Psychosocial Functioning in Transgender Youth after 2 Years of Hormones

Diane Chen; Johnny Berona; Yee-Ming Chan; Diane Ehrensaft; Robert Garofalo; Marco A Hidalgo; Stephen M Rosenthal; Amy C Tishelman; Johanna Olson-Kennedy

doi:10.1056/NEJMoa2206297

Psychosocial Functioning in Transgender Youth after 2 Years of Hormones

N Engl J Med. 2023 Jan 19;388(3):240-250. doi: 10.1056/NEJMoa2206297.

Authors

Diane Chen¹, Johnny Berona¹, Yee-Ming Chan¹, Diane Ehrensaft¹, Robert Garofalo¹, Marco A Hidalgo¹, Stephen M Rosenthal¹, Amy C Tishelman¹, Johanna Olson-Kennedy¹

Affiliation

¹ From the Gender and Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine (D.C., R.G.), and the Pritzker Department of Psychiatry and Behavioral Health (D.C.), Ann and Robert H. Lurie Children's Hospital of Chicago, the Departments of Pediatrics (D.C., R.G.) and Psychiatry and Behavioral Sciences (D.C., J.B.), Northwestern University Feinberg School of Medicine, and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University (J.B.) - all in Chicago; the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital (Y.-M.C.), and the Department of Pediatrics, Harvard Medical School (Y.-M.C.), Boston, and the Department of Psychology and Neuroscience, Boston College, Newton (A.C.T.) - all in Massachusetts; the Department of Pediatrics, Division of Pediatric Endocrinology (D.E., S.M.R.), and the Child and Adolescent Gender Center, Benioff Children's Hospital (D.E., S.M.R.), University of California, San Francisco, San Francisco, and the Gender Health Program, UCLA Health (M.A.H.), and the Division of General Internal Medicine and Health Services Research, Medicine-Pediatrics Section, Department of Medicine, David Geffen School of Medicine (M.A.H.), University of California, Los Angeles, the Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles (J.O.-K.), and the Department of Pediatrics, Keck School of Medicine, University of Southern California (J.O.-K.), Los Angeles - all in California.

Abstract

Background: Limited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol).

Methods: We characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory-II, the Revised Children's Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome.

Results: A total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants.

Conclusions: In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.).

Publication types

Multicenter Study
Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Child
Estradiol
Female
Gender Identity*
Gonadal Steroid Hormones* / therapeutic use
Humans
Male
Prospective Studies
Psychosocial Functioning*
Testosterone / therapeutic use
Transgender Persons* / psychology
Young Adult

Substances

Testosterone
Estradiol
Gonadal Steroid Hormones

Grants and funding

R01 HD082554/HD/NICHD NIH HHS/United States