Research finds significant reduction in depression, suicidality in youth receiving gender-affirming care or puberty blockers

A study abstract to be presented at the 2021 American Academy of Pediatrics National Conference & Exhibition found no effect on generalized anxiety over the 12-month study period.

ITASCA, IL – Researchers found a 60% decrease in moderate and severe depression and 73% decrease in suicidality among transgender and non-binary youth who received puberty blockers or gender-affirming hormones over a 12-month period, according to a study abstract presented during the virtual American Academy of Pediatrics 2021 National Conference & Exhibition.

The prospective study included 104 transgender and non-binary youth ages 13-21 who received treatment at the Seattle Children’s Gender Clinic, which serves a five-state area, between August 2017 and June 2018. While gender-affirming care is associated with reduced long-term adverse mental health outcomes, the authors sought to measure short-term outcomes of gender-affirming care.

“Our study adds to a robust evidence-base that access to puberty blockers and hormones is critical for ensuring the well-being of transgender and non-binary young people,” said Diana Tordoff, MPH; PhD Candidate at the University of Washington Department of Epidemiology.

Transgender and non-binary youth experience high rates of poor mental health outcomes due to lack of social support and anti-transgender stigma.  There continues to be limited access to gender-affirming medical care and an increase in anti-transgender legislation across the country, which causes poor mental health in these youth, according to the authors.

“Unfortunately, multidisciplinary clinics are not accessible to all transgender and non-binary youth. Next, we need to understand how to better serve youth who are not able to make it into a clinical environment.” said co-senior author Kym Ahrens MD MPH, associate professor of pediatrics at Seattle Children’s Hospital, University of Washington, School of Medicine.

Researchers surveyed youth at baseline, 3, 6, and 12 months to assess levels of depression, generalized anxiety and suicidality. They observed a 60% decrease in depression and a 73% decrease in suicidality associated with receipt of gender-affirming hormones or puberty blockers. There were no changes in anxiety noted at each of the time points evaluated.

“Our data supports what we see clinically, an amazing transformation in these young people and includes better mental health, said co-senior author David Inwards-Breland, professor of pediatrics at Rady Children’s Hospital-San Diego and University of California San Diego School of Medicine. “Yet, access to gender-affirming medical care is in jeopardy with the rise in anti-transgender legislation and threatens the youth’s mental health and the providers who serve them.”

This research was funded by Seattle Children’s Center for Diversity and Health Equity and the Pacific Hospital Preservation Development Authority.

Dr. Inwards-Breland will present the study abstract at 3:38PM, Monday, October 11, 2021.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.

ABSTRACT BELOW 

Abstract Title: Mental Health Outcomes and Receipt of Gender-Affirming Care

David Inwards-Breland MD MPH

San Diego, CA, United States

Monday, October 11, 2021: 3:38 PM –

Transgender and non-binary (TNB) youth are disproportionately burdened by mental health outcomes including increased rates of depression, anxiety, suicidal ideation/attempts. Gender-affirming care is associated with reduced long-term adverse mental health outcomes among TNB youth and is associated with a reduced lifetime incidence of suicidal ideation in TNB adults who started medical transition during adolescence. Conversely, TNB youth who present to medical care later in adolescence tend to have more adverse mental health outcomes compared with those who access earlier. Less is known about how gender-affirming care affects mental health in the short-term. We aimed to investigate changes in mental health outcomes among TNB adolescents over the first 12 months of care in an urban multidisciplinary gender clinic. We also sought to understand associations between initiation of pubertal blockers (PB) and gender-affirming hormones (GAH) with changes in mental health outcomes.

Seattle Children’s Gender Clinic (SCGC) serves a four-state area. We recruited TNB patients who completed a phone intake and in-person appointment between August 2017 and June 2018 at SCGC (N=104). We assessed three internalizing mental health outcomes: depression (Patient Health Questionnaire 9-item scale; PHQ-9, generalized anxiety (Generalized Anxiety Disorder 7-item scale; GAD-7), and suicidality (binary outcome measure based on the suicidality measure from the PHQ9) at baseline, 3, 6, and 12 month follow-up surveys. . Outcomes of interest were dichotomized into measures of moderate or severe depression and anxiety (PHQ-9 and GAD-7 scores ≥10). A priori, we considered several sociodemographic and other covariates hypothesized to potentially be associated with our outcomes of interest based on theory and prior research. We used generalized estimating equations (GEE) models to estimate the association between receipt of GAH or PB, modeled as a time-varying exposure, and mental health outcomes after adjusting for temporal trends.

The cohort included 63 (60.6%) youth who identified as transgender male or male, 27 (26.0%) as transgender female or female, 10 (9.6%) as non-binary, and 4 (3.8%) responded “I don’t know” or did not respond. At baseline, 56.7% had moderate to severe depression, 50.0% moderate to severe anxiety, and 43.3% had reported self-harm/suicidal thoughts in the past 2 weeks. After adjusting for temporal trends and baseline covariates we observed a 60% decrease in depression (aOR 0.40; 95% CI: 0.17-0.95) and a 73% decrease in suicidality (aOR 0.27; 95% CI: 0.11-0.65) associated with receipt of GAH and PB. There were no changes in anxiety noted at each of the time points evaluated.

Gender affirming medical interventions were associated with substantial improvement in both depression and suicidality (but no anxiety) over the 12 month period. Given this population's high rates of adverse mental health outcomes, including suicidality, this data provides critical evidence that expansion of access to gender affirming care will save lives.

For release:  12:01 a.m. ET, Friday, October 8, 2021

AAP contact: Lisa Black, 630-626-6084, lblack@aap.org