January 23, 2020 / 9:12 PM / 25 days ago

For some trans youth, suicide risk lowers with puberty suppression

(Reuters Health) - - While only a minority of transgender youth who want puberty-blocking medicines receive this treatment, a new study suggests they may have a lower suicide risk when they get it.

Researchers examined survey data from 20,619 transgender adults ages 18 to 36 who described their current mental health as well as any interest in puberty suppression when they were younger. Overall, about 17% said they had wanted to take drugs to help their outward appearance better match their gender identity when they were growing up.

But only 2.5% of the participants who wanted puberty blockers received treatment. Those who did were less likely to have any history of suicidal thoughts or suicide attempts by the time they reached their mid-30s.

“Transgender youth often experience distress during puberty as their body begins to develop in a way that does not match who they know themselves to be,” said lead study author Dr. Jack Turban of Massachusetts General Hospital in Boston.

Some youth can experience distress during puberty because the changes in their body do not fit their gender identity. This distress can result from changes in the body connected to sex hormones as well as from other people perceiving their gender incorrectly or mistreating them because of their gender identity or expression.

Puberty-blocking medicines can temporarily stop the body from producing sex hormones, pausing the development, for example, of facial hair or breasts. When young patients get puberty blockers, the effects can be reversed by stopping treatment.

While some previous small studies have shown that pubertal suppression is associated with better mental health outcomes for transgender youth, the current study is the first to show that puberty blockers are also associated with a lower risk of suicidal ideation, Turban said by email.

In the current study, about 75% of transgender adults who wanted puberty blockers and received them when they were younger had a history of suicidal thoughts, compared with 90% of their counterparts who wanted the treatment but didn’t get it, researchers report in Pediatrics.

Similarly, about 42% of transgender adults who wanted and received puberty blockers had attempted suicide at some point in their lifetime, compared with 51% of their counterparts who didn’t get treatment.

“We found that youth who desired pubertal suppression and received it had a third the odds of lifetime suicidal ideation observed among youth who desired pubertal suppression but did not receive it,” senior study Dr. Alex Keuroghlian, director of the National LGBT Health Education Center at The Fenway Institute in Boston, said by email.

While younger participants in the study were more likely to want pubertal suppression - about 29% of them did - they didn’t appear much more apt to receive it. Just 4.7% of the 18-year-olds who wanted hormones reported getting this treatment.

One limitation of the study is that researchers didn’t have data to determine whether people who experienced more severe body dysphoria were any more likely to receive hormones, the study team notes.

A separate paper in Pediatrics presented a case study of EF, a 15-year old assigned male at birth who had lived for many years with a nonbinary gender identity and preferred the gender-neutral “they” and “them” pronouns.

EF, identified only by their initials in the paper, displayed gender divergent behavior in preschool and began by elementary school to feel that presenting as outwardly male was at odds with their gender identity.

They experienced worsening gender dysphoria at the onset of puberty, with anxiety about possible voice deepening and facial and body hair growth. They began taking hormones to halt this process, and their dysphoria and anxiety diminished.

“One of the primary benefits of pausing secondary sex characteristic development with pubertal suppression is relief from gender-related distress, which for some includes suicidality,” said Beth Clark, co-author of the paper chronicling EF’s experience and a fellow in women’s gender and sexuality studies at Brandeis University in Waltham, Massachusetts.

“Benefits of pubertal suppression also include providing time for gender exploration and informed decision-making about future options, such as gender-affirming hormone therapy,” Clark said by email.

SOURCE: bit.ly/2Rmtc6n and bit.ly/2tJUSsN Pediatrics, online January 23, 2020.

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