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Depression in Transgender Youth Eases with Recognition, Treatment

Transgender youth often suffer from mental health problems, but a new study has found that their depression and anxiety improve greatly when their gender dysphoria is recognized and treated.

Gender dysphoria is a condition in which the child’s biological gender and the gender with which the child identifies do not match. Transgenderism is the persistent desire to change one’s biological gender.

“Many of our patients suffer greatly from bullying, discrimination, isolation, and lack of support or lack of insurance coverage for the necessary treatment,”  said principal investigator Maja Marinkovic, M.D., a pediatric endocrinologist and medical director of the Gender Management Clinic at Rady Children’s Hospital-San Diego, an affiliate of the University of California, San Diego.

“Youth with gender incongruence or dysphoria need a comprehensive, multidisciplinary approach to care. They are in great need of experienced endocrinologists, therapists, psychiatrists, primary care providers, and surgeons,” said Marinkovic.

The study, which took place at the Rady Children’s Hospital clinic, involved 42 patients with gender dysphoria. Twenty-eight participants were making a female-to-male transition, 13 were male-to-female and one natal girl was gender fluid. That patient reportedly later chose male hormone treatment.

Twenty-six (62 percent) reported that they had depression, anxiety or both and/or cut themselves, with seven patients having a self-cutting history, Marinkovic said. Eleven patients had additional psychiatric or behavioral problems, including attention-deficit/hyperactivity disorder, or ADHD, Asperger’s syndrome/autism spectrum disorder and bipolar disorder.

Often, noted Marinkovic, parents and school staff may not even think of transgenderism, and there is often a delay in having the child assessed by a therapist who is experienced in gender identity problems until much later, when the young person is already deeply depressed or suicidal.

Treatment involved administering gonadotropin-releasing hormone agonists (GnRHa), which Marinkovic described as “puberty blockers,” in seven patients and cross-gender hormones in 32 patients, with only two patients taking both types of hormones.

The average age of starting puberty suppression was 12.5 years, and treatment with cross-gender hormones began at an average age of 16.5 years. Two female-to-male patients had breasts surgically removed at ages 16 and 18 years, she reported. Several other participants wanted to get this type of surgery, but their insurance plans did not cover it or they could not find an experienced surgeon in their area.

“To date, none of the patients expressed regret or stopped therapy,” Marinkovic stated.

Mental health follow-up data were available for 22 out of 26 patients. After treatment, depression, anxiety and/or self-cutting improved in all but two of the participants. Since Rady Children’s Gender Management Clinic began in 2012, it has seen a constant rapid increase in the number of patients referred to the clinic, Marinkovic said.

“There needs to be not only greater awareness and acceptance of this minority group but also improved accessibility to care for youth with gender dysphoria, to decrease the problems often seen in patients who are transgender,” she said.

The results were presented at The Endocrine Society’s 97th annual meeting in San Diego.

Source: The Endocrine Society