Hormone therapies enhance the mental health of transgender youth

By Amy Norton, Healthday Reporter

(health day)

THURSDAY, Jan. 19, 2023 (HealthDay News) — As several US states move to restrict health care for transgender people, a new study shows that such care can significantly improve teens’ mental health.

The study published in New England Journal of Medicine, It followed transgender and non-binary teens who received “gender affirming” hormones – whether estrogen or testosterone – for two years.

During that time, researchers found that two-thirds of teens who struggled with moderate to severe depression showed significant improvement. Many also saw their anxiety symptoms diminish and reported gains in their life satisfaction.

Experts not involved in the study said it supports evidence of the benefits of gender affirming care — health care services for transgender and non-binary people.

Such care could include “puberty blockers” — medications that stop pubertal development — and sex-affirming hormones, which alter patients’ physical features to better align with their gender identity.

In the study, there was a direct correlation between adolescents’ mental health gains and the extent to which hormone therapy gave them the desired physical appearance.

It is known that, compared to their peers, transgender and non-binary teens are more likely to develop mental health problems, substance abuse, and suicide.

A survey conducted last year by the nonprofit Trevor Project found that between 12% and 22% of transgender and non-binary youth had attempted suicide in the past year. And a few – a third – felt accepted at home.

Based on a number of small studies, it appears that gender confirmation care often helps.

“Gender-positive care is safe, effective, and lifesaving,” said Dr. Michele Forcier, a professor of pediatrics at Brown University. “The medications used can lead to more positive mental and physical health outcomes for the vast majority of people who get this care.”

The new study — larger and longer-term than previous studies — reinforces that, according to Forcier.

The findings are based on 315 transgender or non-binary patients, ages 12 to 20, who received gender-affirming care at one of four academic medical centers in the United States. Some were prescribed puberty blockers during early puberty, and they all started with sex-affirming hormones: either estrogen to encourage female traits such as breast development and reduce muscle mass and body hair; or testosterone to promote traits such as increased muscle tone, a deep voice, and facial hair.

The researchers, led by Diane Chen, MD, of Lurie Children’s Hospital in Chicago, tracked the patients for two years.

They found that, on average, study participants experienced an improvement in symptoms of depression and anxiety and an increase in life satisfaction.

Of the 27 severely depressed subjects before hormone therapy, 67% had improved to the “minor or moderate” depression range two years later. Meanwhile, of the 47 young adults with an anxiety disorder, 39% no longer had this diagnosis after two years.

Dr. Gina Sequeira, co-director of the Seattle Child Sexuality Clinic, said the study was rigorously conducted and supports the benefits of early access to gender confirmation care.

She also pointed out some common myths about this care.

One is that gender affirming nurturing is a kind of fringe experience. It’s actually recommended by major medical organizations, Sequera stressed, including the American Academy of Pediatrics.

Furthermore, she said, no medications are administered before a child begins puberty, and when a patient is under the age of 18, parental consent is required for any medication.

These findings come at a time when gender affirmation care is under threat in many US states. Lawmakers are considering bills that would prevent minors — even young adults in some cases — from receiving such care.

“Legislators are interfering with parents’ right to make decisions that are in the best interest of their children,” Sequeira said.

Forcier agreed, saying, “Children should not be pawns in the hands of politicians.”

“The decision to initiate and become involved in gender positive care must be personal and private – between the child and the caregivers and health care providers involved,” she added.

However, hormones alone are not a panacea. In this study, depression and anxiety persisted in some children, and two died by suicide over the two years of follow-up.

In addition, mental health benefits have been seen mainly among young transgender men (those who were identified at birth and who identified as male).

One reason, the doctors said, could be because it takes several years for estrogen to trigger changes in physical traits, such as breast development. Additionally, estrogen does not erase the masculine traits that come with increasing testosterone at puberty.

But there’s also a social factor, Forcier pointed out: Transgender people may face more discrimination, and have less support, than transgender people.

Both doctors said this points to something larger: Like all children, transgender and non-binary teens need supportive adults and peers in their lives in order to thrive.

Forcier stressed the importance of community messaging as well. She said the messages behind the current legislation are “extremely scary, even terrifying” for children and families seeking gender-affirming care.

SOURCES: Michelle Forcier, MD, MPH, Professor, Pediatrics, Brown University Warren Alpert Medical School, Providence, RI; Gina Sequeira, MD, MS, co-director, Seattle Children’s Gender Clinic, Seattle; New England Journal of Medicine, January 19, 2023

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