More mental health issues seen in older vs. younger youths seeking gender-affirming care
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Youths who seek gender-affirming medical care at age 15 years and older and further along in puberty are more likely than their younger peers to report depression, self-harm and suicidal thoughts, researchers reported in Pediatrics.
“Youth with gender dysphoria have high rates of mental health problems, and gender-affirming medical care can provide mental health benefits to these youth,” Julia Sorbara, MD, MSc, a staff physician in the division of endocrinology at The Hospital for Sick Children in Toronto, told Healio. “We had seen that adolescents presenting to our clinic for this care were often older in age and further along in puberty. This observation raised the question of whether timing of presentation to gender-affirming medical care could be associated with mental health status.”
Sorbara and colleagues conducted a cross-sectional study of transgender youths aged 18 years or younger who presented to the Transgender Youth Clinic at The Hospital for Sick Children. Some of the participants presented in the first 2.5 years of the clinic’s opening between October 2013 and June 2016, whereas the rest presented from August 2017 to June 2018 after the clinic’s expansion (n = 300, median age, 15.4 years). Data were extracted from records of the initial visit, including self-reported diagnoses of depression, anxiety and autism spectrum disorders. Use of psychoactive medication, suicidal ideation at the time of or preceding the appointment, and history of self-harm were also recorded. Other collected data included Tanner puberty stage, the age each child recognized gender incongruence, the age of coming out, social transition and age of social transition.
Of all participants, 78% reported at least one mental health problem, with 47.3% reporting suicidal ideation, 44.3% anxiety disorders, 40% depressive disorders, 34.7% self-harm and 14% suicide attempt. A total of 31.3% of participants said they were taking psychoactive medications.
Participants were divided into a younger-presenting group for those who arrived at the clinic before age 15 years (n = 116; median age, 13.9 years) and an older-presenting cohort for those who came to the clinic at age 15 years or older (n = 184, median age, 16.3 years). The older-presenting group reported higher rates of depression (46% vs. 30%), self-harm (40% vs. 28%), suicidal ideation (52% vs. 40%), suicide attempts (17% vs. 9%) and use of psychoactive medications (36% vs. 23%; P < .05 for all) than the younger group. The likelihood of a participant using psychoactive medication increased with each 1-year increase in age (OR = 1.31; 95% CI, 1.05-1.63).
Researchers also found participants in the late puberty stage were more likely to report depression (OR = 5.49; 95% CI, 1.14-26.32) and anxiety (OR = 4.18; 95% CI, 1.22-14.49). Youths who were assigned female at birth were more likely to report self-harm than those who were assigned male at birth (OR = 3.41; 95% CI, 1.42-8.19).
Researchers also noted the time between recognition of gender incongruence to the first clinic visit was similar in both the younger-presenting group (median time, 7.4 years) and the older-presenting group (median time, 6.8 years), meaning the age a child recognizes gender incongruence may be critical to receiving care.
“Our findings suggest that youth with gender dysphoria who present to gender-affirming medical care later in age and puberty may be at particularly high risk for poor mental health,” Sorbara said. “Our study also emphasizes that timely access to gender-affirming medical care and mental health support is important for these youth.”
Sorbara added that the study did not examine causal relationships between mental health problems and age or puberty stage at presentation to gender-affirming medical care. She said future research is also needed to explore transgender youths’ mental health after gender-affirming care begins.
“It will be important to identify whether age or pubertal stage at initiation of gender-affirming medical care predicts psychological well-being in adulthood,” Sorbara said.
For more information:
Julia Sorbara, MD, MSc, can be reached at julia.sorbara@sickkids.ca. Twitter: @julia_sorbara
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