Early care leads to better mental health for trans youths, study finds



Transgender children who receive gender-affirming medical care earlier in their lives are less likely to experience mental health issues like depression and anxiety, according to a new study published in the journal Pediatrics.

“The study highlights that timely access to gender-affirming medical care is really important for youth with gender dysphoria,” said the study’s lead author, Dr. Julia C. Sorbara, a pediatric endocrinologist at the Hospital for Sick Children in Toronto. Gender dysphoria involves a conflict between an individual’s sex assigned at birth and their gender identity.

The study found that transgender youths who sought that type of care — which, for minors, most commonly includes puberty blockers, hormones or both — at a later age and further into puberty were more distressed and more likely to suffer from mental health issues.

“A major part of puberty is developing physical changes, and for youth with gender dysphoria, they begin to develop physical changes that are not in keeping with the gender they identify,” Sorbara said. “This can be very distressing for these young people.”

The study included 300 transgender minors aged 10 to 17 who were being treated at the Hospital for Sick Children. The researchers tracked their ages at the time they first sought care at the Toronto clinic and their reported difficulties with mental health.

More than three-quarters of the youths who went to Sorbara’s clinic reported mental health problems, including depression and anxiety, according to the study.

“The most common were depressive and anxiety disorders, as well as having considered suicide at some point — unfortunately not so out of keeping with what’s been reported from other clinics,” Sorbara said.

Researchers found that those issues were more likely the older the children were when they arrived at the clinic. When compared to children ages 10 to 15, children older than 15 were more likely to have reported diagnoses of depression (46 percent vs. 30 percent) and to have self-harmed (40 percent vs. 28 percent), considered suicide (52 percent vs. 40 percent), attempted suicide (17 percent vs. 9 percent) and required psychoactive medications (36 percent vs. 23 percent).

Sorbara’s study follows another study, also published in Pediatrics, that found that transgender individuals who received puberty blockers during adolescence had lower risks of suicidal thoughts as adults than those who wanted the medication but could not get access to it.

Suicide is a significant problem facing transgender children and adults. The 2020 National Survey on LGBTQ Youth Mental Health by The Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization, found that 40 percent of LGBTQ youths said they have “seriously considered” attempting suicide in the past year.

A 2019 report from the Williams Institute at the UCLA School of Law found a connection between experiences of discrimination, including in medical care, and suicidality for transgender adults, with participants who had experienced discrimination being twice as likely to have attempted suicide compared to those who had not experienced discrimination.

Another recent study found that almost 60 percent of transgender adults were close to someone who has attempted suicide and 25 percent knew someone who had committed suicide and that such exposure has negative impacts on their mental health.

Sorbara also noted that participants in her team’s study were only those “who want to and can access care.” She said many transgender children and adolescents may want or would benefit from such care but are unable to get access to it. She said she hopes her study lends “support to efforts to ensure this care is readily available for the youth that need it.”

The ability of transgender youths to receive gender-affirming medical care has become a political issue, with several states considering measures this legislative session to block access to that type of care. Republican legislators in at least eight states have introduced proposals that would punish doctors and other medical professionals who provide the kind of gender-affirming medical care described in Sorbara’s study. Bills in Missouri and New Hampshire called such care “child abuse.”

In February, over 200 medical professionals signed a letter opposing the bills on the grounds that they “violate the rights and freedoms of transgender young people.”

“Many credible studies of trans youth populations have demonstrated that gender-affirming care is linked to significantly reduced rates of depression, anxiety, substance abuse and suicide attempts,” the letter says. “To put it plainly, gender-affirming care saves lives and allows trans young people to thrive.”

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