Gender-affirming HT improves appearance congruence for transgender adolescents
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Transgender and nonbinary youths had greater appearance congruence — the experience that physical appearance aligns with gender —and less depression and anxiety after 2 years of gender-affirming hormone therapy, according to study data.
“Our results provide robust scientific evidence that improved appearance congruence secondary to hormone treatment is strongly linked to better mental health outcomes in transgender and nonbinary youth,” Diane Chen, PhD, pediatric psychologist with the gender and sex development program at Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor at Northwestern University Feinberg School of Medicine, said in a press release. “This is critical, given that transgender youth experience more depression and anxiety, and are at a higher risk for suicidality than cisgender youth.”
Researchers recruited 315 transgender or gender nonbinary adolescents and young adults aged 12 to 20 years who initiated gender-affirming HT at four gender clinics in the U.S. (mean age, 16 years; 64.8% designated female at birth). Study visits took place at HT initiation and at 6, 12, 18 and 24 months of follow-up. Participants completed the Transgender Congruence Scale to measure body congruence, the Beck Depression Inventory–II, the Revised Children’s Manifest Anxiety Scale and the Positive Affect and Life Satisfaction measures from the NIH Toolbox Emotion Battery at each study visit.
The findings were published in The New England Journal of Medicine.
Changes for all psychosocial outcomes were observed during the study. The cohort had a mean annual increase in appearance congruence of 0.48 points out of a 5-point scale, an annual increase in life affect score of 0.8 points out of a 100-point scale and a 2.32-point increase annually in life satisfaction score out of a 100-point scale. A 1.27-point annual decrease in depression score out of a 63-point scale and a 1.46-point decrease in anxiety score out of a 100-point scale were also observed over the 2-year follow-up period.
Researchers observed a correlation between higher appearance congruence score and lower scores for depression (r = –0.6) and anxiety (r = –0.4) at baseline. Improvements in appearance congruence score over time were associated with decreased scores for depression (r = –0.68) and anxiety (r = –0.52). Higher appearance congruence at baseline was linked to higher baseline scores for positive affect (r = 0.46) and life satisfaction (r = 0.72), and improvements in appearance congruence over time were associated with increases in positive affect (r = 0.74) and life satisfaction (r = 0.84).
Lower scores in depression and anxiety, and improvements in life satisfaction were observed in youths designated female at birth, but not those designated male at birth. At baseline, youths of color had higher scores for appearance congruence and positive affect than white youths, but white adolescents had larger decreases in depression score than youths of color during the study, the researchers reported.
Youths who began gender-affirming HT in early puberty had higher scores for appearance congruence, life satisfaction and positive affect, and lower scores for depression and anxiety at baseline than those starting HT in later puberty. Over time, youths who began HT in later puberty had greater improvements in appearance congruence than those who initiated HT in early puberty, according to the study.
“We are now following this cohort to see whether gains in functioning are sustained over a longer follow-up period, and — given substantial variability in outcomes even after controlling for a number of factors — we hope to discover additional predictors of change to identify youth for whom gender-affirming HT alone is not adequate to address mental health challenges,” the researchers wrote. “We intend to initiate further work with this cohort to focus on understanding reasons for discontinuing gender-affirming hormones among the small subgroup of youth who stopped medical treatment.”
Reference:
Study: Gender-affirming hormones improve mental health in transgender and nonbinary youth. www.luriechildrens.org/en/news-stories/study-gender-affirming-hormones-improve-mental-health-in-transgender-and-nonbinary-youth. Posted Jan. 18, 2023. Accessed Jan. 27, 2023.
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Transgender and nonbinary youths are reported to suffer from poorer mental health than others. Previous studies focused on the associations of gender dysphoria with mental health at baseline or after short follow-up periods. Gender-affirming care of adolescents often progresses from pubertal suppression with gonadotropin-releasing hormone agonists to gender-affirming hormone therapy. Gender-affirming care is associated with improved quality of life and mental health and lower rates of suicide. Sometimes, the claim is made that data are only modest for improvement in mental health with gender-affirming care.
Chen and colleagues investigate the psychosocial functioning of 315 transgender and nonbinary youths during the first 2 years of gender-affirming HT. Their research represents the most robust study to date of the mental health of transgender and nonbinary youths starting gender-affirming HT. The study demonstrated significant mental health benefit with gender-affirming HT and linked underlying factors associated with the improvement. The importance of appearance congruence is evident with it being associated with each psychosocial outcome at baseline and during follow-up. Increase in appearance congruence was associated with decreases in depression and anxiety symptoms and increased positive affect and life satisfaction.
The goal of gender-affirming HT is appearance congruence with the person’s affirmed gender. These findings by Chen and colleagues reassuringly confirm the benefits seen in our patients as they continue on gender-affirming HT and add to the objective evidence for gender-affirming HT that can be used to guide health care policy decisions.
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