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Gender-affirming care helps save lives, cuts depression risk in transgender and nonbinary youth, study finds

Claire Thornton

Dec 17, 2021

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A new study has found a link between gender-affirming hormone therapy for transgender and nonbinary youth and a decrease in depression and suicidal thoughts. It's critical new data that advocates hope will rebut legislative efforts to restrict access to gender-affirming care.

The peer-reviewed study from the Trevor Project was published Tuesday in the Journal of Adolescent Health and marks the first large-scale study documenting the benefits of gender-affirming care among youth. Its findings come as a lack of research has helped fuel state laws restricting access to gender-affirming care for minors. 

In the past year, more than half of transgender and nonbinary youth considered attempting suicide, according to a 2021 survey. Having one's gender identity supported and affirmed is a critical factor in youth mental health, said Amy Green, the study's lead researcher.

"This data shows access to gender-affirming hormones may be one of those areas through which we’re able to reduce those high levels of depression and suicide attempts," Green said.

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Gender-affirming hormone therapy can help reduce feelings of gender dysphoria, which is when one's gender identity and physical gender characteristics feel mismatched, Green said.

"It’s being forced into something that isn’t the right fit," she said. 

Gender dysphoria, along with bullying, discrimination, anti-LGBTQ political rhetoric and lack of support from loved ones all contribute to higher levels of depression among trans and nonbinary youth compared to their cisgender lesbian, gay and bisexual peers, according to the study.

The data matches what Stephen Chukumba observed in the years after his son came out as transgender in 2017 at age 11.

Chukumba, a single father of four in Trenton, N.J., said he didn't know what to do as a parent or where to turn for help at first.

But when he got connected to resources for parents of trans kids on the Human Rights Campaign’s website and started researching gender-affirming care, it was like "a rainbow appeared" over Chukumba's house, he said.

After Chukumba’s son began receiving gender-affirming care in the form of testosterone in early 2021, he became more social at his high school and was selected to join student government.

“He feels very confident in the skins that he’s in, much more so than before,” Chukumba said.

Study finds benefits from hormone therapy, parental support

The study found that among 9,000 trans and nonbinary youth ages 13-24, receiving gender-affirming hormone therapy was associated with a 40% lower risk for depression and seriously considering suicide.

Youth who were not receiving gender-affirming hormone therapy but wanted to faced higher risk of depression and suicidal thoughts.

The study's findings are consistent with existing scientific evidence showing the care improves well-being and decreases suicidal ideation for transgender youth who want it, said Dr. Christine Moser, director of behavioral heath at Children's Mercy's gender pathway services clinic in Kansas City, Mo.

"Transgender youth require access to evidence-based medical care," Moser said. 

Parental support of a child's gender identity can help protect the mental health of trans and nonbinary youth. That support also factors strongly into whether youth can access gender-affirming care, according to the study.

Most respondents receiving gender-affirming hormone therapy said one or more parents support their gender identity. Youth ages 13-17 receiving hormone therapy were the most likely to report parental support.

“Those who have parental support are likely to have more financial means,” said Amy Green, the lead researcher on the study. “What it really speaks to is (gender-affirming hormone therapy) not being accessible enough for those who want it regardless of age.”

Half of all transgender and nonbinary youth surveyed said they would like to use hormone therapy but weren't currently taking gender-affirming hormones.

While youth ages 13-17 receiving hormones were more likely to report support from parents, trans and nonbinary young people ages 18-24 receiving gender-affirming care were more likely to report struggling financially or just being able to meet their basic needs.

Medical care among challenges parents, youth face

Even though all major medical associations, including the American Academy of Pediatrics and the American Psychological Association, recognize the validity of transgender identities and support transgender kids in their transitions, finding accepting doctors isn't easy for most transgender Americans.

As Chukumba's son socially transitioned and began using the pronouns "he" and "him," he wasn't bullied at school. But visits to the doctor's office around the corner from his house became frustrating and uncomfortable, his dad said.

When Chukumba would correct staff at the pediatrician's office when they referred to his son as a female, people wouldn't back down and replied, “It’s what the chart says." 

After a couple of years of being constantly misgendered by medical professionals, finding new doctors at the Children's Hospital of Philadelphia led to the boy getting the care he needed.

“The first time we were able to talk to the nurse, he shared things with her he hadn’t shared with me about his dysphoria, things about his body, challenges he had day to day," Chukumba said. "As a supportive parent I thought I knew everything there was to know. I wasn’t aware of all the challenges he was going through."

Like Chukumba, Pamela Riddle hunted for the right help when her daughter began identifying as a transgender girl. Advice from therapists, an endocrinologist and a diagnosis of gender dysphoria helped early on, she said.

Riddle remembers how starting at age eight, her daughter played dress up at their Minnesota home with feminine clothes like skirts, tall boots and tank tops.

The first time she wore the outfit to go out and play with neighbors, Riddle said it was the happiest she'd ever seen her daughter, who is now 14.

"That’s when I said, 'Ok, I need to get a therapist on board and have her talk to a therapist to talk this out,'" the former teacher said.

For Riddle's daughter, the right medical care has led to positive results. She is receiving puberty blockers and hopes to start hormone replacement therapy in the next year.

“It’s a positive experience because she gets to be who she is, and laugh with her friends and, you know, do well in school because she doesn’t have to be anxious about thinking about if something doesn’t feel right," Riddle, 51, said. 

State ban on gender-affirming medical care cited lack of data

The new study expands on the findings of three smaller clinical studies among youth and other large-scale studies on adults. It also comes as access to gender-affirming care for youth is being fiercely contested in statehouses across the country.

In April, Arkansas' state legislature passed the nation's first bill prohibiting healthcare providers from prescribing or referring transgender minors for gender-affirming medical care.

A federal judge blocked the Arkansas law in July 2021, after a lawsuit filed by the ACLU against the bill received support from 17 state attorneys general.

The Arkansas bill acknowledged some Americans experience distress at identifying with the sex assigned on their birth certificate, including young children.

But it argues because "no randomized clinical trials have been conducted on the efficacy" of hormones "for the purpose of treating such distress," gender-affirming hormone therapy should be banned.

The new evidence showing a link between gender-affirming hormone therapy among youth and significantly lower risk of depression and suicide challenges the argument outlined by the state of Arkansas, Green said.

“The debate has really centered on ‘we don’t know enough about youth,’ and this data adds to that body of literature that’s now showing that yes, just as we see in older adults, younger adults' access to gender-affirming hormones is associated with lower risk for depression and suicide," Green said.

At least 20 states are considering bills that would ban or restrict access to gender-affirming medical care for LGBTQ youth, despite the risks such bans pose for trans and nonbinary youth already accessing hormone therapy.

Green said she's particularly worried about kids in states with bans who will have already started taking gender-affirming hormones.

"Youth who have already been receiving this care would lose access to something that’s been supporting them, that's been serving that purpose of reducing their depression, reducing their suicide risk," Green said.

The Trevor Project helps LGBTQ+ people struggling with thoughts of suicide at 866-488-7386 or text 678-678.

The LGBT National Help Center National Hotline can be reached at 1-888-843-4564.

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