Abstract
ObjectiveTo examine associations between recalled access to gender-affirming hormones (GAH) during adolescence and mental health outcomes among transgender adults in the U.S.MethodsWe conducted a secondary analysis of the 2015 U.S. Transgender Survey, a cross-sectional non-probability sample of 27,715 transgender adults in the U.S. Using multivariable logistic regression adjusting for potential confounders, we examined associations between access to GAH during early adolescence (age 14–15), late adolescence (age 16–17), or adulthood (age ≥18) and adult mental health outcomes, with participants who desired but never accessed GAH as the reference group.Results21,598 participants (77.9%) reported ever desiring GAH. Of these, 8,860 (41.0%) never accessed GAH, 119 (0.6%) accessed GAH in early adolescence, 362 (1.7%) accessed GAH in late adolescence, and 12,257 (56.8%) accessed GAH in adulthood. After adjusting for potential confounders, accessing GAH during early adolescence (aOR = 0.4, 95% CI = 0.2–0.6, p < .0001), late adolescence (aOR = 0.5, 95% CI = 0.4–0.7, p < .0001), or adulthood (aOR = 0.8, 95% CI = 0.7–0.8, p < .0001) was associated with lower odds of past-year suicidal ideation when compared to desiring but never accessing GAH. In post hoc analyses, access to GAH during adolescence (ages 14–17) was associated with lower odds of past-year suicidal ideation (aOR = 0.7, 95% CI = 0.6–0.9, p = .0007) when compared to accessing GAH during adulthood.ConclusionAccess to GAH during adolescence and adulthood is associated with favorable mental health outcomes compared to desiring but not accessing GAH.
Highlights
A recent representative sample of adolescents in the United States (U.S.) found that 1.8% identified as transgender [1]
Demographic and other potential confounding variables that are known to be associated with adverse mental health outcomes among transgender people were collected for participants and included age at time of survey completion (U.S census categories), gender identity, sex assigned at birth, sexual orientation, race/ethnicity (U.S census categories), level of family support for gender identity [22], relationship status, level of education, employment status, household income, having ever received pubertal suppression [8], having ever been exposed to gender identity conversion efforts [23], and having experienced any harassment based on gender identity in K-12 [5]
Significant differences were found based on age at time of study participation, gender identity, sex assigned at birth, sexual orientation, race/ethnicity, family support of gender identity, relationship status, level of education, employment status, household income, having ever received pubertal suppression, having ever been exposed to gender identity conversion efforts, and having experienced verbal, physical, or sexual harassment based on gender identity in K-12 (Table 1)
Summary
A recent representative sample of adolescents in the United States (U.S.) found that 1.8% identified as transgender [1] These young people face a range of mental health disparities, including elevated rates of anxiety, depression, and suicide attempts [2]. Gender minority stress refers to the ways in which society’s mistreatment of transgender people results in worse mental and physical health outcomes. This includes distal factors (gender-related discrimination, gender-related rejection, gender-related victimization, and nonaffirmation of gender identity), as well as subsequent proximal factors (internalized transphobia, negative expectations, and concealment) [4]. Creating safe and affirming social environments for transgender adolescents is considered paramount in preventing adverse mental health outcomes [5]
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