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Trans Teens Benefit From Gender-Affirming Care

In the largest study of its kind in the US, researchers found that gender-affirming hormones have a positive effect on transgender teens’ mental health: The more trans teens’ appearance aligned with their gender identity, the more satisfied they were in life and the less depressed and anxious they felt.

The study, published this week in the New England Journal of Medicine, should be seen as an important scientific counterpoint to the relentless political attacks on the rights of trans youth.

A recent analysis by NPR found that 86% of the more than 300 bills targeting trans people were squarely focused on trans youth. Those laws typically aim to restrict trans teens’ access to sports, prevent them from using the bathroom that aligns with their gender identity, or deny access to gender-affirming health care. Although the courts have generally — but not always — struck down these bills, new ones keep popping up.

These laws are put forth under the guise of protecting children. For example, Georgia Representative Marjorie Taylor Greene, when proposing a bill that would make it a felony to provide gender-affirming care to someone under the age of 18, compared medical interventions for gender dysphoria to child abuse.

But this never-ending game of legal Whac-A-Mole — and the increasingly hostile environment for trans people it fosters — is causing the real harm. Worrying about their safety out in the world alongside the specter of losing access to vital healthcare is creating incredible stress for trans teens and their families. In a survey conducted last year by the Trevor Project, nearly all trans and nonbinary adolescents and teens said they were worried about the consequences of anti-transgender legislation.

Trans and nonbinary youth are already known to experience higher levels of depression and anxiety than their peers. Some 65% of that group reported symptoms of depression in the Trevor Project survey, compared to 47% among cisgender participants — worse, one in five trans or nonbinary teens said they had attempted suicide in the previous year. Canadian researchers have reported similarly dire findings: Trans adolescents were 7.5 times as likely to have attempted suicide as their cisgender, heterosexual peers.

This new study suggests comprehensive health care could alleviate those symptoms. Researchers at four leading children’s hospitals enrolled more than 300 transgender and nonbinary youth, who were followed regularly for two years after beginning hormone therapy to affirm their gender identity. During that time, as their appearance increasingly matched their gender identity, so did their overall well-being — an effect that was sustained over the two years.

The benefit was more pronounced for teens designated female at birth, who accounted for 60% of trial participants. More research is needed, but the team’s hypothesis is those better results come from the more immediate or noticeable effect of taking testosterone, for example, on deepening someone’s voice. By contrast, estrogen-mediated changes can take anywhere from two to five years to be fully realized.

This work confirms what earlier, smaller, shorter-term studies have found, and is a helpful companion to growing evidence that teens who opt for gender-affirming hormones are committed to that choice. In October, a large study conducted in the Netherlands showed that 98% of teens who begin hormone therapy continue it into adulthood. Their findings align with what doctors who treat trans teens report seeing in their practices: trans youth rarely change their mind about treatment. 

That isn’t a surprise for people who regularly treat trans teens. The decision to start puberty-suppressing hormones or gender-affirming treatment is not one the families or medical team caring for teens take lightly. Wait times for gender clinics can be years long, and teens then undergo months of evaluation by behavioral health and medical specialists before drugs are prescribed.

In an editorial accompanying this week’s study, two researchers in the Netherlands who have led oft-cited large studies of trans adolescents point out a few pressing questions that still need to be addressed when it comes to trans youth. One of those is about the need to better understand whether outcomes differ based on the age someone starts therapy (a younger versus older teen). And a larger body of research is needed about the long-term effects of hormone therapy on health issues like bone density and fertility.

To be clear, their questions are mainly about determining the best way to deliver care to teens — not about the value of treatment itself. In fact, the researchers conclude that the US team’s research adds to the growing body of evidence that kids’ mental health improves with gender-affirming hormone treatment, and can be adversely affected by denying it.

There’s no question that researchers need to continue to understand the best way to help transgender youth lead their happiest and healthiest lives. But as evidence grows of the benefits of gender-affirming hormones, political efforts to ban them in order to “protect” kids are becoming increasingly disingenuous.  

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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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