38.1 Mental Health Outcomes in Transgender and Gender Nonbinary Youth Receiving Gender-Affirming Care

Abstract

We sought to understand how the initiation of puberty blockers and gender-affirming hormones (GAH) were associated with changes in depression, anxiety, and suicidality over a 1-year period in a sample of transgender and nonbinary (TNB) adolescents enrolled in an urban multidisciplinary gender clinic. All new patients presenting to Seattle Children’s Gender Clinic for medical services over a 10-month period were recruited to complete assessments at baseline and 3-, 6-, and 12-month follow-up. Depression and anxiety were assessed via the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), which were then dichotomized into measures of moderate or severe depression and anxiety (scores ≥10). Any self-report of self-harm or suicidal thoughts over the past 2 weeks was assessed using PHQ-9 Question 9. We used generalized estimating equations to assess the change from baseline in each outcome at 3-, 6-, and 12-month follow-up. In addition, we estimated bivariate and multivariate logistic models to examine temporal trends and estimate the association between receipt of GAH or puberty blockers at each outcome. A total of 104 TNB youth between 13 and 20 years of age participated in the study. Of these youth, 84 (80.8%), 84 (80.8%), and 65 (62.5%) completed the 3-, 6-, and 12-month surveys, respectively. At baseline, 56.7% had moderate to severe depression, 50.0% had moderate to severe anxiety, and 43.3% reported self-harm or suicidal thoughts in the last 2 weeks. After adjusting for temporal trends and baseline covariates, we observed a 60% decrease in depression (aOR = 0.40; 95% CI, 0.17-0.95) and a 73% decrease in suicidality (aOR = 0.27; 95% CI, 0.11-0.65) associated with the receipt of GAH or puberty blockers. Changes in anxiety were not statistically significant. Gender-affirming medical interventions were associated with substantial improvement in both depression and suicidality over the 12-month period. While there are several limitations to this study, including likely a nonrandomized sample and a reliance on screening tools, this study is the largest and longest prospective study of TNB youth initiating gender-affirming care. Given this population’s high rates of mental health disparities, these data provide critical evidence that the expansion of access to gender-affirming care in youth may save lives.