Transgender youth struggle with high rates of depression and anxiety when they first receive gender-affirming medical care, even when they have the support of their families, a first-of-its kind Canadian study shows.
The research, which was published in the journal Pediatrics, underscores the need for timely mental health support for transgender youth as well as faster access to gender-affirming care, said Dr. Margaret Lawson, an endocrinologist at CHEO who is co-principal investigator of the study.
“Our study found that, in spite of high levels of parental support for trans youth seeking gender-affirming medical care, there was a lack of timely access to care,” she said.
Nearly 17 per cent of the youth studied had tried to take their own lives in the previous year. More than 65 per cent had a probable anxiety disorder and 22 per cent reported depression.
Lawson, who has been providing gender-affirming hormone care to trans youths for 16 years at CHEO, said CHEO’s clinic and one at SickKids hospital in Toronto jointly applied for provincial funding for mental health supports for their patients prior to the pandemic but were turned down. Pediatric psychiatrists and psychologists are in short supply across the province, but Lawson said direct funding for specialized clinics to hire psychologists would help patients.
Mental health needs among all children and youth have increased during the pandemic.
Gender-affirming treatment at CHEO’s gender diversity clinic includes hormone blockers to suppress puberty.
The study followed youth for two years, beginning with their first clinic visit. The youth were all under the age of 16 and had gone through puberty. Many waited years before being seen in one of the clinics, which likely exacerbated mental health issues.
Researchers followed 174 youth and 160 parents. CHEO’s gender diversity clinic is one of 10 clinics across the country that were part of the study.
Research shows transgender adults suffer from high levels of depression, anxiety and suicidal ideation as well as discrimination and difficulty accessing health care.
The study’s authors wrote it might be possible to avert adverse adult outcomes “if trans people accessed gender-affirming medical care, if needed, at younger ages.”
Researchers will continue to follow the youth and their families and aim to look at whether rates of depression, anxiety and suicidal thoughts among the youth and stresses reported by families change over time after the youth have received gender-affirming care.
The authors also noted there is limited research on health-care experiences and mental health outcomes for trans youth.
Lawson said there has been an exponential growth in referrals to CHEO’s clinic since it opened in 2011. When she began treating transgender adolescents in 2006, Lawson would see one or two youth a year. In 2019, CHEO’s clinic had 280 referrals.
Although use of estrogen and testosterone therapies in trans adolescents is supported by major medical associations, the authors acknowledged that efforts to undermine such gender-affirming care for trans adolescents are ongoing and “collection of high-quality data is vital to counteract(ing)” those efforts.
Of the 174 participants, the vast majority, 137, were assigned female at birth and 37 were assigned male. That reflects an internationally documented “ratio shift which now favours trans-masculine youth,” wrote the authors.
In addition to treating more trans youth who were assigned female at birth, the overall numbers of youth being referred for treatment is increasing.
Lawson said the lack of resources for trans adolescents should be getting widespread attention.
“This is an important issue and a population that needs more support.”
The patients Lawson sees have been diagnosed with gender dysphoria, which is defined in the Diagnostic and Statistical Manual of Mental Disorders as the psychological distress that results from a mismatch between a person’s sex assigned at birth and their gender identity.
Research has linked access to treatment that blocks puberty with better mental health outcomes, including a reduction in suicidal ideation.