Hormone Therapy Use and Mental Health Outcomes Among Transgender Adults

Background and Purpose: Transgender and gender diverse individuals (TGD) often seek to align their appearance with their gender identity through gender-affirming medical care such as hormone therapy (HT). HT can offer significant benefits to TGD people, including improved mental health and quality of life. Questions remain of whether having unmet HT needs (wanting to use HT but reporting no prior HT use) is associated with mental health outcomes, and whether the timing of HT initiation predicts mental health status. We hypothesized that those currently using HT will exhibit better mental health status compared to those who want to use HT but do not. We also hypothesized starting HT at a younger age would be associated with better mental health outcomes.

Methods: This study used secondary data from the 2018 Michigan Transgender Health Survey, a community and online convenience sample of TGD individuals living in Michigan (N=659), approved by the University of Michigan Institutional Review Board. Data were analyzed using SPSS Version 26. Analysis included descriptive statistics and bivariate analyses of the relationship between HT use and age of HT initiation and mental health outcomes (suicidal ideation and suicide attempts).

Results: Participants were 19% transfeminine, 30% transmasculine, and 26% nonbinary. Most (75%) of the sample identified as White, with a mean age of 28.6 years (range=18-84). Half the sample reported ever using HT (53%); 28% wanted to use HT but had not, and 17% were not interested in using HT. Half the sample reported suicidal ideation in the past year, and 25% reported prior suicidal ideation. Over 30% of the sample attempted suicide in the past. There were no differences in frequencies of suicide attempts among different HT use categories. However, participants whose HT needs were unmet were more likely to report suicidal ideation compared to those whose HT needs were met (either used HT or didn’t want to, 57% vs. 47%, p=.036). Unexpectedly, among participants who had used HT, those reporting past-year suicidal ideation had initiated HT use at significantly younger ages compared to those with no past-year suicidal ideation (mean age = 25.1 vs. 28.4, p=.005).

Conclusions and Implications: Among a sample of TGD adults with high rates of suicidal ideation and suicide attempts, we found that participants with unmet gender-affirming care needs (wanting to use HT) were more likely to experience suicidal ideation. This suggests that there are missed opportunities to provide medically necessary gender-affirming care that could impact mental health to transgender individuals. Yet, earlier initiation of HT use was associated with experiencing past-year suicidal ideation. TGD individuals who seek out HT earlier may experience increased minority stress or other distress and are therefore more likely to experience suicidal ideation. Increased and long-term mental health support and community resources may be needed for those initiating gender-affirming care, particularly at younger ages. Further studies are needed to further distill the relationship between the age of initiation of HT and mental health outcomes.