For Transgender People, Starting Hormone Therapy in Teens Helps Mental Health

A new study finds that transgender people get greater mental health benefits if they start gender-confirming hormone therapy when they are teenagers rather than waiting until adulthood.

“This study is particularly relevant now because many state legislatures are introducing bills that would prohibit this type of care for transgender youth,” said study leader Dr. Jack Turpin. He is a postdoctoral scientist in child and adolescent psychiatry at Stanford Medicine in California.

“We are adding to the evidence base that shows why gender affirmation care is beneficial from a mental health perspective,” Turpan explained in a Stanford University press release.

For the study, Turpan and his team analyzed data from the largest-ever survey of transgender adults in the United States, which was conducted in 2015.

Compared with those who started hormone therapy during adulthood, those who started treatment in their teens were less likely to have thoughts of suicide, major mental health disorders, and substance use problems.

The researchers also found that participants who received the hormones at any age were less likely to have such problems than those who wanted treatment but never received it.

The study was published online January 12 in the journal PLUS ONE.

The goal of gender affirmation hormone therapy using estrogen or testosterone is to match a transgender person’s physical characteristics to their gender identity.

The study authors explained that offering hormone therapy in adolescence means that a transgender teen can go through puberty in a way that matches their gender identity.

Of the more than 27,000 participants in the survey, researchers focused on nearly 21,600 people who said they wanted to receive hormone therapy. Of those who wanted treatment, 119 started at age 14 or 15 (early adolescence), 362 started at age 16 or 17 (late adolescence) and more than 12,000 started after their 18th birthday (adulthood). More than 8,800 wanted hormone therapy (the control group) but never received it.

The survey showed that participants who received hormone therapy were less likely to have experienced severe psychological distress during the previous month and a lower risk of suicidal thoughts in the previous year.

Compared to the control group, the risk of severe psychological distress was 222%, 153% and 81% lower for those who started hormones in early adolescence, late adolescence, and adulthood, respectively.

Also compared to the control group, the risk of suicidal thoughts in the previous year was 135%, 62% and 21% lower among those who started hormones in early adolescence, late adolescence and adulthood, respectively.

The study also found that respondents who started hormones in early or late adolescence had lower rates of heavy drinking in the past month and lifelong illicit drug use than those who started hormones in adulthood.

However, those who started hormone therapy in adulthood were more likely to drink excessively and use illegal substances than those who never received the treatment.

“Some individuals may become more confident and socially engaged when they start taking hormones,” Turpan noted, and this increased confidence and socialization may be associated with drug use.

“This finding speaks to the importance of creating culturally tailored substance abuse counseling programs for transgender individuals,” he said.


  • Stanford Medicine, press release, January 12, 2022

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