Immediate access to testosterone reduces gender dysphoria among transgender adults
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Key takeaways:
- Transgender adults have greater reductions in gender dysphoria if they receive testosterone therapy immediately vs. a 3-month wait.
- Early access to testosterone also reduced depression and suicidality.
Transgender and gender-diverse adults who received testosterone therapy immediately instead of after a standard care waiting period of 3 months had greater reductions in gender dysphoria, depression and suicidality, according to study data.
“This clinical trial demonstrates the benefits of early access to testosterone in transgender and gender-diverse adults,” Brendan J. Nolan, MBBS, an endocrinologist and PhD candidate at Austin Health in Victoria, Australia, and the University of Melbourne, told Healio. “It is the first clinical trial to randomize transgender participants to early access vs. standard care (delay due to waiting lists) testosterone, and therefore the first to provide evidence supporting the benefits of early access to testosterone therapy in transgender and gender-diverse individuals.”
Nolan and colleagues conducted an open-label randomized clinical trial in which 64 transgender and gender-diverse adults aged 18 to 70 years who were seeking masculinization were enrolled at clinics specializing in transgender and gender-diverse health in Melbourne from November 2021 to July 22, 2022 (median age, 22.5 years). Participants were randomly assigned to begin testosterone therapy within 1 week of their first study visit or be placed on a 3-month standard care waiting list and receive no treatment during the study. Participants randomly assigned to testosterone were able to choose their formulation. Gender dysphoria was assessed through the Gender Preoccupation and Stability Questionnaire, depression was measured using the Patient Health Questionnaire-9 and suicidality was assessed using the Suicidal Ideation Attributes Scale. All three questionnaires were administered at baseline and 3 months.
The study was published in JAMA Network Open.
At baseline, all participants had clinically significant levels of gender dysphoria with a score on the Gender Preoccupation and Stability Questionnaire of higher than 28 points. At 3 months, the testosterone group had a greater reduction in gender dysphoria score compared with the waitlist group (mean difference, –7.2 points; 95% CI, –8.3 to –6.1; P < .001). There was a reduction in gender dysphoria score of 11 points or more in 39% of the testosterone group vs. no participants in the waitlist group (P < .001).
Adults receiving testosterone had greater reductions in depression as measured by the Patient Health Questionnaire-9 (mean difference, –5.6 points; 95% CI, –6.8 to –4.4; P < .001) and suicidality as measured by the Suicidal Ideation Attributes Scale (mean difference, –6.5 points; 95% CI, –8.2 to –4.8; P < .001) compared with those in the waitlist group. An improvement in depression score of five points or more was observed in 61% of the testosterone group compared with 13% receiving standard care. Among participants with suicidality at baseline, 52% of those in the testosterone group had resolution at 3 months compared with 5% in the waitlist group.
“I hope [the study] provides an impetus for more clinicians to provide gender-affirming medical care,” Nolan said. “It also has implications for service delivery to reduce waiting lists at gender clinics and provide timely access to gender-affirming care.”
Nolan said similar studies with a longer-term follow-up are needed to better analyze the impact of gender-confirming hormone therapy on mental health outcomes.
For more information:
Brendan J. Nolan, MBBS, can be reached at nolan.b@unimelb.edu.au.
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