Suicide Risk Reduces 73% in Transgender, Nonbinary Youths with Gender-Affirming Care

Diana Tordoff, MPH

Transgender and nonbinary youths have particularly high rates of poor mental health outcomes compared with their cisgender counterparts. According to investigators, these disparities are likely a consequence of social rejection, lack of support from parents, bullying and discrimination.

Multiple sources of previously published research, found medical gender-affirming interventions to be helpful in improving the quality of life for transgender and nonbinary youths by decreasing rates of long-term mental health adverse outcomes

However, despite the existing evidence, legislation criminalizing and subsequently limiting access to gender-affirming medical care for minors is increasing across the country. A team of investigators, led by Diana Tordoff, MPH, Department of Epidemiology, University of Washington, examined the changes in mental health in youths after receiving this care.

The Impact of Gender-Affirming Care

Investigators said that previous data showed gender-affirming hormones (GAH), puberty blockers (PBs), and gender-affirming surgeries have been found to be independently associated with reduced depression, anxiety and additional adverse mental health outcomes.

Puberty blockers administered during puberty can actually reduce suicide risk in this population. A decreased lifetime incidence of suicidal ideation was also found among adults who received access to puberty blockers during adolescence.

Investigators wanted to better understand the affect of gender-affirming care on mental health immediately following the initiation of care.

"Given the high risk of suicidality among [transgender and nonbinary] adolescents, there is a pressing need to better characterize mental health trends for TNB youths early in gender-affirming care," investigators wrote.

Understanding Transgender & Nonbinary Youth

A prospective observational cohort study was performed to examine transgender and nonbinary youths who sought care at Seattle Children's Gender Clinic, an urban multidisciplinary gender clinic. Investigators evaluated the changes in mental health over the first year of receiving puberty blockers and/or gender-affirming hormones to see if they impacted depression, anxiety, and/or suicidality.

Main outcomes were measured with the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up.

Among the 104 youths (13-20 years) who participated, 63 were transmasculine individuals (60.6%), 27 transfeminine individuals (26%), 10 nonbinary or gender fluid individuals (9.6%), and 4 individuals who didn't know or did not respond to the gender identity question (3.8%).

At baseline, more than half of individuals (56.7%) had moderate to severe depression and exactly half had moderate to severe anxiety. Self-harm or suicidal thoughts were reported by 45 individuals (43.3%).

Antitransgender Legislation Can Have Negative Outcomes for These Youths

By the end of the 12 month follow-up study, 69 individuals (66.3%) received PBs, GAHs, or both. 35 youths hadn't received either intervention (33.7%). While there was no association found between these interventions and anxiety (adjusted odds ratio, 1.01; 95% CI, 0.41, 2.51) investigators found promising results.

With an adjustment for temporal trends and potential cofounders, individuals were 60% less likely to experience depression (aOR, 0.40; 95% CI, 0.17-0.95) and 73% less likely to experience suicidality (aOR, 0.27; 95% CI, 0.11-0.65) when compared to youths who did not received gender-affirming interventions.

In the conclusion, investigators focused on the need to address antitransgender legislation and the additional need for medical systems and insurance providers to decrease barriers and expand access to gender-affirming care.

"The associations with the highest [adjusted odds ratio] were with decreased suicidality, which is important given the mental health disparities experienced by this population, particularly the high levels of self-harm and suicide," investigators wrote. "Our findings have important policy implications, suggesting that the recent wave of legislation restricting access to gender-affirming care may have significant negative outcomes in the well-being of [transgender and nonbinary] youths."