Earlier access to gender-affirming hormones linked to better mental health

key takeaways

  • Gender-affirming hormone therapy (GAHT) helps people adjust their bodies to better match their gender identity.
  • Researchers found that transgender people who wanted GAHT suffered fewer mental health problems if they started in adolescence, rather than in adulthood or not at all.
  • While experts agree that standard of care should include GAHT as an option, public awareness and policy still need to catch up with the science.

In a new study, researchers found that adults who started gender-affirming hormone therapy (GAHT) during their teens had better mental health than those who started treatment later or didn’t receive it at all.

“Some trans people struggle with anxiety that doesn’t match their body,” lead study author Jack Turban, MD, MHS, lead researcher in Stanford’s Child and Adolescent Psychiatry, told VigorTip via email.

But gender-affirming hormones, which alter secondary sex characteristics such as hair growth, body fat distribution and tone of voice, can help people adjust their bodies to better match their gender identity.

Gender-affirming hormone therapy may be part of medical transition

Mary Parrish, LPC, a consultant in New Orleans who regularly meets LGBTQ+ clients, agrees. “A lot of times, people who want to transition feel like impostors in their lives,” they said.

But once those who wanted GAHT started using it, they added, “they started to be able to see themselves differently and answer some questions about who they were.”

This can help prevent feelings of depression and anxiety. “Once they can get in, their insides are closer to their outsides,” added Parish.

However, Turban added that GAHT is only one part of the options needed in gender-diverse care. “We also need to focus on creating safe school environments, warm family relationships, supportive public policies, and more,” Turban said.

The study was published in PLOS ONE mid-January.

mental health struggle

Parrish often sees clients with common mental health issues, such as depression and anxiety. They also work with clients to demonstrate the impact of gender diversity on mental health, especially when there is insufficient care and support.

“There’s a huge feeling that they don’t belong, like they have a problem,” Parrish said.

Often, clients come to her when transitioning or considering. “They’re struggling with who they are, and that’s always caused by some depression, anxiety, trauma or substance use,” they said.

What does transgender mean?

But Parrish says that treating gender dysphoria — and all the depression, anxiety and confusion surrounding it — is all about building confidence. “We usually start by asking them to build their own narrative about who they are and how society and their family’s expectations are governed,” added Parish.

Researchers like Turban see GAHT as an aid to this process. “[GAHT] Leads to positive mental health outcomes such as reduced anxiety, depression and suicide,” he said. On the other hand, he added, those who want GAHT but don’t have access to it often experience adverse mental health issues.

Most of Parrish’s customers who want GAHT can get it, but they know that’s not the case for all of them. Aside from access, sometimes navigating insurance and healthcare costs becomes a barrier for many.

“I’ve seen people run out of medication, or their insurance needs to enroll in a certain type of treatment, but they don’t do it,” they said. “So there are other access issues with this population.”

Early hormone therapy protects mental health

This isn’t the first study to look at GAHT and mental health. “Studies of transgender adolescents who receive gender-affirming medical care in early adulthood have shown positive mental health outcomes,” Turban said.

However, this is the first study to compare people who receive GAHT at different ages with those who crave it but have not yet used it.

Turban and colleagues looked at data from a 2015 survey of more than 21,000 transgender adults in the United States who reported wanting GAHT. 41% had never used it, while the rest started treatment between the ages of 14-15 (0.6%), 16-17 (1.7%) and 18 and older (56.8%).

They found that those who started GAHT during their teenage years (ages 14-17) had better mental health than those who started treatment later (ages 18 and older). Specifically, people who started treatment during adolescence were less likely to experience suicidal thoughts or substance abuse. Before GAHT, older adults were at greater risk for mental health problems.

For the trans community, accessible healthcare can be life-changing

At the same time, individuals in both groups struggled less with mental health than people who wanted GAHT but didn’t yet use it.

They noted that those who started treatment as adults were more likely to experience behaviors such as alcoholism than those who had never received hormone therapy.

However, the researchers note that the findings are related. In other words, the connection may be reversed. People with better mental health may be more likely to get GAHT.

People in the study may also have misremembered details about when they started treatment (such as their age) or how their mental health has changed over time. Everyone may not easily and accurately recall how they felt at some point in the past.

what does this mean to you

If you’re seeking GAHT treatment, directories like RAD Remedy and MyTransHealth can connect you with affirmative and affordable care nationwide.

Importance of visiting

Access to gender-affirming therapy is critical to the current and future mental health of many trans people. While there are certainly people who choose not to have it, that’s a lot different than not being able to access it.

“While there is broad consensus in the medical establishment that gender diversity is not pathological and that gender should definitely be the standard of care, many of the general public, including politicians, have yet to catch up with medicine,” Turban said.

Parrish agrees and emphasizes that we need to do a better job of educating people, from parents at home to children at school, about the multi-layered concept of gender.

Transgender Health for People of Color

“Our gender, gender and identity manifest in different ways throughout our lives,” they said. “We need to have a deeper conversation about this mobility from a very early age.”

Universal healthcare should also be a top priority, Parrish believes.

“It’s about making sure the policy is in everyone’s best interests, not just those in control,” they said. Under such a policy, access to health care and costs associated with treatment may become more manageable.

Universal health care may also help separate health care policy from political trends.

“In recent years, we’ve seen a resurgence of anti-trans legislation, much of it targeting young people (their ability to go to the bathroom, play sports, access health care),” Turban said. “I hope that research like this will continue to spread, especially as politicians will make decisions based on science and data.”