Gender-affirming hormones improve psychosocial functioning in transgender youth

1. In this prospective cohort study, gender-affirming hormone (GAH) treatment was associated with improved positive affect and life satisfaction in transgender youth. 

2. GAH treatment was also associated with decreased depression and anxiety symptoms.

Evidence Rating Level: 2 (Good)

Study Rundown: GAH are used to alleviate gender dysphoria for transgender and nonbinary youth by increasing appearance congruence. GAH are important interventions that improve psychosocial functioning in transgender and non-binary youth and lead to enduring improvements over time. In this prospective cohort study following transgender youth on GAH significant improvement occurred in appearance congruence, positive affect, and life satisfaction. Additionally, depression and anxiety scores significantly decreased over time. Increases in appearance congruence were associated with a decrease in depression and anxiety scores and an increase in positive affect and life satisfaction scores over time. Youth who initiated GAH early in puberty had higher scores for appearance congruence, positive affect, and life satisfaction at baseline than those who initiated GAH later. Youth who initiated GAH later in puberty saw greater improvements in appearance congruence than those initiating GAH early in puberty. A limitation of the study is that although significant improvements were observed for youth on GAH, there remains a large variability, and some did not improve. It is prudent to examine other important factors that affect transgender and nonbinary youth beyond access to gender-affirming care.

Click to read the study in NEJM

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In-Depth [prospective cohort study]: This prospective, observational cohort study examined the psychosocial functioning of transgender and nonbinary youth after 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 treatment initiation. A total of 291 participants had longitudinal data on primary outcome variables available. Significant within-participant improvements were observed for all psychosocial outcomes (Wilk’s lambda, 0.32; p<0.001). Increases in appearance congruence (annual 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, 1.64 to 3.00) were observed. Decreases were observed for depression (annual change on a 63-point scale, -1.27; 9% CI, -1.98 to -0.57) and anxiety scores (annual change on a 100-point scale, -1.46; 95% CI, -2.13 to -0.79) over the two-year treatment period. Increases in appearance congruence were associated with decreases 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). Initiation of GAH early in puberty had higher scores for appearance, congruence, positive affect, and life satisfaction at baseline. Youth initiating GAH later in puberty had greater improvements in appearance congruence than those initiating GAH early in puberty. In summary, the present study found that GAH improved the quality of life of youth over a period of two years.

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