Hormone therapy is one route through which a transgender person’s physical characteristics can be brought in line with their gender identity, but exactly when is the most effective and safe time to begin the treatment has proven to be a contentious topic. Now, the largest-ever survey of transgender adults from the United States has found that starting hormone treatment as a teenager can reduce suicidal ideation, substance abuse, and the onset of major mental health disorders among transgender people.
This new research, published in the journal PLOS ONE, was led by researchers from the Stanford University School of Medicine. They surveyed over 27,000 transgender people from the US, who volunteered to take part in 2015. All participants were over 18 years of age and of the 27,715 surveyed, 21,598 had expressed an interest in hormone therapy.
“There’s no one correct way to be transgender,” said lead author Dr Jack Turban, a postdoctoral scholar in pediatric and adolescent psychiatry at Stanford Medicine, in a statement. While some transgender individuals don’t wish to seek hormone therapy, “for some transgender youth, their negative reactions to living in bodies that develop during puberty in ways that don’t match who they know themselves to be can be very damaging.”
Data analyses focused on people interested in hormone therapy, looking at what age participants began hormone therapy (14 to 15, 16 to 17 or 18+) compared to a control group of 8,860 participants who wanted but never received hormone therapy. Participants self-reported their mental health, touching on topics including substance use and suicidal thoughts or attempts. They also completed a questionnaire to assess their psychological well-being.
Participants who received hormone treatment had a lower instance of severe psychological distress or suicidal ideation in the year preceding the survey compared to the control group. For severe psychological distress, these odds were slashed by 222 percent, 153 percent, and 81 percent among participants whose hormone therapy began in early adolescence (14-15), late adolescence (16-17), and adulthood, respectively. For suicidal ideation, there was a reduction of 135 percent, 62 percent, and 21 percent respectively.
While those who received hormone therapy in their teens had lower odds of substance abuse compared to the control group, those who received it in adulthood saw a higher likelihood compared to people who never received treatment.
“Some individuals may become more confident and socially engaged when they begin taking hormones,” said Turban. “This finding speaks to the importance of creating culturally tailored substance-use counseling programs for transgender individuals.”
The researchers hope the findings can be brought to the attention of legislators so that they can see that their data doesn’t support bills that would outlaw hormone therapy for transgender youth.
“These results won’t be surprising to providers, but unfortunately a lot of legislators have never met any transgender youth,” Turban said. “It’s important for legislators to see the numbers that back up the experiences of transgender youth, their families and the people who work in this field."
"We are adding to the evidence base that shows why gender-affirming care is beneficial from a mental health perspective.”