Early access to gender-affirming hormones linked to better mental health, study finds

By Jo Yurcaba

Access to gender-affirming hormone therapy in adolescence is associated with better mental health outcomes for transgender adults, according to a new study.

The research, published Wednesday in the peer-reviewed journal PLOS One, was based on data from the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, which surveyed more than 27,000 trans people across the country. It compared the psychological distress and suicidal thoughts experienced by 12,738 trans adults who had access to gender-affirming hormones during early adolescence, late adolescence or adulthood to the distress and suicidal thoughts experienced by 8,860 trans adults who desired hormones but never had access to them.

The odds of negative mental health outcomes decreased significantly among trans people who had access to gender-affirming hormones from ages 14 to 17. Access to gender-affirming hormones during this period was associated with one-third the odds of severe psychological distress in the previous month and half the odds or less of suicidal ideation in the previous year when compared to trans people who wanted hormones but never had access to them, according to study co-author Dana King, a data programmer and analyst for the Fenway Institute at Fenway Health, a Boston-based LGBTQ health care and research organization.

And while those who had access to gender-affirming hormones as adults also had lower odds of past-month severe psychological distress and suicidal ideation, the difference wasn’t as stark, the report found.

The study’s senior author, Dr. Alex S. Keuroghlian, the director of the National LGBTQIA+ Health Education Center at the Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program, said the study’s results show the dangers of state legislation to ban gender-affirming medical care, including hormones, for trans minors.

“These results argue against waiting until adulthood to offer gender-affirming hormones to transgender adolescents and suggest that doing so may put patients at greater mental health risk,” Keuroghlian said in a news release. “They also add to the growing evidence base suggesting that legislation restricting transgender adolescents’ access to gender-affirming medical care would result in adverse mental health outcomes.”

More than 20 states considered bills last year that would have banned gender-affirming health care for transgender minors, according to the American Civil Liberties Union. Only Arkansas passed a law completely banning access to gender-affirming health care, including puberty blockers and hormones, for trans minors; a judge blocked the law from taking effect in July pending the outcome of litigation. Tennessee enacted a more limited law that bans doctors from providing gender-affirming hormone treatment and surgery to prepubescent minors.

A recent poll by the Trevor Project, an LGBTQ youth suicide prevention and crisis intervention group, found that just the public discussion affected trans and nonbinary youths’ mental health. Eighty-five percent of trans and nonbinary youths, and two-thirds of all LGBTQ youths, said recent debates about anti-trans state laws negatively affected their mental health.

At least seven states introduced anti-trans bills in the first week of the year, including some that would limit trans youths’ access to gender-affirming health care.

Supporters of the bills argue that such health care is “experimental” and that trans young people shouldn’t have access to it until they are adults.

However, in addition to the new study published in PLOS One, a growing body of evidence — also based on the 2015 U.S. Transgender Survey — has found that earlier access to gender-affirming care, such as puberty blockers, hormones and surgery, has positive mental health outcomes and that delaying access to such care can lead to negative outcomes, including an increased risk of suicidal thoughts.

Research published in JAMA Psychiatry in September 2019 found that exposure to “conversion therapy,” a discredited practice that seeks to change a trans person’s gender identity, is associated with suicidal thoughts and suicide attempts.