Transgender adults experience less distress after gender-confirming care access as teens
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Key takeaways:
- Transgender adults who live in more transgender-friendly states are less likely to avoid health care.
- Gender-confirming care access during adolescence was linked to lower likelihood for severe depression.
Among transgender adults who received gender-confirming care as adolescents, those living in transgender-supportive states are less likely to avoid health care than those who live in unsupportive states, according to study data.
In a subanalysis of data from the 2015 U.S. Transgender Survey, researchers examined psychological and self-reported health outcomes for transgender or gender-diverse adults. In addition to transgender adults from supportive states being less likely to avoid health care, participants who reported receiving a puberty blocker, hormone therapy or undergoing surgical transition during adolescence had less severe psychological distress than adults who did not receive gender-confirming care during their youth.
“Our findings offer insights into the effect of state-level stigma on transgender and gender-diverse adolescents and point to the importance of enacting long-term legislative safeguards against transgender and gender-diverse discrimination and removing barriers to accessing the full spectrum of care for adolescents who identify as transgender and gender diverse,” Min Kyung Lee, MS, a graduate research assistant in the School of Industrial Engineering at Purdue University, and colleagues wrote in a study published in LGBT Health.
Researchers collected data from 27,715 transgender and gender-diverse adults who participated in the 2015 U.S. Transgender Survey. The Kessler-6 Psychological Distress Scale was administered, with a score of 13 or higher indicating severe psychological distress. Participants reported whether they had suicidal ideation in the year before the survey and whether they avoided health care in the past year due to possible mistreatment. General health was self-reported on a scale of 1 to 5, with 1 indicating excellent health. Participants were divided into groups based on whether they accessed puberty blockers, HT or surgical transition during adolescence. Those who did not access any gender-confirming care as youths were put into a control group. State-level legislation data were obtained from the Movement Advancement Project. States received points for having positive transgender-related laws and lost points for laws that were considered harmful for transgender people. States were separated based on quantiles into three groups: unsupportive, neutral or supportive toward transgender people.
Adults who reported receiving a puberty blocker (adjusted OR = 0.22; 95% CI, 0.06-0.8), HT (aOR = 0.72; 95% CI, 0.54-0.96) or undergoing surgical transition (aOR = 0.32; 95% CI, 0.17-0.61) during adolescence were less likely to report severe psychological distress than those who did not receive gender-confirming medical care.
“Given that a source of gender dysphoria is the mismatch between the physical body and gender identity, gender-affirming medical care can alleviate gender dysphoria by altering the body to align with one’s gender identity, consequently leading to reduced body dissatisfaction and improved psychological functioning,” the researchers wrote. “Adolescence is a critical period in the life course, marked by significant physical and emotional changes. Experiencing persistent discomfort during this critical time can have long-term negative effects on general and psychological health outcomes.”
Adults who received HT (aOR = 2.3; 95% CI, 1.23-4.28) or underwent surgical transition (aOR = 3.42; 95% CI, 1.68-7) as adolescents were more likely to avoid health care in the past year than those who did not receive gender-confirming care as adolescents. However, health care avoidance was impacted by the state participants lived in. Adults who lived in a state with transgender-supportive legislation and received puberty blockers (aOR = 0.29; 95% CI, 0.09-1), HT (aOR = 0.37; 95% CI, 0.15-0.92) or surgical transition (aOR = 0.22; 95% CI, 0.08-0.6) as youths were less likely to avoid health care than those living in unsupportive states.
“These findings highlight the importance of educating health care professionals on the health care needs of transgender and gender-diverse individuals, increasing the number of health professionals who identify as transgender and gender diverse, and creating a safe and inclusive environment for all patients,” the researchers wrote.
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