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High burden of mental health conditions warrants multidisciplinary approach in transgender care

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January 9, 2019

Australian adults who identify as transgender are more likely than cisgender individuals to have mental health conditions, including depression, anxiety and ADHD, according to findings published in Transgender Health.

In a retrospective study, Ada S. Cheung, PhD, MBBS, FRACP, an endocrinologist and clinician researcher in the department of medicine at the University of Melbourne, Australia, and colleagues analyzed electronic medical records of 540 patients who attended new consultations for gender dysphoria at a primary care clinic (n = 257) and at an endocrine specialist clinic (n = 283) in Melbourne between 2011 and 2016. Researchers assessed sociodemographic parameters, including education level, employment status and history of homelessness, as well as clinical characteristics, including medical morbidities and psychiatric conditions, and history of gender-affirming surgeries or gender-affirming hormone therapy regimens.

Researchers observed a 10-fold increase in the number of transgender individuals newly attending endocrine specialist clinics during the study period; annualized data were not available for primary care. The mean age at first consultation was 27 years, and median BMI was 25.6 kg/m², with 18% of the cohort identifying as gender nonbinary.

Researchers noted a prevalence of psychiatric conditions among transgender adults that was higher than matched Australian population means, including depression (55.7% vs. 7.9%), anxiety (40.4% vs. 16.3%), autism spectrum disorder (4.8% vs. 0.7%) and ADHD (4.3% vs. 1.1%). Among patients with ADHD, 32% were prescribed stimulant medications.

The choice of HT for transgender patients varied widely, according to researchers. The most frequently used regimen for transgender women was estradiol valerate combined with spironolactone or cyproterone acetate, whereas transgender men most frequently used intramuscular testosterone injections.

“A coordinated, multidisciplinary approach to transgender health care, including psychosocial interventions to support mental health and neurobehavioral conditions in adults in parallel to gender-affirming treatments are essential to meet the needs of this socially disadvantaged cohort,” the researchers wrote. “There are many future research priorities, including studies to assess and understand the links between neurobehavioral conditions and gender dysphoria, clinical trials to provide evidence-based treatment pathways and studies to evaluate optimal models of health service provision to improve quality of life and minimize mental health burden.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

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