How age of gender-affirming medical care impacts mental health

For children who are transgender, gender non-binary, or otherwise gender incongruent, the risk of mental health issues can be high. One way for children and adolescents who are gender incongruent to reduce that risk is to get gender-affirming medical care. However, many children and adolescents who are gender incongruent seek this care at later ages. An investigation in Pediatrics examines if there’s a relationship between the age of presentation for gender-affirming medical care and mental health problems.¹

The investigators performed a cross-sectional chart review of patients who were presenting for gender-affirming medical care. They classified the participants as either younger presenting youth, those aged < 15 years at time of presentation, or older presenting youth (those aged ≥ 15 years. The participants self-reported their mental health issues and medication use, which was compared between the 2 groups. Each participant provided information on the age of recognition of gender incongruence, age of coming out, and age of social transition. If the ages for these events wasn’t recorded, the participants’ birth date was used to estimate the age of events.

There were 300 participants included in the investigation with 116 younger presenting youth and 184 older presenting youth. After presenting for care, the investigators found that more older presenting young than younger presenting youth reported a depression diagnosis (46% vs 30%), needed psychoactive medication (36% vs 23%), engaged in self-harm (40% vs 28%), considered suicide (52% vs 40%), or attempted suicide (17% vs 9%), with all P < .05. Following control for covariates, investigators found that late puberty (Tanner stage 4 or 5) was linked with anxiety disorders (odds ratio 4.18 [95% CI: 1.22–14.49]) and depressive disorders (odds ratio 4.18 [95% CI: 1.22–14.49]). Older age was only stayed linked to psychoactive medication use (odd ratio 1.31 [95% CI: 1.05–1.63]).

The researchers concluded that both late pubertal stage and older age are tied to worse mental health among adolescents who are gender incongruent and presenting for gender-affirming care. These results provide more data on how this group is vulnerable and in need of appropriate care.

Reference

1. Sorbara J, Chiniara L, Thompson S, Palmert M. Mental health and timing of gender-affirming care. Pediatrics. September 21, 2020. Epub ahead of print. doi:10.1542/peds.2019-3600