that transgender adolescents have access to GAH.