For transgender people, initiating gender-based hormone therapy in adolescence is associated with better mental health than waiting until adulthood, according to a new study from Stanford University School of Medicine.
The study, which appeared online on January 12 in PLOS ONE, is based on data from the largest study of transgender adults in the United States, a group of more than 27,000 people who responded in 2015. The new study found that transgender people those who started hormone therapy in adolescence had fewer suicidal thoughts, were less likely to experience serious mental disorders, and had fewer substance abuse problems than those who began taking hormones in adulthood. age. The study also documented better mental health among those who received hormones at any age than those who wanted but never received treatment.
Gender-strengthening hormonal treatment with estrogen or testosterone can help bring a transgender person’s physical characteristics in line with their gender identity. In adolescence, hormone therapy can allow a transgender teenager to go through puberty in a way that matches their gender identity.
This study is particularly relevant now because many state legislatures are introducing bills that would ban this type of care for transgender youth. We are adding to the evidence base that shows why gender-based care is beneficial from a mental health perspective. “
Jack Turban, MD, Postdoctoral Fellow in Pediatric and Adolescent Psychiatry at Stanford Medicine
Tarban is the lead author of the study. The senior author is Dr. Alex Keuroglian, associate professor of psychiatry at Harvard Medical School and director of the National LGBTQIA + Health Center at the Fenway Institute.
The largest study of transgender adults
Researchers analyzed data from the 2015 Transsexual Survey in the United States, which included responses to a survey of 27,715 transgender people across the country. Participants who were at least 18 when surveyed filled out extensive questionnaires about their lives.
Because some transgender people do not want hormone treatment, the study focused on 21,598 participants who reported wanting to receive hormones. The results were analyzed based on when participants started hormone therapy: 119 started at 14 or 15 years of age (early adolescence), 362 started at 16 or 17 years of age (late adolescence), 12,257 started after 18 years of age. her birthday (adulthood) and 8,860 participants who served as a control group wanted, but never received hormone therapy.
Participants answered several questions about their mental health, including their history of suicidal thoughts and suicide attempts, as well as their history of drinking and using illicit drugs. They filled out a questionnaire to assess whether they had experienced severe psychological stress, which means that they met the criteria for a diagnosed mental illness in the previous month.
The analysis was monitored for several factors that could affect the mental health of the participants, regardless of whether they were receiving hormonal treatment: age at the time of the study; gender identity; sex determined at birth; sexual orientation; race or ethnicity; level of family support for gender identity; Marital status; level of education; Employment status; household income; use of treatment to suppress puberty; any attempt to force them to be gendered; and experiences of verbal, physical or sexual harassment based on their gender identity in classes K-12.
Compared with the members of the control group, the participants who underwent hormonal treatment had a lower chance of experiencing severe psychological stress in the previous month and a lower chance of suicidal thoughts in the previous year. The chances of severe psychological distress are reduced by 222%, 153% and 81% for those who started hormones in early adolescence, late adolescence and adulthood, respectively. The chances of suicidal thoughts from the previous year were 135% lower in people who started taking hormones in early adolescence, 62% lower in those who started in late adolescence and 21% lower in those who started as adults compared with the control group.
In addition, participants who started taking hormones in early or late adolescence had a lower chance of drinking in the last month and using illicit drugs for life than those who started taking hormones in adulthood.
But researchers have found that those who start hormone therapy in adulthood are more likely to engage in excessive drinking and illegal use than those who have never received treatment. “Some people may become more confident and socially engaged when they start taking hormones,” Tarban said, adding that in some cases this increased trust and social commitment may be linked to substance use. “This finding speaks to the importance of creating culturally appropriate counseling programs for the use of substances for transgender people.
To find out if participants’ mental health before treatment affected their ability to access treatment, the researchers also assessed whether participants in each group had ever been suicidal but had not had suicidal feelings in the previous year.
“It was a measure to improve mental health over time,” Tarban said. “People are more likely to meet these criteria if they have access to and receive hormones than if they have not. The finding suggests that access to hormones improves mental health, not the other way around, he said.
Building evidence of gender-based medical care
Tarban and his colleagues hope lawmakers across the country will use the new findings to inform their political decisions. Although several bills banning gender-based medical care for transgender youth have been introduced in state legislatures in recent years, almost all have failed to become law, he said, adding that all major medical organizations support the provision of gender-based care. incl. hormone therapy for patients who wish to do so and who meet the criteria set by the Endocrine Society and the World Professional Association for Transsexual Health.
“There is no one right way to be transsexual,” Tarban said. Some transgender people do not want to take hormones and feel comfortable with their bodies as they are. Young people seeking care in sex clinics are routinely offered counseling as part of treatment to help them understand what types of care are best suited to their circumstances.
For those who want sex-promoting hormones, refusing treatment can cause significant stress, Tarban said.
“For some transgender young people, their negative reactions to life in bodies that develop during puberty in ways that do not correspond to what they know can be very harmful,” he said. For example, people who feel uncomfortable with developing breasts may react by tying their breasts so tightly that they develop skin infections or rib fractures.
“These results will not come as a surprise to providers, but unfortunately many lawmakers have never met transgender young people,” Tarban said. “It is important for legislators to see the numbers that support the experience of transgender young people, their families and the people who work in this field.