Study: Gender-affirming hormones improve mental health in transgender and nonbinary youth
Evidence from largest study in U.S. on the impact of gender-affirming hormones, with longest follow-up
Peer-Reviewed PublicationTransgender and nonbinary youth experienced significant improvement in appearance congruence (or the degree to which physical characteristics align with gender) and sustained improvements in depression and anxiety over two years after starting treatment with gender-affirming hormones, according to a multicenter U.S. study funded by the National Institutes of Health (NIH) and published in the New England Journal of Medicine.
“Our results provide robust scientific evidence that improved appearance congruence secondary to hormone treatment is strongly linked to better mental health outcomes in transgender and nonbinary youth,” said lead author Diane Chen, PhD, pediatric psychologist with the Gender and Sex Development Program at Ann & Robert H. Lurie Children’s Hospital of Chicago and Associate Professor at Northwestern University Feinberg School of Medicine. “This is critical, given that transgender youth experience more depression and anxiety, and are at a higher risk for suicidality than cisgender youth.”
Many transgender or non-binary teens experience gender dysphoria, or the persistent distress caused by the discrepancy between their gender identity and physical appearance. Gender-affirming hormones (testosterone or estradiol) are used as treatment to foster gender-congruent secondary sex characteristics, such as breast development or facial hair.
"The critical results we report demonstrate the positive psychological impact of gender-affirming hormones for treatment of youth with gender dysphoria,” said senior author Johanna Olson-Kennedy, MD, Medical Director of the Center for Transyouth Health and Development at Children’s Hospital Los Angeles. “Amidst a landscape of misinformation, we hope these findings support the use of timely and appropriate medical interventions for this vulnerable group of adolescents."
All the centers participating in the study employ a multidisciplinary team, comprising medical and mental health providers, that collaboratively determines whether gender dysphoria is present and gender-affirming medical care is appropriate. For minors, parental consent is required to initiate medical treatment.
“The positive findings of this observational study match the lived clinical experience of mental health experts who, in their many years of providing gender-affirming care, have repeatedly learned from the youth themselves about their mental health,” said co-author Diane Ehrensaft, PhD, Director of Mental Health at the UC San Francisco Child and Adolescent Gender Center, and Professor of Pediatrics. “As the longitudinal study proceeds, we look forward to learning more from this cohort of patients – all of whom were screened carefully before beginning gender-affirming hormone treatment – about their journey going forward.”
The study, the largest of its kind in the U.S., included 315 transgender and non-binary youth ages 12-20 years. Study visits occurred every six months for two years after treatment initiation, which is the longest follow-up reported to date. Researchers examined measures of appearance congruence, depression, anxiety, positive affect and life satisfaction.
They found that overall, appearance congruence, positive affect, and life satisfaction increased, while depression and anxiety symptoms decreased. Appearance congruence was associated with each psychosocial outcome assessed at baseline and during the follow-up period.
"Our results provide a strong scientific basis that gender-affirming care is crucial for the psychological well-being of our patients,” said co-author Robert Garofalo, MD, MPH, Principal Investigator for the study at Lurie Children’s, Co-Director of Lurie Children’s Gender and Sex Development Program and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “We must ensure that access to this care remains available to youth with gender dysphoria.”
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD082554).
About Lurie Children’s
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine.
About Children’s Hospital Los Angeles
Children’s Hospital Los Angeles is at the forefront of pediatric medicine, offering acclaimed care to children from across the world, the country and the greater Southern California region. Founded in 1901, Children’s Hospital Los Angeles is the largest provider of care for children in Los Angeles County, the No. 1 pediatric hospital in the Pacific region and California, and among the top 10 in the nation on U.S. News & World Report’s Honor Roll of Best Children’s Hospitals. Clinical expertise spans the pediatric care continuum for newborns to young adults, from everyday preventive medicine to the most advanced cases. Inclusive, kid- and family-friendly clinical care is led by physicians who are faculty members of the Keck School of Medicine of USC, and proven discoveries reach patients faster through The Saban Research Institute of Children’s Hospital Los Angeles—among the top 10 children’s hospitals for National Institutes of Health funding. The hospital also is home to the largest pediatric residency training program at a freestanding children’s hospital in the western United States. To learn more, follow us on Facebook, Instagram, LinkedIn, YouTube and Twitter, and visit our blog at CHLA.org/blog.
About UCSF Health
UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is ranked among the top 10 hospitals nationwide, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit https://www.ucsfhealth.org/. Follow UCSF Health on Facebook or on Twitter
JOURNAL
New England Journal of Medicine
Do sexual orientation and gender
identity affect your stroke risk?
Peer-Reviewed PublicationUCSF-ZSFG Study Suggests ‘Non-Traditional’ Factors Drive Higher Rates
People who identify as lesbian, gay, bisexual, transgender or non-binary may have a higher risk for stroke at a younger age, as well as a possible higher risk for recurrence than those who identify as straight and cisgender, according to a small study in San Francisco.
Researchers from UC San Francisco and Zuckerberg San Francisco General Hospital (ZSFG) reviewed the medical records of 26 stroke patients who identified as sexual and gender minorities and compared them with 78 age-matched stroke patients who were not sexual and gender minorities. Findings appear in Neurology Clinical Practice on Jan. 18, 2023.
While stroke subtypes and traditional stroke risks, such as smoking, hypertension and diabetes, were similar for both groups, the sexual and gender minority patients were more likely to have “non-traditional stroke risks.” These included HIV and current or previous history of syphilis and hepatitis C, conditions that can increase stroke risk as a result of inflammation and blockage of blood vessels.
“While positivity rates were higher for substance abuse, as well as HIV, hepatitis C and syphilis for people in the sexual and minority group, they were more likely to be tested, which may account for them,” said senior author, Nicole Rosendale, MD, a neurohospitalist in the UCSF Department of Neurology and ZSFG.
Of those patients tested for HIV, 8 of the 23 (34.8%) in the sexual and gender minority group were positive, versus none of the 36 patients in the non-minority group. For hepatitis C, 4 of 14 (28.5%) patients tested in the minority group had or had had the virus, compared with 4 of 19 (21%) in the non-minority group. Among those tested for syphilis, 5 of the 19 (26.3%) had or had had syphilis in the minority group, versus none of 25 tested patients in the non-minority group.
The minority group also had a higher rate of substance use, itself a risk factor for all three conditions, with 11 of 18 (61.1%) testing positive for substances in urine tests during their hospital admissions, compared with 19 of 56 (33.9%) in the non-minority group.
Due to the limited number of minority patients in the study, researchers were unable to link specific subgroups to risks, said Rosendale, who is also affiliated with the UCSF Weill Institute for Neurosciences.
“Previous studies have shown that the prevalence of HIV and syphilis is highest in transgender women, and in gay and bisexual cisgender men. Stroke risk appears to be higher in lesbian women than in straight women, with one study showing that they had higher rates of self-reported stroke,” Rosendale said. “There may be many reasons for this – higher rates of smoking, higher prevalence of obesity, effects of discrimination on vascular health and limited access to health care.”
While the average age of stroke patients at the study hospital was 69, the average age of the sexual and gender minorities group was 55.
The researchers also discovered that the minority group was more likely to experience recurrent stroke, despite similar follow-up rates as the non-minority group. “Future research will need to explore the drivers of recurrent stroke, including the role of minority stress,” said Rosendale. “Stigma, prejudice and discrimination create an inherently stressful environment that translates into health issues.”
Co-Authors: Corresponding author is Michael Diaz, MD, clinical fellow in the UCSF Department of Neurology.
Funding: UCSF Academic Research Systems, the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR991872.
About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is ranked among the top 10 hospitals nationwide, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit https://www.ucsfhealth.org/. Follow UCSF Health on Facebook or on Twitter
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JOURNAL
Neurology Clinical Practice
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