Study: Gender-affirming hormone therapy improves mental health

Gender-affirming hormone therapy not only improves the mental health of transgender, nonbinary, and gender-diverse people — it does so over the long term, according to a study published Monday in JAMA Network Open.

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The findings come at a time when gender-affirming care is under attack, especially for youth, but in some quarters for adults as well. And under an executive order from Donald Trump, the federal government no longer recognizes the existence of trans, nonbinary, and intersex people.

“In the US, transgender, nonbinary, and gender diverse (TGD) adults have high rates of depression,” the study explains. “Gender-affirming hormone therapy (GAHT) is associated with improved mental health outcomes, yet existing US studies have short follow ups and lack sample diversity.”

Studies on this issue “often rely on samples from specialized gender clinics, are homogeneous in sociodemographic characteristics, have relatively short follow-up periods, and do not consider the context of other TGD health disparities, such as high HIV burden,” the authors continue. “Data are lacking in clinical samples of TGD primary care settings and with diversity in terms of age, gender identity, race and ethnicity, socioeconomic characteristics, and HIV status.”

For their report, the authors looked at data from the Legacy study, tracking 3,592 adult trans, nonbinary, and gender-diverse primary care patients at two community health centers, Fenway Health in Boston and Callen-Lorde in New York City, with 48 months of follow-up. Both centers had long provided gender-affirming hormone therapy and didn’t have unnecessary barriers to care.

Those who were prescribed this therapy had a 15 percent lower risk of reporting moderate-to-severe depression symptoms throughout follow-up, compared with those who didn’t receive hormone therapy. “These findings highlight that the provision of GAHT in primary care settings using an informed consent model may improve moderate-to-severe depressive symptoms for TGD patients,” the researchers note.

“The consideration of gender identity differences in … depression and data related to GAHT prescribing is a novel contribution of this study, given that many public health surveillance efforts do not routinely collect TGD-specific information,” the authors write. “Indeed, transgender women and patients who were nonbinary assigned female sex at birth had a significantly increased risk of moderate-to-severe depressive symptoms compared with transgender men in the cohort.” Treatment therefore may need to be tailored for various groups within this population.

“Furthermore, the prevalence of moderate-to-severe depressive symptoms in this TGD cohort underscores the importance of universal screening for depression in this population accompanied by appropriate systems to ensure diagnosis, treatment, and follow-up for those with depressive symptoms,” the researchers add.

On the whole, “findings support the mental health–promoting role of GAHT and contribute to the evidence base that GAHT is a medically necessary treatment that improves mental health outcomes longitudinally for TGD people for those who want it,” the authors conclude. “Study findings highlight the importance of gender-affirming care models delivered in primary care settings, low-barrier access to GAHT for TGD patients, and integration of GAHT into primary care with other services to address TGD mental health inequities.”

The authors are affiliated with the University of Michigan, Harvard Medical School, the Harvard T.H. Chan School of Public Health, the Brown University School of Public Health, Fenway Health, Callen-Lorde, and other institutions.