Hormone therapy associated with positive changes in appearance, mental health for transgender and nonbinary youth

The largest study of its kind ever conducted in the US highlights the impact of gender-affirming hormone therapy on the psychosocial functioning and mental health of transgender and non-binary youth.

A multicenter study of more than 300 transgender and nonbinary youth funded by the National Institutes of Health (NIH), study results show that undergoing gender-affirming hormone therapy is associated with increases in appearance congruence, positive affect, and satisfaction with life, with further analysis pointing to associations between increased appearance congruence and improvements in life satisfaction as well as depression and anxiety symptoms.

“Our results provide a solid scientific basis that gender-affirming care is critical to the psychological well-being of our patients,” said lead researcher Robert Garofalo, MD, MPH, co-director of the Child Gender and Gender Development Program at Lurie and professor of pediatrics at Northwestern University Feinberg School of Medicine in a statement: “We must ensure that access to this care remains affordable for youth with gender dysphoria.”

Called the Trans Youth Care–United States (TYCUS) Study, the current study was designed as a prospective, observational study with the intent to assess the physical and psychosocial outcomes associated with undergoing gender-affirming hormone therapy among trans and binary youth in the United States. Study participants were 12-20 years old and were recruited from gender clinics at Ann and Robert H. Lurie Children’s Hospital of Chicago, UCSF Benioff Children’s Hospital, Children’s Hospital Boston, and Children’s Hospital Los Angeles from July 2016 to June 2019.

According to the study protocol, study visits were performed at baseline and again at 6, 12, 18, and 24 months after initiation of treatment. During these visits, participants completed the Transgender Congruence Scale, the Beck Depression Inventory–II, the Child Manifest Anxiety Scale-Revised, and measures of positive affect and life satisfaction from the NIH Toolbox Emotion Battery. The researchers noted that 2 different cohorts were created as part of TYCUS, a cohort evaluating the effects of sex-affirming hormone therapy and another evaluating the effects of gonadotropin-releasing hormone agonist therapy. The present study reports only the effects of sex-affirming hormone therapy.

For analysis purposes, latent growth curve modeling was used to assess the trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a 2-year period. The researchers noted that additional analyzes are planned to examine how baseline levels and rates of change in appearance correlate with each psychosocial outcome of interest.

A total of 315 participants with up to 5 follow-up visits were identified for inclusion in the study. A total of 6114 observations were recorded from this cohort during the study period. This cohort had a mean age of 16±1.9 years, 60.3% were transmasculine, 64.8% were identified as female at birth, and 58.7% were non-Latino or non-Latino white. The researchers indicated that 2 participants died by suicide during the study and 6 withdrew before completion, but data that were collected before death or study withdrawal were included in the analyses.

During the follow-up period, appearance conformity scores increased (yearly increase on a 5-point scale, 0.48 points [95% CI, 0.42 to 0.54]; standardized β=1.47), as well as T scores for positive affect (annual increase on a 100-point scale, 0.80 points [95% CI, 0.08 to 1.54]; β=.19) and life satisfaction (annual increase on a 100-point scale, 2.32 points [95% CI, 1.64 to 3.00]; β=.52). In addition, the researchers observed decreased scores for depression (63-point annual change, −1.27 points; 95% CI, −1.98 to −0.57; standardized β=−.29) and T scores for anxiety (annual change on a 100-point scale, -1.46 points [95% CI, -2.13 to -0.79]; β=-.35).

Further analysis showed that increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and concurrent decreases in depression and anxiety symptoms. During the study period, the most common adverse reaction was suicidal ideation, which was reported in 11 (3.5%) subjects.

“Our results provide strong scientific evidence that improved appearance congruence following hormone treatment is strongly associated with better mental health outcomes in transgender and nonbinary youth,” said researcher Diane Chen, Ph.D., a pediatric psychologist in the Program for sex and gender development at Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor at Northwestern University Feinberg School of Medicine, in the aforementioned statement. “This is critical given that transgender youth experience more depression and anxiety and are at higher risk for suicidality than cisgender youth.”

This study, “Psychosocial functioning in transgender youth after 2 years of hormones,” was published in New England Journal of Medicine.

This article was published by our sister publication HCP Live.

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