Psychosocial Effects of Gender Affirming Care on Young Patients
In the last decade, there has been an increase in the number of clinics offering gender affirming care. Gender affirming care deals with gender dysphoria, which is the discomfort that arises when the physical characteristics of someone’s biological sex do not match their desired gender identity. Usually, gender affirming care involves giving patients gonadotropin-releasing hormone (GnRH) agonists, which are hormones that prevent the sex organs from releasing hormones. This treatment has many uses, one of which is delaying puberty because this period in development may cause discomfort for a child seeking gender affirming care. Additionally, doctors can also administer reproductive hormones to induce the secondary sex characteristics desired by the patient. It is important to measure how gender affirming care impacts the physical and mental health of patients, so patients and parents can give informed consent. Previous studies that analyzed the psychosocial effects, or psychological and social well-being, of gender affirming medical care have been limited, as they had small sample sizes or were relatively short-term studies.
Gonadotropin-Releasing Hormone (GnRH) agonists are given at 1, 3, 6, or 12 months at a time through syringe injection or a hormonal patch. These GnRH agonists prevent the release of Follicle stimulating Hormone (FSH) and Luteinizing Hormone (LH), which then prevents the release of estrogen and testosterone respectively.
Image Source: Karolina Kaboompics
A recent study published in the New England Journal of Medicine aimed to give a higher-quality analysis of the effects of gender affirming care. The research team observed 315 patients from 12 to 20 years old that were currently receiving gender affirming care. Around two-thirds of the participants were transmasculine, meaning they are biologically female but identify their gender as more masculine, and a third were transfeminine, who are biologically male but identify their gender as more feminine. They measured several changes, including gender appearance congruence, in which participants rate their satisfaction on their change in physical appearance. They also measured the positive affect of the patients, life satisfaction, depression, and anxiety by doing 5 follow-up studies with participants over 2 years. The researchers found that during the study period, appearance congruence increased, the positive affect of the patients increased, life satisfaction increased, depression decreased, and anxiety decreased. These improvements were small (about a 1 to 2 point increase out of 100 points on the scales used in the study) but significant. Also, they found that participants given gender-affirming hormones (GAH) earlier in puberty had greater improvements in life satisfaction, positive affect, appearance congruence, depression, and anxiety. However, only transmasculine participants showed significant decreases in depression and anxiety. Unfortunately, 3.5 percent of the participants had suicidal thoughts, and 2 participants died by suicide during the study.
The researchers discussed some possible meanings and takeaways from these results. Because gender appearance congruence improved along with life satisfaction and positive effect, they suggest this provides evidence that gender appearance congruence directly improves mental health. They also suggested that only transmasculine participants had a significant decrease in depression and anxiety because of the difference in hormones given to transmasculine and transfeminine teenagers. Estradiol, which promotes the development of traditionally female traits, acts slower than testosterone, which promotes the development of traditionally male traits. Since this study took place only over 2 years, it may not have captured the effects of estradiol over a longer period of time. Additionally, greater social acceptance of transmasculine individuals may affect their positive outcomes. However, this study and conclusion have limitations: there was large variability in the psychosocial outcomes, the study did not have a control. The researchers still claim that their findings support the use of GAH as effective gender affirming care, but in the future, studies over longer periods are needed to better inform doctors, researchers, and prospective patients.
The researchers discussed some possible meanings and takeaways from these results. Because gender appearance congruence improved along with life satisfaction and positive effect, they suggest this provides evidence that gender appearance congruence directly improves mental health. They also suggested that only transmasculine participants had a significant decrease in depression and anxiety because of the difference in hormones given to transmasculine and transfeminine teenagers. Estradiol, which promotes the development of traditionally female traits, acts slower than testosterone, which promotes the development of traditionally male traits. Since this study took place only over 2 years, it may not have captured the effects of estradiol over a longer period of time. Additionally, greater social acceptance of transmasculine individuals may affect their positive outcomes. However, this study and conclusion have limitations: there was large variability in the psychosocial outcomes, the study did not have a control. The researchers still claim that their findings support the use of GAH as effective gender affirming care, but in the future, studies over longer periods are needed to better inform doctors, researchers, and prospective patients.
Featured Image Source: Pixabay
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