This article was published on February 17th, 2022

Transgender people who start taking gender-affirming hormones in adolescence have better mental health outcomes than transgender people who start taking these hormones in adulthood, according to new research led by Stanford University School of Medicine.

The study, published on online journal PLOS One, examined the relationships between various factors in the lives of transgender people. The research shows that transgender individuals who began hormone treatment in adolescence are less likely to experience suicidal thoughts, major mental health disorders, or substance-abuse problems than those who begin hormone treatment in adulthood. 

Furthermore, transgender people of any age who have been prescribed hormones appear to have better mental health than those who wanted but never received hormone treatment.

Researchers used a sample of responses from over 27,000 survey respondents who had completed a questionnaire about their lives, with participants being at least 18 years old when they took the survey. However, not all transgender people favour hormone treatment; thus, the researchers focused on 21,598 participants who had stated that they wanted to receive hormones. 

Suicidal ideation

The findings revealed that 119 people started hormone therapy between the ages of 14 and 15 (early adolescence), 362 began it between ages 16 and 17 (late adolescence), 12,257 started it after turning 18 (adulthood), and 8,860 who, in addition to being the control group, wanted but did not receive hormone treatment.

Participants who underwent hormone treatment had lower odds of experiencing severe psychological distress and suicidal ideation than members of the control group. The odds of severe distress were 222% lower for those who began hormones at an early age, 153% lower in those who started at a later age, and 81% lower in those who began as adults. 

Previous-year suicidal ideation was 135% lower for early initiators, 62% lower for late initiators, and 21% lower among adults compared with control group members.

The study involved questions about participants’ mental health, including the severity of their suicidal thoughts and attempts and the frequency of their binge drinking and drug use. A questionnaire was used to determine whether the study volunteers had

experienced severe psychological distress within the past month, an indicator of a diagnosable mental illness.

Binge drinking 

“These results argue against waiting until adulthood to offer gender-affirming hormones to transgender adolescents and suggest that doing so may put patients at greater mental health risk,” said senior study author Dr. Alex S. Keuroghlian. “They also add to the growing evidence base suggesting that legislation restricting transgender adolescents’ access to gender-affirming medical care would result in adverse mental health outcomes,” he added.

Likewise, the research stated that individuals who began hormone therapy in early or late adolescence were less likely to engage in binge drinking and illicit drug use than those who started hormone therapy in adulthood.

“This study highlights that the U.S. has failed to make gender-affirming medical care accessible,” said lead study author Dr. Jack Turban, Chief Fellow in Child & Adolescent Psychiatry at the Stanford University School of Medicine. He added: “We urgently need to work on training more clinicians and combatting insurance discrimination.”

Turban further cautioned, however, that failing to provide transgender people with access to gender-affirming medical care could drive them to seek hormones on the black market, which could lead to serious health problems.