Earlier therapy reduces distress in trans adults

Gender-affirming treatment in early adolescence appears to improve mental health into adulthood.

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Transgender people have much better mental health if they start gender-affirming hormone treatment in their teens rather than later in life, according to possibly the largest ever survey of trans adults. 

Participants who had gender-affirming treatment at any age were markedly less suicidal and distressed compared to those who had none, but the benefits were greatest for those who began treatment in their earlier teens. 

“This gives us some solid evidence that helping young people by referring them to gender clinics and acknowledging their gender identity is not just being nice, it’s preventing harm and improving their mental health in the longer term,” said Brisbane GP Dr Fiona Bisshop, president of the Australian Professional Association for Trans Health.

The study authors noted that as many as 40% of transgender young adults were estimated to have attempted suicide. 

The cross-sectional study drew on US survey data collected in 2015 from over 20,000 transgender adults who wanted gender-affirming treatment, which may include estrogen and testosterone. It compared mental health outcomes for those who received therapy at age 14-15, 16-17, and 18 and over and those who wanted but never received hormones.

Transgender adults who began treatment aged 14-15 were 70% less likely to have had severe psychological distress in the previous month and 60% less likely to have considered suicide in the past year than those who wanted treatment but did not have access to it.

Those who had treatment aged 16-17 were also 70% less likely to have had severe psychological distress in the previous month, and 50% less likely to have considered suicide in the last year.

Those who accessed hormone therapy as adults were 40% less likely to have been severely psychologically distressed in the past month and 20% less likely to have suicidal thoughts in the past year.

Unexpectedly, those who received hormone therapy as adults were more prone to binge drinking and illicit drug use than the comparison group. 

“One possible reason for this finding is that transgender people may become more socially engaged following the improvement in self-confidence that we often see come along with starting gender-affirming hormones,” lead author Dr Jack Lewis Turban told The Medical Republic. 

“It’s important to note that … we did not see higher rates of substance use among people who were able to access gender-affirming hormones as adolescents. Furthermore, access to gender-affirming hormones during adolescence was associated with lower odds of substance use when compared to not accessing gender-affirming hormones until adulthood,” he said.

Dr Bisshop said the findings confirm that taking an affirmative approach to gender medicine and providing timely medical care to young transgender people prevents harm. 

“All of us who work in the field of trans medicine or gender medicine are aware of the fact that most people feel better once they start affirming therapy, and that’s regardless of age,” she told The Medical Republic. 

An affirmative approach is one that supports a person’s gender identity psychologically, medically and surgically. This includes accepting the pronouns and name a person wants to use and the way they want to dress, Dr Bisshop said.

“There’s absolutely no evidence that you can affect someone’s gender identity by allowing them to express the gender identity they already have,” she added. “What you’re doing is having a positive effect on their mental health. And I think that’s what this research is showing.”

PLOS ONE 2022, online 12 January