ODP414 Incidence of Suicidal Events in Transgender Patients with Initiation of Gender Affirming Hormone Therapy

Abstract

Abstract Objectives Our study aims to evaluate objective markers of suicidal events to further evaluate the relationship between incidence of suicidal events and initiation of gender affirming hormone therapy (HT). Introduction Transgender individuals are at higher risk for suicide compared with non-transgender individuals. Previous studies have revealed that a much higher percentage (18–45%) of transgender persons have attempted suicide in their lifetime, compared with the general population (4.6%). Methods We performed a retrospective chart review of adults at the local Veterans Administration (VA) from January 1, 2008 to December 31, 2020 of patient charts that include ICD-9 and ICD-10 code of F64. X, transgender, male-to-female transgender, female-to-male transgender, gender dysphoria, gender identity disorder, non-binary. Charts were reviewed for incidences of suicidal events defined as requiring hospitalizations, mental health crisis interventions, suicide attempts, and suicide completion. Charts were also reviewed for HT initiation, and mental health medication prescriptions. Data was compared using McNemar's Test or Chi Squared as appropriate. Results 106 patients were found with the ICD codes with an average age of 50 years (standard deviation (SD) 15). Of those, 93 (88%) have previously been prescribed or are currently prescribed HT with an average age of initiation of 41 years (SD 14). Among all patients studied 98 (92%) were diagnosed with a mental health disorder, 57 (54%) had a history of suicidal event, and 50 (47%) had history of mental health medication prescription. Of persons on HT 49 (53%) had a suicidal event prior to the initiation of hormone therapy compared with 31 (33%) who had suicidal events after initiation of HT which was statistically significant (p<0. 001). The most common suicidal event was hospitalization (41), followed by crisis interventions (27), suicide attempt (3), and suicide completion (1). Of all patients on HT: 39 (42%) had no suicidal events pre or post-HT, 5 (5%) had no suicidal events pre-HT but did have suicidal events post-HT, 23 (25%) had suicidal events pre-HT and no suicidal events post-HT, and 26 (28%) had suicidal events pre and post-HT (p<0. 001). Conclusions Among transgender patients at our local VA on HT the incidence of suicidal event prior to initiation of HT was higher than that after initiation of HT. History of suicidal event prior to initiation of HT predicted future incidence of suicidal event after initiation of HT. Potential confounders include mental health evaluation and treatment prior to initiation of HT, limited duration of follow up, age at HT initiation, and initiation of new mental health medication prescriptions.