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Early access to gender-affirming hormones linked to better mental health, study finds

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Early access to gender-affirming hormones linked to better mental health, study finds

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Access to gender-affirming hormone therapy in adolescence is associated with better mental health outcomes for transgender adults, new study finds.

The research, published Wednesday in the peer-reviewed journal PLOS One, was based on data from the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, which surveyed more than 27,000 trans people across the country. the country. He compared the psychological distress and suicidal thoughts experienced by 12,738 trans adults who had access to gender-affirming hormones in early adolescence, late adolescence or adulthood to distress and the suicidal thoughts felt by 8,860 trans adults who wanted hormones but never had access to them.

The chances of negative mental health outcomes decreased significantly among trans people who had access to gender-affirming hormones between the ages of 14 and 17. Access to gender-affirming hormones during this period was associated with a third of the risks of psychological distress and a half-month or less chances of suicidal ideation in the previous year compared to trans people who wanted hormones but never had access to them, according to study co-author Dana King, a data programmer and analyst for the Fenway Institute of Fenway Health, a Boston-based LGBTQ health care and research organization.

And while those who had access to gender-affirming hormones in adulthood also had a lower risk of severe psychological distress and suicidal ideation in the past month, the difference was not so glaring. , according to the report.

Lead author of the study, Dr Alex S. Keuroghlian, director of the National LGBTQIA + Health Education Center at the Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program, said the study results show the dangers of state legislation to prohibit gender-affirming medical care, including hormones, for trans minors.

“These findings militate against waiting until adulthood to offer gender-affirming hormones to transgender adolescents and suggest that this may put patients at greater mental health risk,” Keuroghlian said in a statement. hurry. “They also add to the growing evidence base suggesting that legislation restricting transgender adolescents’ access to gender-affirming medical care would lead to negative mental health outcomes.”

According to the American Civil Liberties Union, more than 20 states last year reviewed bills that would have banned gender-affirming health care for transgender minors. Only Arkansas has passed a law that completely bans access to gender-affirming health care, including puberty blockers and hormones, for trans minors; a judge blocked the law’s entry into force in July pending the outcome of the litigation. Tennessee passed a more limited law that prohibits doctors from providing hormone therapy and gender-affirming surgery to prepubescent minors.

A recent poll from the Trevor Project, a suicide prevention and crisis intervention group for LGBTQ youth, found that only public discussion affected the mental health of trans and non-binary youth. Eighty-five percent of trans and non-binary youth, and two-thirds of all LGBTQ youth, said recent debates over anti-trans laws have had a negative impact on their mental health.

At least seven states introduced anti-trans bills in the first week of the year, including some that would limit trans youth’s access to gender-affirming health care.

Supporters of the bills argue that this health care is “experimental” and that trans youth should not have access to it until they are adults.

However, in addition to the new study published in PLOS One, a growing body of evidence – also based on the 2015 US Transgender Survey – found that earlier access to gender-affirming care, such as puberty blockers, hormones and surgery, has positive effects. mental health problems and that delaying access to such care can lead to negative outcomes, including an increased risk of suicidal ideation.

Research published in JAMA Psychiatry in September 2019 found that exposure to “conversion therapy,” a discredited practice that seeks to change a trans person’s gender identity, is associated with suicidal thoughts and suicide attempts.

Another study, published in the journal Pediatrics in January 2020, found that trans people who received puberty blockers during adolescence had a lower risk of suicidal thoughts in adulthood than those who wanted puberty blockers. puberty but did not have access to it.

And a third study, published last year in JAMA Surgery, found that trans people who didn’t have the gender-affirming surgery they wanted were almost twice as likely to report severe psychological distress. and suicidal thoughts, and they also reported higher incidences of binge eating. consumption of alcohol and tobacco.

Trans people often do not have access to or have to delay obtaining gender-affirming care for a variety of reasons. Nearly one in five trans people are uninsured, according to a 2020 Kaiser Family Foundation study. A report last year from the Center for American Progress found that even when insured, 40 percent of transgender respondents – and 56 percent of trans respondents of color – said their health insurance companies refused the gender care coverage, which includes treatments like hormones and surgery.

The Center for American Progress survey also found that nearly half of transgender people – and 68% of transgender people of color – reported experiencing abuse from a health care provider, including a refusal of care and verbal or physical abuse in the past year. the survey, which was conducted in June 2020.

A senior author of the recent PLOS One study, Jack Turban, senior researcher in child and adolescent psychiatry at Stanford University School of Medicine, said the new research highlights that the States- States “have failed to make gender-affirming medical care accessible.”

“We urgently need to work on training more clinicians and tackling insurance discrimination,” Turban said, adding that “the lack of access to gender-affirming medical care could result in the use of non-prescribed gender-affirming hormones through purchasing hormones online or on the black market without medical supervision, which can lead to adverse effects on physical health.

The study found that a significant proportion of trans people who wanted gender-affirming hormones, 41%, had no access to them at all. It also found that rates of suicidal ideation in the previous year were still high among all trans people – including those with access to gender-affirming hormones – compared to the general population.

“Transgender people face a range of other psychosocial stressors that contribute to chronic stress on minorities including, but not limited to, discrimination in employment, lack of safe access to public facilities and physical violence, ”the study says.

It calls for future epidemiological and intervention research to understand and treat chronic stress of minorities in trans people who have access to gender-affirming hormones and those who do not. For trans adolescents, the study states that “creating safe and supportive school environments appears to be of particular importance, in addition to providing gender-affirming medical care, as well as psychological, legal and surgical affirmation of the child. kind if necessary.

If you or someone you know is at risk of suicide, please call National lifeline for suicide prevention at 800-273-8255, text TALK to 741741 or visit for additional resources.

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Early access to gender-affirming hormones linked to better mental health, study finds

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