Just out: Study of trans adolescents confirms puberty blockers and HRT are associated with improved mental health

The use of puberty blockers and cross-sex hormone therapy for trans adolescents is not a new or recent development, and this protocol has been in use since the mid-1990s. Clinical data on outcomes in this population is abundant: numerous studies of trans youth who’ve taken puberty blockers have shown significant reductions in gender dysphoria, depressive and anxious symptoms, self-harm, and suicidality, along with improvements in body satisfaction and overall psychological functioning and quality of life. Despite uninformed depictions in the press as an untested treatment fraught with unknowns, adolescent transition has consistently been found to have strong beneficial effects for gender-dysphoric youth, and major medical and pediatric organizations endorse this as a suitable and necessary treatment for appropriately evaluated youth.

This is hardly so new that nobody knows what it does. So the latest study of this treatment by Tordoff et al. (2022) simply adds further confirmation to a large existing body of evidence that clearly points in one direction: adolescent transition helps trans youth.

The authors followed a cohort of 104 youth ages 13-20 at Seattle Children’s Gender Clinic for a period of 12 months, with 66.3% of these youth having received puberty blockers and/or HRT after one year and 33.7% receiving neither. Participants were given the PHQ-9 measure of depression and thoughts of self-harm or suicide and the GAD-7 scale of anxiety symptoms at baseline, 3 months, 6 months, and 12 months. This provided an opportunity to compare the rates of these symptoms among youth who received treatment and who did not.

All of these symptoms were extremely common among these youth at baseline, with 56.7% having moderate-to-severe depression, 50% having moderate-to-severe anxiety, and 43.3% reporting recent thoughts of self-harm or suicide. At 12 months followup, controlling for confounders, those youth who received medical treatment were only 40% as likely as those who did not to experience moderate-to-severe depression (p = .04, 95% CI 0.17–0.95), and only 27% as likely to have recent thoughts of self-harm or suicide (p = .003, 95% CI 0.11–0.65). However, no difference was seen in the frequency of moderate-to-severe anxiety. The authors note that the mental health benefits of transition for adolescents may be most prominent in the reduction of depression and suicidality:

A recent cohort study of TNB youths in Dallas, Texas, found that total anxiety symptoms improved over a longer follow-up of 11 to 18 months; however, similar to our study, the authors did not observe statistically significant improvements in generalized anxiety. This suggests that anxiety symptoms may take longer to improve after the initiation of gender-affirming care. In addition, Olson et al found that prepubertal TNB children who socially transitioned did not have increased rates of depression symptoms but did have increased rates of anxiety symptoms compared with children who were cisgender. Although social transition and access to gender-affirming medical care do not always go hand in hand, it is noteworthy that access to gender-affirming medical care and supported social transition appear to be associated with decreased depression and suicidality more than anxiety symptoms.

This study, like other studies before it, shows that gender-affirming treatment does have a significantly positive effect on these youth, and often makes the difference between feeling hopeless and feeling alive, between wanting to die and wanting to survive. Transition helps trans youth survive. Studies like these provide evidence that constrains what “child abuse” looks like in an environment where that important notion is all too often misused by the baseless, antiscientific and overreaching policy dictates of the Texas state government and beyond. And these are not the outcomes of abusers. ■