Immediate access to gender-affirming hormone therapy eases distress, depression, suicidal thoughts for transgender adults, research finds

By Giri Viswanathan

(CNN) — Prompt access to hormone therapy can be a key tool in improving the mental health of transgender people, according to new research.

In the research, which was presented Sunday at the annual meeting of the Endocrine Society, a team of scientists at the University of Melbourne found that reducing the waiting period for gender-affirming testosterone therapy also lowered psychological distress called gender dysphoria among transgender adults. The study is undergoing peer review and has not yet been published.

The researchers also found a clinically significant decrease in depression, with over a 50% reduction in suicidality among study participants who didn’t have to wait to start hormone therapy.

“This is the world-first randomized clinical trial supporting the significant benefits of testosterone in reducing gender dysphoria, depression and suicidality in trans individuals desiring commencement of testosterone,” said lead study author Brendan Nolan, a Ph.D. candidate at the university, in a news release.

According to the American Psychiatric Association, gender dysphoria refers to the psychological distress that people who are transgender may experience due to the discrepancy between their gender identity and the sex they were assigned at birth.

People who are transgender experience high rates of depression and suicidal ideation because of issues like stigma, abuse and trouble accessing medical care, according to the 2015 US Transgender Survey. The survey, which included over 27,000 transgender adults across the United States, found that more than 40% had attempted suicide in their lifetime.

Nolan’s team examined the impact of accessible testosterone therapy on the mental health of 64 transgender adults who were seeking treatment to become more masculine. Gender-affirming hormone therapy like this is considered “medically necessary” by the World Professional Organization for Transgender Health’s Standards of Care.

The guidelines, which are considered the gold standard for transgender health care, recommend hormone therapy for transgender people “who wish this treatment due to demonstrated improvement in psychosocial functioning and quality of life.”

Nolan says there’s ample research to track the benefits that gender-affirming hormone therapy can have for gender dysphoria and depression. None of the studies, however, has compared a “group of trans people starting hormones to a group of trans people who want to be on hormones,” he told CNN.

During a three-month, open-label randomized control trial, the study participants were split into two groups: an “intervention group” in which participants were able to start testosterone therapy immediately and a cohort with a standard three-month waiting period. Participants’ mental health was screened via a questionnaire, called a PHQ-9, which assessed their risk of depression and suicide, according to an abstract of the study.

With a shorter waiting period for the intervention group, instead of a longer wait for the control group, none of the participants had to put off treatment for longer than the three-month standard waiting period, Nolan said.

Nolan’s team found that those who immediately began treatment showed decreased gender dysphoria and a clinically significant reduction in depression compared with those on the waiting list.

The researchers also found less suicidal ideation among the fast-tracked group: Thoughts of suicide resolved in 11 – or 52% – of the people receiving immediate testosterone therapy who had indicated suicidal ideation on their initial screening.

The same was true of only one participant given standard care.

Previously, Nolan noted, endocrinologists had no evidence to show the benefits of early access to testosterone. But his research helps change that, he says.

“I hope that it gets more doctors interested in the area,” he said, “and more doctors willing to prescribe testosterone, given that now we’ve got evidence to show the mental health benefits of early initiation of testosterone.”

The-CNN-Wire
™ & © 2023 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.