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Two years after starting gender-affirming hormone treatments, transgender and nonbinary youth experienced a sustained reduction in depression and anxiety and achieved a significantly improved alignment between their gender and physical characteristics, reports a large new study.
The study demonstrates that gender-affirming hormone treatment is valuable for transgender and nonbinary adolescents—a group at an elevated risk of suicidality, depression, and anxiety.
The study, from July 2016 through June 2019, included 315 transgender and nonbinary young people 12 to 20 years of age.
They were treated by clinics at the Ann and Robert H. Lurie Children’s Hospital of Chicago, Boston Children’s Hospital, the UCSF Benioff Children’s Hospitals in the San Francisco area, and Children’s Hospital in Los Angeles. The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Young people at risk
According to a 2022 study by the Trevor Project, about three-quarters of transgender and nonbinary youth experienced symptoms of anxiety in the previous year compared to cisgender youth. Over half experienced depression.
The same study found roughly half of the transgender and nonbinary youth had considered suicide, and that one in five had attempted suicide.
The new study “further validates the struggles so many trans youth face on a daily basis, which partially revolves around fitting in, feeling comfortable in their own skin, and being happy in their everyday life,” said Dr. Zishan Khan, a psychiatrist with Mindpath Health in Texas, who was not involved in the study, speaking to Medical News Today.
Dr. Megan Gandy of West Virginia University’s School of Social Work, who was also not involved in the study, said its findings are consistent with previous research.
“Such studies serve to contradict the misguided thoughts and perceptions many people have regarding such treatment,” Dr. Khan added.
Gender dysphoria and euphoria
When a person’s body and appearance conflict with their gender identity, they may experience “gender dysphoria.”
“It is well-documented that such dysphoria is associated with higher rates of unwanted psychological outcomes such as suicide, depression, anxiety, substance use, emotional dysregulation, and others,” said Dr. Gandy.
Bringing a person’s physical characteristics in line with their gender identity is referred to as “gender congruence.”
The new study found that achieving gender congruence was associated with reductions in depression and anxiety symptoms.
Dr. Luke R. Allen, psychologist at Student Psychological and Counseling Services at the University of Nevada, Las Vegas, who was not involved in the study, pointed out to Medical News Today that the way we see ourselves — and the way others perceive us — has a strong influence on “worry, anxiety, and our willingness to put ourselves out there, to make friends, and pursue other important relationships and activities.”
“The constant fear of being judged, and associated dysphoria, can be debilitating for many,” he said.
Dysphoria can be especially challenging for young transgender and nonbinary teens facing the hormonal changes that come with puberty.
A youth confronted with body hair, voice changes, breast development, and so on may turn to hormone suppression to prevent permanent, unwanted changes to their body. Gender-affirming hormones, on the other hand, take a more positive approach by changing body characteristics to math a person’s gender identity.
When gender dysphoria is resolved, a very different, more enjoyable, psychological state often arises: gender euphoria, or “gender joy,” said Dr. Gandy.
Dr. Gandy described gender euphoria as the idea that there is joy to be had in gender presentations that are congruent with the person’s gender identity.
How bans on hormone therapy affect youth
Dr. Gandy called the new research a “rigorous longitudinal study,” saying, “this is a reliable source of scientific information that adds to the growing body of literature that is informing this area of practice.”
“Clinicians and scientists may find that it is a helpful study in the midst of the growing political climate that bans such medical treatment,” she added.
“There is so much misinformation out there, and many people simply don’t realize that this is not just a phase these children are going through,” said Dr. Khan.
Dr. Khan also noted that “gender-affirming hormone therapy is not necessarily a dangerous and extreme measure that people receive and end up regretting or having long lasting negative effects in their lives.”
“Again and again, research demonstrates positive mental outcomes among transgender and nonbinary youth who receive gender-affirming hormones,” Dr. Allen said.
“This is often ignored, depending on where one is receiving their news,” he added.
Wherever bans on gender-affirming hormone treatments are in place, predicted Dr. Gandy, research such as this study will be impossible, leaving their burden on transgender nonbinary youth unknown. She also fears that bans threaten to hinder the progress of scientific research, affecting everyone.
Rather, she hopes, “Clinicians, scientists, and the broader public can use this article to make informed decisions about their support of gender-affirming hormone treatment for gender-diverse adolescents.”