Hormone Therapy Tied to Lower Depression Risk

TOPLINE:

Gender-affirming hormone therapy (HT) delivered in a primary care setting was associated with a 15% reduced risk for moderate to severe depressive symptoms in transgender, nonbinary, and gender-diverse adults in a new cohort study.

METHODOLOGY:

• LEGACY was an observational cohort study that included almost 3600 transgender, nonbinary, and gender-diverse patients at federally qualified community health centers (FQHCs) in Boston and New York from 2016 to 2019.
• All participants were adults (median age, 28 years; 63% White individuals) and had a gender identity different from their sex assigned at birth. And 84.5% received gender-affirming HT at baseline.
• The Patient Health Questionnaire (PHQ) was used to assess symptoms of moderate to severe depressive symptoms in the previous 2 weeks.
• Factors such as demographics, age, socioeconomics, and HIV status using a blood test were also assessed.

TAKEAWAY:

• Patients prescribed gender-affirming HT had a significantly lower risk for moderate to severe depressive symptoms over 48 months of follow-up than those who were not prescribed the treatment (adjusted risk ratio [ARR], 0.85; 95% CI, 0.75-0.98).
• Compared with transgender men, risk for moderate to severe depression was higher in transgender women (aRR, 1.18; 95% CI, 1.05-1.32) and nonbinary individuals assigned female at birth (aRR, 1.17; 95% CI, 1.01-1.35).
• Socioeconomic factors influenced the risk for depression, with a higher risk for public insurance holders (aRR, 1.35; 95% CI, 1.22-1.49) than private insurance holders.
• Older age was inversely associated with depression risk. Compared with individuals aged 18-24 years, risk was significantly lower for those aged 31-40 years (aRR, 0.77), 41-50 years (aRR, 0.81), and older than 51 years (aRR, 0.64).

IN PRACTICE:

The results support that gender-affirming HT “is a medically necessary treatment that improves mental health outcomes longitudinally for TGD [transgender, nonbinary, and gender-diverse] people for those who want it. Study findings highlight the importance of gender-affirming care models delivered in primary care settings,” the investigators wrote.

SOURCE:

This study was led by Sari L. Reisner, ScD, MA, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan. It was published online on March 17 in JAMA Network Open.

LIMITATIONS:

The gender-affirming context of FQHCs, including trained clinicians and inclusive practices, may have influenced the association between gender-affirming HT and depressive symptoms. The cohort was relatively young, urban-based, and drawn from safety net populations, which may have limited generalizability. Selection bias was also possible because participants self-selected into the treatment. Additionally, the study did not assess HT duration or gender-affirming surgery uptake. Screening for depression relied on PHQ tools rather than diagnostic assessments, with different screening methods used at study sites, potentially introducing site-related variability.

DISCLOSURES:

LEGACY was funded by the Patient-Centered Research Outcomes Institute. Two of the seven investigators reported receiving royalties from various sources for editing textbooks, including those on transgender and gender-diverse healthcare and gender-affirming psychiatric care.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.