Psychiatric comorbidities frequent among transgender teens

There is a high incidence of psychiatric comorbidities among gender nonconforming teenagers, with about two-thirds and one-third experiencing depression and anxiety, respectively, according to a study presented at ENDO 2020.

“The prevalence of psychiatric comorbidities, suicidal ideation, and self-injuring behaviour is high among gender nonconforming youth, but in this population, significantly worse among affirmed males,” said the researchers led by Dr Veronica Figueredo from the Nicklaus Children’s Hospital in Miami, Florida, US.

This retrospective, single-centre study was conducted at a paediatric endocrinology practice in Miami. The researchers examined data of 158 transgender teenagers who attended the clinic between 2014 and 2019. Majority of the study population were affirmed males (female to male; 67.7 percent), 29.7 percent were affirmed females (male to female), and 2.5 percent identified as non-binary.

Onset of gender dysphoria symptoms began earlier in affirmed females compared with affirmed males (median 7.21 vs 9.65 years) as did initial social affirmation (median 12.36 vs 13.50 years). Among affirmed males, 38 percent identified as straight, 47 percent were bisexual, 12 percent were homosexual, and 1 percent identified as asexual, whereas among affirmed females, 54.3, 37.1, and 8.6 percent identified as straight, bisexual, and homosexual, respectively.

There was a high prevalence of psychiatric comorbidities in this population (78.5 percent). [ENDO 2020, abstract SUN-062]

About two-thirds of the population experienced depression (66.5 percent), followed by about one-third who experienced anxiety (33.5 percent). Attention deficit hyperactivity disorder affected 10.1 percent, bipolar disorder affected 1.9 percent, bulimia affected 1.3 percent, and 0.6 percent each experienced anorexia nervosa and post-traumatic stress disorder.

Psychiatric comorbidities were more common in affirmed males compared with affirmed females (84.1 percent vs 66 percent). Affirmed males were also more likely than affirmed females to have a history of suicidal ideation (70.1 percent vs 49 percent) and self-injury or cutting (56.1 percent vs 25.5 percent).

Affirmed males and affirmed females initiated hormonal treatment at approximately the same age (mean 15.75 and 15.58 years, respectively). Level of gender dysphoria, ranging from 0 (no dysphoria) to 10 (highest possible dysphoria) reduced following the initiation of hormone treatment, from 8.08 to 3.99 among affirmed males and from 7.87 to 2.96 among affirmed females.

“An increasing number of transgender youths are seeking therapeutic options to change their bodies and match their gender identity,” said Figueredo. “Both [affirmed females and affirmed males] had significant improvement in the degree of dysphoria after beginning hormonal treatment,” said Figueredo and colleagues.

Previous research has shown a higher degree of mental health conditions among transgender and/or gender nonconforming youth compared with their cisgender peers. [Pediatrics 2018;141:e20173845; JAMA Netw Open 2019;2:e1911058; BMC Public Health 2020;20:138]

“[Nonetheless,] there is limited scientific literature regarding gender nonconforming youth in paediatric practice,” noted Figueredo and colleagues.