Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review

Abstract

We sought to systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people. We searched PubMed, Embase, and PsycINFO through June 10, 2020 for studies evaluating quality of life (QOL), depression, anxiety, and death by suicide in the context of gender-affirming hormone therapy among transgender people of any age. We excluded case studies and studies reporting on less than 3 months of follow-up. We included 20 studies reported in 22 publications. Fifteen were trials or prospective cohorts, one was a retrospective cohort, and 4 were cross-sectional. Seven assessed QOL, 12 assessed depression, 8 assessed anxiety, and 1 assessed death by suicide. Three studies included trans-feminine people only; 7 included trans-masculine people only, and 10 included both. Three studies focused on adolescents. Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide. Future studies should investigate the psychological benefits of hormone therapy among larger and more diverse groups of transgender people using study designs that more effectively isolate the effects of hormone treatment.

Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women

“…The authors would like to explicitly advocate against this last option, as withholding medical care is unethical and may be associated with the use of GAHT obtained from alternative sources [ 28 , 29 ], without appropriate safety monitoring. In addition to ethical and safety concerns, prescription of GAHT has been associated with improvements in mental health and potentially even reduced risk of death by suicide [ 30 , 31 ]. If GAHT was withheld until viral suppression was achieved, however, one might expect the rates of viral suppression between the 2 groups to reconverge over time once GAHT was started.…”

Sex and Gender Differences in Clinical Pharmacology: Implications for Transgender Medicine

“…For transgender adults, these interventions may reduce gender dysphoria, a discomfort associated with a disconnect from one’s primary and/or secondary sex characteristics or sex assigned at birth. Hormone therapy is a cost‐effective medical intervention for transgender adults, 8 and it is associated with improved psychological outcomes and quality of life 1,9 . This medical intervention causes marked physiologic and hormonal changes in transgender adults, 10,11 but its effect on the disposition of other prescribed medications is poorly understood.…”

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

“…The prevalence of depression and low quality of life is high in transgender study populations (73) and one of the more important aims of GAHT is to improve the quality of life. GAHT is considered beneficial for the quality of life and reduction of depression ( 74), but high-quality data are limited (75). Importantly, suicide rates remain high in transgender persons after GAHT (76).…”