Transgender and non-binary youth comprise a significant proportion of high-school-aged individuals in the United States, comprising approximately 2 to 9% of the population. Many of these young people experience gender dysphoria, persistent distress that arises from the incongruence between their gender identity and their external appearance.
In recent years, there has been increasing recognition of the importance of gender-affirming medical care for transgender and nonbinary youth, including the use of hormones such as gonadotropin-releasing hormone (GnRH) agonists to suppress puberty and gender-affirming hormones (GAH) such as testosterone or estradiol to promote the development of secondary sex characteristics that align with their gender identity. One of the key goals of such medical care is to alleviate gender dysphoria by increasing appearance unity, or the alignment between one’s gender identity and physical appearance.
The study, published in The New England Journal of Medicine, investigated the longitudinal course of psychosocial functioning in transgender and non-binary youth who received gender-affirming hormones (GAH) over 2 years. The study hypothesized that appearance congruence, positive affect, and life satisfaction would increase, and depression and anxiety symptoms would decrease following GAH initiation. The study also explored potential moderating effects of demographic and clinical characteristics, such as age, designated sex at birth, racial and ethnic identity, and the timing of GAH initiation in puberty.
The study’s findings were consistent with previous research and showed that transgender and non-binary youth experienced improvements in psychosocial functioning after receiving GAH. Specifically, depression and anxiety symptoms decreased, and positive affect and life satisfaction increased over the 2-year follow-up period. The study also found that appearance unity, or the alignment between gender identity and physical appearance, improved and was associated with improved psychosocial outcomes.
The study also highlighted the importance of avoiding gender-incongruent pubertal changes. Youth who had not undergone substantial gender-incongruent puberty had higher scores for appearance congruence, positive affect, and life satisfaction and lower scores for depression and anxiety at baseline than those who had undergone substantial puberty. Early access to gender-affirming medical care may positively impact psychosocial functioning.
Furthermore, the study found that the effects of GAH on psychosocial outcomes varied based on designated sex at birth. Depression and anxiety symptoms decreased, and life satisfaction increased significantly among youth designated female at birth but not among those designated male at birth. The study’s authors speculated that the observed differences might be due to the timing and duration of hormone-mediated changes in puberty and the visibility of changes associated with testosterone-mediated puberty compared to estrogen-mediated puberty.
Overall, the findings of this study contribute to the growing body of research supporting the positive effects of gender-affirming medical care, including GAH, on the psychosocial well-being of transgender and non-binary youth. The study suggests that appearance unity may be a mechanism by which GAH influences psychosocial functioning and that early access to gender-affirming care may be associated with better outcomes. However, further research with more extended follow-up periods and larger sample sizes is needed to understand better the long-term effects of GAH and other gender-affirming medical interventions on the health and well-being of transgender and nonbinary youth.
