1. In multivariable analysis based on survey data, transgender adults who wanted and received pubertal suppression therapy had lower odds of lifetime suicidal ideation, compared with transgender adults who wanted but did not receive the therapy.
2. Overall, very few (2.5%) of the respondents who had wanted pubertal suppression received it. Those who were younger, had greater family support of gender identity, and higher total household income were more likely to have received pubertal suppression if they had wanted it.
Evidence Rating Level: 3 (Average)
Study Rundown: Previous studies have demonstrated that transgender youth suffer from elevated risk of suicidality and internalizing psychopathology. Gender-affirming interventions, including “puberty blocking” treatments based on gonadotropin-releasing hormone analogues, have been developed for transgender adolescents, but few studies have examined the association between these treatments and mental health. In this cross-sectional study, researchers used national survey data of transgender adults aged 18 to 36 years from the 2015 US Transgender Survey to study the relationship between pubertal suppression and adult mental health outcomes, including measures of suicidality and substance use. After adjusting for socioeconomic traits, individuals who had received pubertal suppression had significantly lower odds of lifetime suicidal ideation when compared with individuals who had wanted but did not receive the intervention.
This study was limited by its cross-sectional design, and reverse causation cannot be ruled out. Nonetheless, the study is strengthened by its large, nationally-representative data set. For physicians, these findings highlight the importance of making pubertal suppression therapy available to transgender adolescents who want it.
In-Depth [cross-sectional study]: Researchers used survey data from the 2015 US Transgender Survey from the National Center for Transgender Equality. Participants included 20 619 transgender adults aged 18 to 36 years recruited through community outreach. Surveys were conducted online and anonymously and collected data on socioeconomic traits, past desire for and use of puberty blocking hormones, and adult mental health outcomes, including past-month severe psychologic distress, lifetime illicit drug use, and past-year and lifetime suicidal ideation, plan, and attempts. Multivariable logistic regression was used to examine associations between pubertal suppression and adult mental health outcomes.
Of the survey respondents included in the sample, 16.9% reported that they have ever wanted pubertal suppression, while only 89 (2.5%) of these respondents reported having received this treatment. After adjusting for socioeconomic traits, including family support, sexual orientation, education level, and total household income, individuals who received pubertal suppression had decreased odds of lifetime suicidal ideation (adjusted odds ratio [aOR]: 0.3; 95% confidence interval [CI]: 0.2-0.6), when compared with those who wanted pubertal suppression but did not receive it. There were no significant differences between individuals who did and did not receive pubertal suppression in mental health and substance use in multivariable analyses.
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