• Posted June 20, 2023

Hormonal Therapies Boost Mental Health of Transgender People, and Few Stop Treatment

In the face of an ongoing and widespread legal assault on transgender rights -- one that threatens to cut off access to critical aspects of trans health care -- a pair of new studies suggest that gender-affirming medical care is a lifesaving treatment for those who need it.

One study finds that when trans men get immediate access to hormone/testosterone therapy as part of a gender-affirming treatment plan, their mental health improves markedly. Another finds that when trans teens embark on hormone therapy they rarely, if ever, regret their decision.

"Gender-affirming hormone therapy is hormone treatment to align physical characteristics -- such as facial hair, changes to muscle mass or body fat -- with an individual's gender identity,"explained study author Brendan Nolan, an endocrinologist with Austin Health in Melbourne, Australia.

"For people desiring 'masculinization,' this involves the same doses and types of testosterone used to treat cisgender men [when someone's sex at birth matches their own gender identity] with low testosterone,"added Nolan, who is pursuing his doctorate at the University of Melbourne.

For the study, Nolan's team tracked how 64 adult trans men fared over a three-month period. All wanted to begin testosterone treatment immediately. But only half were allowed to do so. The other half was told to ride out a standard three-month waiting list.

"We found that the people who received earlier access to testosterone had significant reductions in gender dysphoria, depression and suicidal thoughts, compared to the people commencing testosterone in three months,"he said. Gender dysphoria describes the distress that can arise when one's assigned gender at birth does not match one's actual gender identity.

While 21 patients in the immediate treatment group had been contemplating suicide prior to testosterone therapy, that figure plunged to just 11 patients within three months, a 52% drop. By comparison, just one patient in the wait-listed group ceased to have suicidal thoughts during the same timeframe, representing just a 5% improvement.

Those who gained quick access to testosterone treatment also experienced a quick and broad easing of the overwhelming sense of discomfort that typifies gender dysphoria.

Nolan and his colleagues presented their results last weekend at the annual meeting of the Endocrine Society in Chicago.

The Australian team's findings come in the midst of a ramped-up conservative effort to torpedo access to gender-affirming care, and trans health care in general.

According to the American Civil Liberties Union (ACLU), there are now roughly 500 anti-LGBTQ state bills under consideration, primarily in deep-red or red-leaning states.

Of these, 130 bills are specifically focused on efforts to make health care -- particularly trans health care -- either very difficult to obtain or outright illegal.

Among those efforts are bills that seek to prevent trans patients from accessing Medicaid-covered care; bills that seek to strip all insurance coverage for medically necessary health care for trans patients; bills specifically designed to ban all gender-affirming care for trans youth; and bills that seek to block funding for facilities that provide such care.

The Trans Legislation Tracker notes that about 20 such bills have in fact already been signed into law in Arizona, Florida, Georgia, Iowa, Idaho, Indiana, Louisiana, Mississippi, Missouri, Montana, North Dakota, Nebraska, Oklahoma, South Dakota, Tennessee, Texas, Utah and West Virginia.

Yet another study presented at the Endocrine Society meeting took aim at one notion often floated by groups engaged in the effort to strike down access to trans care: that many teens who embark on gender-affirming hormone therapy will likely come to regret their decision.

In this instance, a team led by Dr. Vin Tangpricha, from Emory University in Atlanta, spent several years tracking therapy adherence among 82 trans and gender-non-conforming teens, all of whom embarked on gender-affirming hormone therapy -- involving either estrogen or testosterone -- at some point between 2016 and 2019.

The result: Over a treatment period that lasted an average of almost two years, only three patients ended up stopping hormone therapy -- out of a pool of 36 trans girls, 45 trans boys and one non-binary teen.

In fact, not a single teen returned to identifying with their birth gender. Of the three that ceased hormone treatment, one stopped because of insurance problems, one stopped to have a baby, and one stopped to switch to a non-binary status.

"In the 2% of people who discontinued hormone therapy, the vast majority did not discontinue due to a change in gender identity," noted Tangpricha. "They discontinued due to a personal preference or some other medical issue. The vast majority of transgender and gender diverse people seeking gender affirming hormone therapy continue on these therapies. This indicates that these gender identities are persistent and sustained."

In other words, concerns that minors who embark on gender-affirming care may end up regretting their decision later may be largely unfounded.

Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco, suggested that, in each study, the findings reinforce the prevailing medical consensus.

"Gender-affirming medical interventions help people to align their bodies with their gender identities, which can help to alleviate distress,"Turban explained.

Adolescents struggling with gender dysphoria have been able to access gender-affirming care for several decades, he noted, "and for many decades longer in adults."

The findings of the Australian study "are largely in line with the large body of literature that already existed linking these interventions to improved mental health outcomes,"Turban said.

"The finding that the vast majority of trans kids don't change their mind about gender-affirming medical interventions is also in line with past research," he added.

Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

There's more on efforts to deny care to trans patients at the ACLU.

SOURCES: Brendan Nolan, PhD candidate, endocrinologist, Austin Health, Heidelberg, Victoria, Australia, and doctoral student, University of Melbourne; Vin Tangpricha, M.D., Ph.D.professor of medicine, division of endocrinology, metabolism & lipids, department of medicine, Emory University School of Medicine, Atlanta; Jack Turban, MD, MHS, director, gender psychiatry program, University of California, San Francisco; Endocrine Society annual meeting, Chicago, June 15-18, 2023