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• Posted February 28, 2022

Medical Treatments for Trans Youth Cut Rates of Depression, Suicidal Thoughts

Although Texas Gov. Greg Abbott has deemed it "child abuse," access to "gender-affirming" services cuts the odds of severe depression and maybe even suicide among transgender teens, a new study finds.

Investigators came to that conclusion after tracking the mental health of 104 transgender and nonbinary kids, aged 13 to 20. Over a year, roughly two-thirds received puberty blockers, gender-affirming hormone treatment or both; the remainder had no treatment.

Those who got treatment experienced a 60% drop in depression risk and a 73% drop in suicidal thoughts, on average, researchers found.

"Our study builds on what we have already seen from an already staggering amount of scientific research," explained study lead author Diana Tordoff. "Access to gender-affirming care saves trans youth's lives."

The finding flies in the face of a push by Abbott to criminalize medical care for transgender teens in Texas. Last week, Abbott sent a new policy position letter to the Texas Department of Family and Protective Services, noting that failure to report such treatment could result in criminal penalties.

The term gender-affirming treatment "describes care provided by health care professionals who are affirming of transgender people's gender and are trained to provide competent and inclusive health care services," explained Tordoff, a doctoral candidate in the department of epidemiology at the University of Washington.

Alongside hormones and puberty blockers, such care can also include menstrual suppression and/or surgery, she noted.

About 150,000 American teens and 1.4 million adults currently identify as transgender, according to data cited by the American Medical Association and GLMA (Health Professionals Advancing LGBTQ Equality).

The study participants were patients at the Seattle Children's Gender Clinic. About 60% were transgender males (assigned female at birth); about a quarter were transgender female (assigned male at birth); and 10% were binary, or gender-fluid. Nearly two-thirds were white.

At the study's launch between 2017 and 2018, close to 60% of the participants said they were struggling with depression. About half reported feeling anxious, and more than four in 10 said they had contemplated harming themselves or taking their own life.

Prior to the investigation, only seven had been treated with either puberty blockers or hormones. But by the end of the year-long study period, 66% ended up receiving one or both.

The majority of participants completed mental health surveys three months, six months and one year following study enrollment.

In teens who did not undergo hormone or puberty blocking treatment, the risks for depression and suicidal thoughts were found to have doubled or even tripled at the three-month and six-month marks, Tordoff and her colleagues reported in the Feb. 25 issue of JAMA Network Open.

By contrast, those who had received treatment reaped a significant mental health dividend. While no impact was seen on anxiety levels, kids treated with hormones and/or puberty blockers saw dramatic drops in both depression and suicide risk.

"The results of this new study are in line with several past studies that have linked gender-affirming medical care to improved mental health outcomes for transgender youth," noted Dr. Jack Turban. He is chief fellow of child and adolescent psychiatry at the Stanford University School of Medicine and co-author of an accompanying editorial.

"This study once again reaffirms that efforts to ban gender-affirming care for transgender and gender diverse youth are dangerous and will lead to adverse mental health outcomes," Turban added.

Yet such efforts continue apace. Last year, bills to criminalize gender-affirmation care were introduced in 21 states, although such treatment is widely endorsed as safe and effective by the American Medical Association, GLMA and the Endocrine Society, among others.

The Endocrine Society condemned Abbott's position, saying "medical evidence, not politics, should inform treatment decisions."

"Being forced to experience puberty consistent with the sex recorded at birth is extremely distressing for many transgender and gender-diverse individuals," the society said in a statement last week.

"When an individual's gender identity is not respected and they cannot access medical care, it can result in higher psychological problem scores and can raise the person's risk of committing suicide or other acts of self-harm," the statement continued.

Tordoff agreed. Efforts like the one in Texas, she said, "will have profound immediate and long-term negative impacts on the well-being of trans youth and their families, both by increasing stigma and discrimination experienced by these youth, and denying them access to critical, lifesaving, evidence-based health care."

She also pointed out that insurance denials for gender-affirming care coverage "are still very common," even though "federal and state law prohibits most public and private health plans from transgender-based discrimination."

"This creates significant barriers to accessing gender-affirming care, both for trans youth and adults," Tordoff stressed.

More information

There's more on gender affirmation treatment at UCSF.

SOURCES: Diana M. Tordoff, MPH, PhD candidate, department of epidemiology, University of Washington, Seattle; Jack Turban, MD, MHS, chief fellow, child and adolescent psychiatry, Stanford University School of Medicine, Palo Alto, Calif.; JAMA Network Open, Feb. 25, 2022