Receipt of gender-affirming care reduces depression, suicidality in transgender, non-binary youth

Receipt of gender-affirming care led to a reduced risk of depression and suicidality among transgender and non-binary (TNB) youth, according to a prospective study presented at the American Academy of Pediatrics 2021 National Conference & Exhibition (AAP 2021).

“Our data supports what we see clinically, an amazing transformation in these young people and includes better mental health,” remarked co-senior author Professor David Inwards-Breland from the Rady Children’s Hospital-San Diego and University of California San Diego School of Medicine, San Diego, California, US.

“Given this population’s high rates of adverse mental health outcomes, including suicidality, this data provides critical evidence that expansion of access to gender-affirming care will save lives,” said the authors.

Participants were 104 TNB individuals aged 13–21 years who completed a phone intake and in-person appointment between August 2017 and June 2018 at the Seattle Children’s Gender Clinic, a multidisciplinary gender clinic in Seattle, Washington, US, which serves a five-state area. Depression, anxiety, and suicidality were measured at baseline, and with follow-up surveys at 3, 6, and 12 months using the Patient Health Questionnaire 9-item scale (PHQ-9) for depression, Generalized Anxiety Disorder 7-item scale (GAD-7) for generalized anxiety, and a binary outcome measure from the suicidality measure on the PHQ-9 for suicidality.

Of the cohort, 60.6 percent (n=63) identified as transgender male or male, 26.0 percent (n=27) as transgender female or female, and 9.6 percent (n=10) as non-binary, while 3.8 percent (n=4) did not respond or responded with “I don’t know”.

Rates of depression, anxiety, and suicidality were high at baseline, with 56.7 percent having moderate to severe depression (PHQ-9 score ≥10), 50.0 percent having moderate to severe anxiety (GAD-7 score ≥10), and 43.3 percent having thoughts of suicide or self-harm in the 2 weeks before baseline.

There was a 60 percent reduced risk of depression following receipt of pubertal blockers or gender-affirming hormones (adjusted hazard ratio [adjHR], 0.40, 95 percent confidence interval [CI], 0.17–0.95). [AAP 2021, Section on LGBT Health and Wellness Program]

The risk of suicidality reduced by 73 percent after receipt of pubertal blockers or gender-affirming hormones (adjHR, 0.27, 95 percent CI, 0.11–0.65).

Anxiety levels did not change at the various assessment points.

“TNB youth are disproportionately burdened by mental health outcomes including increased rates of depression, anxiety, [and] suicidal ideation [or] attempts,” said the authors.

While the long-term benefits to mental health following gender-affirming care in this population have been observed, the short-term outcomes have been less apparent, they continued.

“Our study adds to a robust evidence-base that access to puberty blockers and hormones is critical for ensuring the well-being of TNB young people,” stated co-author Diana Tordoff, a PhD candidate at the University of Washington Department of Epidemiology, Seattle, Washington, US.

The authors also focused on the importance of early access to medical transition. “Gender-affirming care … is associated with a reduced lifetime incidence of suicidal ideation in TNB adults who started medical transition during adolescence. Conversely, TNB youth who present to medical care later in adolescence tend to have more adverse mental health outcomes compared with those who access earlier,” they noted.

According to co-senior author Associate Professor Kym Ahrens from the Seattle Children’s Hospital, University of Washington School of Medicine, not all TNB youth are able to access multidisciplinary clinics.

“[In addition,] access to gender-affirming medical care is in jeopardy with the rise in anti-transgender legislation and threatens the youth’s mental health and the providers who serve them,” noted Inwards-Breland.

“Next, we need to understand how to better serve youth who are not able to make it into a clinical environment,” said Ahrens.