A study released earlier this month—the largest of its kind in the United States—demonstrates that trans youth are happier after receiving gender-affirming hormones.
Researchers at Lurie Children’s Hospital’s Stanley Manne Children’s Research Institute in Chicago conducted the study, which was published in the New England Journal of Medicine. The research was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The study followed 315 trans and non-binary youth from the United States, who ranged in age from 12 to 20 years old, for two years after they started on hormone replacement therapy (HRT). Researchers met with participants every six months to evaluate their well-being.
Sixty-seven percent of participants who began the study experiencing severe depression reported minimal or moderate depression levels at its conclusion. And on average, participants who had milder depression at the beginning of the research ended up below clinical levels after receiving hormones. Forty percent of participants who met the threshold for clinic anxiety at the beginning of the trial experienced a drop in symptoms that put them below clinical levels after they started HRT.
Researchers found a major contributor to these decreases was the fact that HRT led to changes in youths’ appearances, which helped them feel more comfortable in their bodies. This also led to reports of better mood and increases in total life satisfaction.
Diane Chen, a pediatric psychologist with the Gender & Sex Development Program at Lurie Children’s Hospital of Chicago, is the study’s lead author. In a news release, she pointed out that these results are particularly significant since trans youth experience high rates of poor mental health.
“Our results provide robust scientific evidence that improved appearance congruence secondary to hormone treatment is strongly linked to better mental health outcomes in transgender and non-binary youth,” she says. “This is critical, given that transgender youth experience more depression and anxiety, and are at a higher risk for suicidality than cisgender youth.”
Chen’s claims are supported by previous research: according to The Trevor Project, trans youth are at higher risk for suicide than their cis counterparts. Among the participants in this study, two died by suicide. This suggests that hormones are not a cure-all. Unfortunately, other medical and social factors, such as discrimination, can continue to affect trans youth once they have access to care.
Most subjects in this study had already undergone puberty and had never been given puberty blockers—but 24 of the participants had either begun puberty blockers early in puberty or started on hormones while puberty was ongoing. Kids who had been given access to early interventions reported feeling better about their appearance over time and experienced higher life satisfaction. Researchers say this is because changes that arise during puberty are difficult to reverse, and trans kids who experience puberty often struggle with their body image to a higher degree.
Transmasculine participants also saw a greater reduction in anxiety and depression and a higher increase in life satisfaction than their transfeminine counterparts. This might be partially due to differences in how society accepts transfeminine people compared to transmasculine people.
The study’s researchers point out that physical changes youth experience when taking testosterone—like a deeper voice—could be “more pronounced and observable” than changes derived from taking estrogen. Some physical changes, like breast growth, do not reach their full effect until two to five years have passed. Researchers say in the study that “a longer follow-up period may be necessary to see an effect on depression, anxiety and life satisfaction” for transfeminine youth taking estrogen.
While the study stopped following participants after two years, other research has also found that gender-affirming care helps trans youth in the long term. A larger study from the Netherlands demonstrated that 98 percent of trans teens on hormones carry on into adulthood. Together, these studies suggest what many trans people already feel—being trans is not a trend, and very few people who transition are likely to change their minds.
Even with building evidence pointing to its benefits, legislators in several U.S. states are trying to limit or ban gender-affirming care. Alabama, Arkansas, Arizona and Tennessee have all passed bans into law that target best-practice medical care for trans youth. In Alabama and Arkansas, judges have thankfully blocked the bans.
Still, legislators in other states continue to attempt to erode trans rights, even proposing bills banning care for young adults. Oklahoma and South Carolina, for example, have proposed bills that would make helping people under the age of 26 access gender-affirming hormones or surgery a felony, while Kansas and Mississippi are trying to ban gender-affirming care for anyone under 21.
The study’s researchers object to these attempts to bar youth from accessing care. “We must ensure that access to this care remains available to youth with gender dysphoria,” co-author Robert Garofalo, a principal investigator for the study, says in the news release.
In the future, the researchers plan to continue observing the participants to record results over a longer term. They are also working on a comparable study examining the effects of puberty blockers.
In the news release, senior author Johanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, explains, “Amidst a landscape of misinformation, we hope these findings support the use of timely and appropriate medical interventions for this vulnerable group of adolescents.”