Suicide risk reduced by 73% in transgender and non-binary youth with gender-affirming care
Transgender and non-binary youth have particularly high rates of poor mental health outcomes compared to their cisgender counterparts. According to the investigators, these disparities are likely a consequence of social rejection, lack of parental support, bullying and discrimination.
Several sources of previously published research found that gender-affirming medical interventions were helpful in improving the quality of life of transgender and non-binary youth by decreasing rates of long-term adverse mental health effects.
However, despite the existing evidence, legislation criminalizing and subsequently limiting access to gender-affirming medical care for minors is on the rise across the country. A team of researchers, led by Diana Tordoff, MPH, Department of Epidemiology, University of Washington, examined mental health changes in young people after receiving such care.
The impact of gender-affirming care
Investigators said previous data showed that gender-affirming hormones (GAHs), puberty blockers (PB) and gender-affirming surgeries were independently found to be associated with a reduction in depression, anxiety and other adverse mental health effects.
Puberty blockers given during puberty may actually reduce the risk of suicide in this population. A decrease in the lifetime incidence of suicidal ideation has also been found in adults who had access to puberty blockers during adolescence.
Investigators wanted to better understand the effect of gender-affirming care on mental health immediately after care begins.
“Given the high risk of suicide among [transgender and nonbinary] adolescents, there is an urgent need to better characterize mental health trends for TNB youth at the start of gender-affirming care,” the investigators wrote.
Understanding transgender and non-binary youth
A prospective observational cohort study was performed to examine transgender and non-binary youth who sought care at the Seattle Children’s Gender Clinic, an urban multidisciplinary gender clinic. Investigators assessed changes in mental health during the first year of receiving puberty blockers and/or gender-affirming hormones to see if they impacted depression, anxiety and /or suicidality.
Primary outcomes were measured using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up.
Of the 104 young people (13-20 years old) who participated, 63 were transmasculine individuals (60.6%), 27 transfeminine individuals (26%), 10 non-binary or gender fluid individuals (9.6%), and 4 individuals who did not know or did not answer the question on gender identity (3.8%).
At baseline, more than half of the people (56.7%) suffered from moderate to severe depression and exactly half suffered from moderate to severe anxiety. Self-harm or suicidal thoughts were reported by 45 people (43.3%).
Anti-transgender legislation can have negative consequences for these young people
At the end of the 12-month follow-up study, 69 people (66.3%) had received PBs, HAGs, or both. 35 youth had received none of the interventions (33.7%). Although no association was found between these interventions and anxiety (adjusted odds ratio, 1.01; 95% CI, 0.41, 2.51), the researchers found promising results.
With adjustment for time trends and potential co-founders, individuals were 60% less likely to experience depression (aOR, 0.40; 95% CI, 0.17-0.95) and 73% less likely to be suicidal (aOR, 0.27; 95% CI, 0.11-0.65) compared to youth who did not receive gender affirmation interventions.
In the conclusion, the investigators focused on the need to address anti-transgender legislation and the additional need for medical systems and insurance providers to reduce barriers and expand access to gender-affirming care. .
“The associations most [adjusted odds ratio] were with decreased suicidality, which is important given the mental health disparities experienced by this population, particularly high levels of self-harm and suicide,” the investigators wrote. “Our findings have important policy implications, suggesting that the recent wave of legislation restricting access to gender-affirming care may have significant negative effects on the well-being of [transgender and nonbinary] youth.”