For Transgender People, Starting Hormone Therapy in Teens Helps Mental Health

Transgender people get greater mental health benefits if they start gender-affirming hormone treatment when they’re teens instead of waiting until they’re adults, a new study finds.

“This study is particularly relevant now because many state legislatures are introducing bills that would outlaw this kind of care for transgender youth,” said study lead author Dr. Jack Turban. He’s a postdoctoral scholar in pediatric and adolescent psychiatry at Stanford Medicine in California.

“We are adding to the evidence base that shows why gender-affirming care is beneficial from a mental health perspective,” Turban explained in a Stanford news release.

For the study, Turban and his team analyzed data from the largest-ever survey of U.S. transgender adults, conducted in 2015.

Compared to those who began hormone treatment during adulthood, those who started the treatment in their teens were less likely to have thoughts of suicide, major mental health disorders and substance abuse problems.

The researchers also found that participants who received hormones at any age were far less likely to have such problems than those who wanted but never received the treatment.

The study was published online Jan. 12 in the journal PLOS ONE.

The goal of gender-affirming hormone treatment with estrogen or testosterone is to match a transgender person’s physical characteristics with their gender identity.

Providing hormone therapy in adolescence means that a transgender teenager can go through puberty in a way that matches their gender identity, the study authors explained.

Of the more than 27,000 survey respondents, the researchers focused on the nearly 21,600 who said they wanted to receive hormone treatment. Of those who wanted treatment, 119 began at age 14 or 15 (early adolescence), 362 began at age 16 or 17 (late adolescence) and more than 12,000 began after their 18th birthday (adulthood). More than 8,800 wanted but never received hormone therapy (control group).

Respondents who received hormone treatment had a lower risk of severe psychological distress during the previous month and a lower risk of suicidal thoughts in the previous year, according to the survey.

Compared to the control group, the risk of severe psychological distress was 222%, 153% and 81% lower for those who began hormones in early adolescence, late adolescence and adulthood, respectively.

Also compared to the control group, the risk of suicidal thoughts in the previous year was 135%, 62% and 21% lower among those who began hormones in early adolescence, late adolescence and adulthood, respectively.

The study also found that respondents who began hormones in early or late adolescence had lower rates of past-month binge drinking and lifetime illicit drug use than those who began hormones in adulthood.

However, those who started hormone treatment in adulthood were more likely to binge-drink and use illicit substances than those who never had the treatment.

“Some individuals may become more confident and socially engaged when they begin taking hormones,” and this increased confidence and socialization may be linked to substance abuse, Turban noted.

“This finding speaks to the importance of creating culturally tailored substance-use counseling programs for transgender individuals,” he said.

More information

The Hormone Health Network has more on transgender health.

SOURCE: Stanford Medicine, news release, Jan. 12, 2022