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For transgender and nonbinary youth, having access to gender-affirming hormone therapy (GAHT) when they want it can greatly impact their odds of depression and significantly lower their risk of suicide.
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  • New research from The Trevor Project found that transgender and nonbinary youth under 18 who received gender-affirming hormone therapy (GAHT) had nearly 40 percent lower odds of depression this past year.
  • They also had a nearly 40 percent lower likelihood of suicide attempts.
  • The study also found that almost 80 percent of young people who received GAHT reported that they had at least one parent who also supported their gender identity.
  • The research highlights how access to gender-affirming care can greatly impact the mental and physical health of transgender and nonbinary youth.

A new peer-reviewed study from researchers at The Trevor Project highlights just how impactful access to gender-affirming hormone therapy (GAHT) can be for transgender and nonbinary youth.

Published today in the Journal of Adolescent Health, the study showed a link between access to GAHT and lower rates of depression, suicidal ideation, and suicide attempts among transgender and nonbinary youth in the United States.

Released during an era when harmful legislation in states throughout the country aim to ban access to this treatment for young people, this research underscores how necessary equity and access to gender-affirming care is, for both the mental health and overall health and well-being of transgender and nonbinary young people.

To calculate the data for this study, researchers from The Trevor Project turned to their 2021 National Survey on LGBTQ Youth Mental Health, which was conducted online between October 12, 2020 and December 31, 2020. It surveyed a total of 34,759 LGBTQ youth between 13 and 24 years old.

Out of that number, 11,914 identified as being transgender or nonbinary, and 9,019 of that number provided data on GAHT. (The Trevor Project reports that “transgender and nonbinary” is an umbrella term that incorporates a wide variety of identities for noncisgender people.)

The researchers found that half of all transgender and nonbinary respondents said they were not using GAHT but would like to use such therapies, while 36 percent said they were not interested in GAHT. Additionally, 14 percent were already receiving GAHT.

One of the most striking findings is that transgender and nonbinary youth who were receiving GAHT showed a lower chance of experiencing depression recently as well as considering suicide compared to youth who wanted access to GAHT but did not receive it.

The Trevor Project reveals that young people under 18 who received GAHT had nearly 40 percent lower odds of both depression or attempting suicide within the past year.

Tied closely to this issue of access is parental or guardian support. The study shows that almost 80 percent of young people who received GAHT reported that they had at least one parent who also supported their gender identity.

As has been evidenced across the board, in all aspects of American healthcare, racial disparities are deeply embedded in who ultimately gets access to this kind of medical therapy.

Young People of Color showed lower rates of access to GAHT when they wanted it compared to their white peers.

Amy Green, PhD, vice president of research for The Trevor Project, told Healthline that past studies on GAHT access have been clinical, looking at small samples of young people and charting their experiences over time.

Those smaller scale studies have shown that receiving GAHT and gender-affirming care have shown increase in body satisfaction as well as lower rates of depression, but they haven’t often included comparison groups to offer a more comprehensive, big-picture look at the mental health impact that access, or lack of access, to GAHT can have on a young person.

This also includes people who wanted this kind of care but didn’t receive or couldn’t receive it.

She said this new study offers a nuanced, comprehensive look and offers a roadmap to how we can discuss and tackle improved access to GAHT for young people moving forward.

Green said “one of the stronger findings” in the study is the benefits experienced by those youth who reported having the support of their gender identity from parents compared to youth who experienced a lack of support.

Green said we “need to find ways to provide better education and support and information to parents” because it’s not only a “huge protective factor” for the mental health of transgender and nonbinary youth, but is also a necessity for them to have access to the care they need, particularly for minors.

She said that if medical professionals and society at large targets this issue of parental and guardian support and acceptance of their child’s gender identity, if we address it as a key factor in the mental health challenges that can stem from gender dysphoria, we’ll be doing a great service to our trans and nonbinary youth in this country.

“If they can have that [parental] support, then in terms of their mental health, they can be better kept safe from rejection, which is one of our big risk factors, and they can then have better access to medications to help them reduce their dysphoria,” Green said.

Dr. Jack Turban, fellow in child and adolescent psychiatry at Stanford University School of Medicine, where he researches the mental health of transgender youth, echoed Green in how important this element of parental and guardian support is for young people who might be experiencing gender dysphoria and who might want access to GAHT.

“Medical interventions are just one aspect of gender-affirming care for transgender youth. We also know that family acceptance of a young person’s gender identity is a major protective factor against mental health problems,” said Turban, who was not affiliated with this research. “A big part of the clinical work in this area is helping families understand, support, and validate their children’s experiences.”

Turban told Healthline that, in general, parental consent is required for a minor to access various gender-affirming medical interventions.

An adolescent who doesn’t have this support from a parent or a guardian is generally unable to access needed care at all.

What can a young person do who would like to access GAHT but doesn’t have this support?

“Generally, adolescents aren’t able to access gender-affirming medical care without parent support. Sadly, there is a great deal of misinformation out there about gender-affirming medical care, which results in many families never seeking out initial conversations with a gender clinic to access accurate information,” Turban said.

He explained that it’s important families know that “going to a gender clinic doesn’t mean an adolescent is going to immediately start medical interventions.”

“Families often come to the clinic just to hear medically accurate information. This is vital given that there is so much misinformation online and in the media,” Turban said.

Green said that prior data reveals that a lot of gender care clinics and gender-specialty clinics tend to serve a greater proportion of white transgender and nonbinary youth compared to Youth of Color.

These Young People of Color “tend to have greater difficulty accessing care, which includes mental health and other healthcare,” Green said.

“There shouldn’t be a barrier to treatment that deals with an aspect of someone’s race and ethnicity, we shouldn’t see any differences in terms of who is able to get care. The fact that we do points to larger systemic issues in healthcare,” she said.

“If you look at any of the data on COVID-19, for example, it really has highlighted, both in mental health care and in healthcare more broadly, how much less access Communities of Color have to healthcare and to affordable healthcare. That is unfortunately an issue that we are seeing played out here.”

Turban said that “young people with intersectional identities” — think Trans Youth of Color, for example — “have higher rates of mental health difficulties.”

This is due to what he calls “multiple dimensions of stigma” that impacts them.

Turban pointed to past research that reveals these Young Trans People of Color are less likely to be able to access gender-affirming medical care in general.

“Sadly, there are too few medical providers trained in gender-affirming medical care, particularly for adolescents. This has resulted in long clinic wait lists — sometimes over a year. We desperately need medical schools and residencies to improve education in this area,” he said. “With 1.9 percent of adolescents in the United States identifying as transgender, it’s unconscionable that so few doctors are trained to care for these young people.”

When asked what the overarching takeaway from this study is, Green said people should come away with the reality that LGBTQ youth who are transgender and nonbinary need to have access to gender affirming hormones if they want.

She said this is crucial given that transgender and nonbinary youth have “some of the highest risk for depression and for suicide.”

“We should be focused on looking for ways we can support those youth rather than ways that we further contribute to stigma and rejection,” Green said. “Unfortunately, there are legislations and policies that are enacted or planned across the country that are working to take away some of the affirming care for transgender and nonbinary youth.”

She said data like this is important in that it shows that, for a majority of these youth, access to care like GAHT is associated with improved mental health outcomes. Legislation designed to strip access away can negatively impact these young people.

The “negative rhetoric” that swirls around this legislation can play a major role in these negative outcomes.

Turban echoed those thoughts.

“This study comes at a critical time, as several states have been introducing unscientific legislation that would limit access to gender-affirming medical care for transgender youth, despite opposition from all major medical organizations,” he said. “Hopefully this study will bring more attention to just how dangerous this proposed legislation is.”