Gender-affirming care, puberty blockers 'can save lives' for transgender, non-binary youth

Researchers found a decrease in depression and suicidality among transgender and non-binary youth receiving puberty blockers or gender-affirming care, according to a presentation at the AAP National Conference & Exhibition.

Presenting author David J. Inwards-Breland, MD, MPH, chief of the division of adolescent and young adult medicine and co-director of the Center for Gender Affirming Care at Rady Children’s Hospital-San Diego, collaborated on the study with colleagues at the University of Washington, Northwestern Medicine and Seattle Children’s Hospital, where Inwards-Breland founded its Gender Care Clinic.

In an interview with Healio, Inwards-Breland, who is also a clinical professor at the University of California San Diego School of Medicine, said his work in Seattle helped to inspire the study. In starting and serving as the medical director of the Gender Care Clinic at Seattle Children’s Hospital, Inwards-Breland found that interventions that helped patients transition drastically improved mental health issues around depression and anxiety and decreased suicidality and suicidal ideation.

“The other piece of it was that I did see clinically an increase of depression symptoms, increase in anxiety, increase in suicidal ideation and suicide attempts around the 3-month point, and I didn't understand why. And so that really made me want to put [the data] together,” Inwards-Breland said.

Inwards-Breland and his colleagues surveyed 104 transgender and non-binary patients aged 13 to 21 years who received treatment at Seattle Children’s Gender Clinic between August 2017 and June 2018. The patients were surveyed to assess levels of depression, anxiety and suicidality at the outset of their treatment, followed by the same survey at 3 months, 6 months and 12 months.

The cohort included 63 youth (60.6%) who identified as transgender male or male, 27 (26%) who identified as transgender female or female, 10 (9.6%) who identified as non-binary and 4 (3.8%) who responded “I don’t know” or did not respond.

“At baseline, 56.7% had moderate to severe depression, 50% had moderate to severe anxiety, and 43.3% had reported self-harm/suicidal thoughts in the past 2 weeks,” the researchers wrote. “After adjusting for temporal trends and baseline covariates we observed a 60% decrease in depression (adjusted OR = 0.40; 95% CI, 0.17-0.95) and a 73% decrease in suicidality (aOR = 0.27; 95% CI, 0.11-0.65) associated with receipt of [gender-affirming hormones] and [pubertal blockers]. There were no changes in anxiety noted at each of the time points evaluated.”

While the decreases in depression and suicidality pleased the researchers, Inwards-Breland said they were surprised to see no “statistically significant improvement” in anxiety.

“We know that transgender and non-binary youth have anxiety, particularly around being misgendered in their community, in the doctor's office, etc.,” Inwards-Breland said. “And so we thought that as their bodies were changing, and as they became more confident in who they were, that anxiety would improve, but we didn't see that change. As a physician who prescribes antidepressants and anti-anxiety medication, we often see that depression gets better before anxiety. I think anxiety takes a little longer to actually improve.”

Inwards-Breland noted that fellow pediatricians could benefit their transgender and nonbinary patients by practicing gender-affirming care in the primary care world.

“We know that, for many of these youth, the social transition and even legal transition with name changing, gender marker change is not enough, and they actually need the medical intervention,” Inwards-Breland said. “These interventions can save lives.”

Reference:

Research finds significant reduction in depression, suicidality in youth receiving gender affirming care or puberty blockers. https://www.eurekalert.org/news-releases/930195. Published Oct. 8, 2021. Accessed Oct. 10, 2021.