Diana M. Tordoff, MPH; Jonathon W. Wanta, MD; Arin Collin, BA; Cesalie Stepney, PhD; David J. Inwards-Breland, MD, MPH; Kym Ahrens, MD, MPH
Article Information
JAMA Netw Open. 2022;5(2):e220978. doi:10.1001/jamanetworkopen.2022.0978
Abstract
Importance Transgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care.
Objective To investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality.
Design, Setting, and Participants This prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021.
Exposures Time since enrollment and receipt of PBs or GAHs.
Main Outcomes and Measures Mental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome.
Results Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded “I don’t know” or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51)…
CRITIQUES & REVIEWS
A Multipronged, Evidence-Based Approach to Improving Mental Health Among Transgender and Gender-Diverse Youth
Brett Dolotina, BS; Jack L. Turban, MD, MHS
A growing body of research indicates that transgender and gender-diverse (TGD) youth experience considerable mental health disparities when compared with their cisgender peers, including higher rates of depression, anxiety, and suicidality.1 …(see more)….
Researchers Found Puberty Blockers And Hormones Didn’t Improve Trans Kids’ Mental Health At Their Clinic. Then They Published A Study Claiming The Opposite. (Updated)
A critique of Tordoff et al. (2022)
Singal-Minded – Jesse Singal – April 7 2022
An article called “Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care” was published in JAMA Network Open late in February. The authors, listed as Diana M. Tordoff, Jonathon W. Wanta, Arin Collin, Cesalie Stepney, David J. Inwards-Breland, and Kym Ahrens, are mostly based at the University of Washington–Seattle or Seattle Children’s Hospital.
In their study, the researchers examined a cohort of kids who came through Seattle Children’s Gender Clinic. They simply followed the kids over time as some of them went on puberty blockers and/or hormones, administering self-report surveys tracking their mental health. There were four waves of data collection: when they first arrived at the clinic, three months later, six months later, and 12 months later.
The study was propelled into the national discourse by a big PR push on the part of UW–Seattle. It was successful — Diana Tordoff discussed her and her colleagues’ findings on Science Friday, a very popular weekly public radio science show, not long after the study was published…
The University of Washington Is Putting Trans Kids At Risk By Distorting Suicide Research
This has been a shameful episode
Singal-Minded – Jesse Singal – Sept 2022
Anyone who has read my work knows that I am not a fan of harm inflation. I don’t like the tendency to treat more and more things as “harmful” or even “violent,” because I think this is usually a derailing tactic employed by individuals who don’t want to engage in conversation or argument.
But it’s obviously true that in some cases, the propagation of some types of information can be reasonably described as harmful or even potentially dangerous. Few of even the free-speechiest of free speech bros would deny this. And I genuinely think what the University of Washington School of Medicine is doing — has been doing, since April — could put trans kids at risk.
For those late to this: In April I published a very long post laying out the severe flaws in a study about puberty blockers and hormones University of Washington researchers published in JAMA Network Open, and how they exaggerated the results when describing them to the media and to UW’s own PR apparatus. The very short version is that the study has so many flaws that it does not provide us with any evidence whatsoever supporting the idea that kids who went on gender-affirming medicine (GAM) experienced beneficial outcomes relative to the kids who did not…
CITATION TRACING TOOLS
