A new study reveals that hormone therapy improves mental health for transgender teens

Transgender teens reported more life satisfaction and fewer symptoms of depression and anxiety after two years of sex-affirming hormone therapy, according to a new study.

The study, published Wednesday in the New England Journal of Medicine, evaluated 315 transgender youth, ages 12 to 20, with an average age of 16, while they were on sex-affirming hormone therapy for two years.

The researchers are a group of doctors and professors associated with universities and children’s hospitals in Chicago, Boston, and Los Angeles. The work was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Researchers used scales measuring depression and anxiety, positive emotions and life satisfaction, and appearance congruence—meaning how much a trans person feels in line with their gender identity. Participants rated each of these factors numerically.

The researchers found that, on average, participants reported increases in positive emotions, life satisfaction, and appearance fit. These increases were associated with reductions in symptoms of depression and anxiety.

The findings, the researchers wrote, support the use of hormone therapy as an effective treatment for trans and nonbinary youth.

The researchers said their findings suggest that appearance compatibility is important for the well-being of trans and nonbinary youth. Differences in mental and physical health between young people who have experienced significant “gender-congruent” adolescence – puberty associated with their assigned sex at birth – and those who also do not support the importance of appearance for well-being.

Only a small subgroup (24 participants) in the study did not enter gender-incongruent comprehensive puberty, either because they started puberty blockers at an early stage of puberty or started on sex-affirmative hormones when puberty began later.

“Those who did not go through a significant gender-congruent adolescence had higher scores at baseline for appearance congruence, positive affectivity, and life satisfaction, and lower scores for depression and anxiety at baseline, than youth who had undergone significant intrinsic adolescence,” i.e., their associated adolescence researchers determined their assigned gender Wrote.

They also noted that depression and anxiety symptoms were significantly reduced and life satisfaction was significantly increased among trans and nonbinary youth who identified as female at birth, but not for those who identified as male at birth. They wrote that this difference can be attributed to several factors: First, some estrogen-related physical changes, such as breast enlargement, can take two to five years to reach “maximum effect.”

As a result, the researchers speculated that a longer follow-up period may be necessary for transgender youth to see an effect on their mental health.

Second, they wrote, physical changes from testosterone-induced puberty, such as a deeper voice, may be “more pronounced and observable” than those associated with estrogen-induced puberty.

Third, the researchers wrote that differences in anxiety and life satisfaction may be related to less social acceptance of transfeminine people compared to transmasculine people.

Research published in 2021 in the Journal of Adolescent Health suggested that transfeminine youth may experience minority stress more than transmasculine youth, which is the stress faced by stigmatized minority groups such as LGBTQ individuals.

The authors of the new study wrote that understanding the impact of gender-affirming hormones on the mental health and well-being of transgender and non-binary youth “will seem crucial given the documented mental health disparities observed in this population, particularly in context.” the growing politicization of gender-affirming medical care.”

In the past two years, state legislatures have considered dozens of bills that seek to restrict access to gender-affirming medical care, such as puberty blockers, hormone therapy, and surgery for minor transgender people.

Governors in four states — Arkansas, Alabama, Tennessee, and Arizona — have enacted restrictions on such due diligence, but the enactment of the measures in Arkansas and Alabama has been blocked by federal judges until a lawsuit is filed.

So far this year, lawmakers have passed such laws in at least 16 states.

Supporters of this law argue that care is experimental and that minors are too young to make decisions about medical care that could have irreversible effects.

However, medical societies such as the American Medical Association and the American Academy of Pediatrics, among others, oppose efforts to restrict gender-affirming care for minors.

These groups point to a growing body of research finding that caring for transgender youth with disproportionately high suicide rates has significant mental and physical health effects.

A national survey published last year by the Trevor Project, a national youth suicide prevention and crisis response organization, found that more than half (53%) of transgender and nonbinary youth had seriously considered suicide in the past year. About 1 in 5 (19%) reported having attempted suicide in the past year.

In addition to the New England Journal of Medicine study, nearly half a dozen studies have shown that access to puberty blockers and hormone therapy can improve mental health outcomes, including reducing suicidal ideation among transgender youth.

Three studies, two published in 2020 and the other in 2021, found that earlier access to gender-affirming medical care was associated with better mental health.

A 2021 study published in the Journal of Adolescent Health, based on data from the Trevor Project, found that gender-affirming hormone therapy was strongly linked to a lower risk of suicide and depression for transgender youth aged 13-24. .

The researchers behind the New England Journal of Medicine Study noted some limitations to their study. For example, they recruited participants from gender clinics at children’s hospitals in Chicago, Boston, and Los Angeles.

As a result, they said, the findings may not apply to teens who do not have access to gender-affirming comprehensive care, or to teens who are self-medicating with gender-affirming hormones.

They also noted that the improvement in mental health was very diverse, with some participants continuing to report high levels of depression and anxiety and low levels of positive emotions and life satisfaction.

Two participants died by suicide during the study, and six were withdrawn, according to the researchers. They added that the information collected before they died or left the study was included in the analyses.

The study did not examine other factors, such as parental support, that are known to affect psychosocial functioning among trans youth. The study also lacked a comparison group, which the researchers said limited their ability to establish causation. They plan to examine other factors and will continue to monitor the group to see if improvements are sustained over a longer period of time.

If you or someone you know is in crisis, call 988 to reach the Suicide & Crisis Lifeline. You can also call the network formerly known as the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741, or visit SpeakingOfSuicide.com/resources for additional resources.

This article was originally published on NBCNews.com.

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