Access to Gender-Affirming Care Improves Psychosocial Functioning

On January 19, 2023, the New England Journal of Medicine published a study noting that access to gender-affirming care was correlated with improved psychosocial functioning in teens and young adults. Investigators concluded that access to care was critical for improving mental health.

The study focused on transgender and nonbinary youth between the ages of 12 and 20 who received gender-affirming hormones (GAH) such as testosterone or estradiol. Participants were followed for two years after GAH initiation and were observed for physical and psychosocial outcomes.

Psychosocial outcomes were quantified based on their completion of the Transgender Congruence Scale, Beck Depression Inventory-II, Revised Children’s Manifest Anxiety Scale, and Positive Affect and Life Satisfaction measure from the NIH. These questionnaires and assessments were completed at baseline, 6 months, 1 year, 18 months, and 2 years.

Among 315 transgender and nonbinary participants, feelings of appearance congruence, positive affect, and life satisfaction improved across the two years. Researchers noted a positive correlation between appearance congruence, positive affect, and life satisfaction, meaning that as appearance congruence improved, so did the other two. Conversely, participants also had decreased depression and anxiety symptoms.

Adverse side effects following GAH were minimal, with the most common side effect, suicidal ideation, affecting 3.5% of participants. Two participants died by suicide during the study.

Researchers concluded, “In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning.”

These results support the need to widen access to gender-affirming care. The recent political climate surrounding gender-affirming care has been a significant concern for transgender or nonbinary individuals and their providers. Bills introduced in 2021 have attempted to restrict and ban gender-affirming care, specifically for pediatric populations, with four states enacting the ban.

Based on the results of this study, these actions could have extreme and unfavorable outcomes for pediatric mental health, leading to increased rates of depression, anxiety, gender dysphoria, and more. Clinicians are encouraged to advocate for expanded access to care, citing evidence from studies, such as this one, explaining the importance of gender-affirming care.