1. In this prospective cohort study, treatment with gender-affirming hormone (GAH) was associated with improved positive affect and life satisfaction in transgender youth.
2. GAH treatment was also associated with reduced symptoms of depression and anxiety.
Level of evidence rating: 2 (good)
Study overview: GAHs are used to alleviate gender dysphoria for transgender and nonbinary youth by increasing appearance congruence. GAHs are important interventions that improve psychosocial functioning in transgender and nonbinary youth and lead to sustained improvements over time. In this prospective cohort study that followed transgender youth at GAH, there were significant improvements in appearance congruence, positive affect, and life satisfaction. In addition, depression and anxiety scores decreased significantly over time. Increases in appearance congruence were associated with decreases in depression and anxiety scores and increases in positive affect and life satisfaction scores over time. Youth who started GAH early in puberty had higher appearance congruence, positive affect, and life satisfaction scores at baseline than those who started GAH later. Youth who started GAH later in puberty saw greater improvements in appearance concordance than those who started GAH early in puberty. A limitation of the study is that although significant improvements were observed in youth on the GAH, great variability remains and some did not improve. It is prudent to examine other important factors affecting transgender and nonbinary youth beyond access to gender-affirming care.
Click to read the study in NEJM
Relevant literature: Health coverage and care of transgender people – Threats and opportunities
In-Depth [prospective cohort study]: This prospective, observational cohort study examined the psychosocial functioning of transgender and nonbinary youth following GAH initiation. Latent growth curve modeling was used to examine individual trajectories of multiple psychosocial outcomes. Study visits occurred at baseline, 6, 12, 18, and 24 months after initiation of treatment. A total of 291 participants had available longitudinal data on the primary outcome variables. Significant within-participant improvements were observed for all psychosocial outcomes (Wilk’s lambda, 0.32; p<0.001). Increased appearance congruence (yearly increase on a 5-point scale, 0.48; 95% confidence interval [CI], 0.42 to 0.54), positive affect (annual increase on a 100-point scale, 0.80; 95% CI, 0.08 to 1.54), and life satisfaction (annual increase on a 100-point scale, 2 .32; 95% CI to 1.64 3.00). Reductions were observed in depression (63-point annual change, -1.27; 9% CI, -1.98 to -0.57) and anxiety scores (100-point annual change, -1.46; 9% CI, -1.98 to -0.57). 95% CI, -2.13 to -0.79) over the 2-year treatment period. An increase in appearance congruence was associated with a decrease in depression (r=-0.68) and anxiety (r=-0.52) scores. Increases in appearance congruence were also associated with increases in positive affect (r=0.74) and life satisfaction (r=0.84). GAH onset in early puberty had higher appearance, concordance, positive affect, and life satisfaction scores at baseline. Youth who started GAH later in puberty had greater improvements in appearance concordance than those who started GAH early in puberty. In summary, this study found that GAH improved youth quality of life over a two-year period.
Picture: PD
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