Depression, suicidal ideation rates high among transgender teens
Many adolescents who identify as transgender or gender nonconforming were identified as experiencing psychological comorbidities, such as depression, anxiety and suicidal ideation, with a greater burden observed among transgender males vs. transgender females, according to findings accepted for presentation at the Endocrine Society Annual Meeting.
“In our group of patients with gender dysphoria, there are two to three times more affirmed males — those assigned female at birth — than affirmed females , which differs from statistics in the adult literature,” Alejandro Diaz, MD, director of the division of pediatric endocrinology at Nicklaus Children's Hospital in Miami, told Healio. “We also found that suicidal ideation, the degree of gender dysphoria, that is, negative feelings about the gender assigned at birth, and depression were significantly higher among affirmed males.”
In a retrospective chart review, Diaz and Veronica Figueredo, MD, a pediatric resident physician at Nicklaus Children’s Hospital in Miami, analyzed demographic and clinical data from 158 transgender adolescents attending a pediatric endocrinology clinic in Miami between 2014 and 2019. Participants were affirmed males (n = 107) affirmed females (n = 47) and those who identified as gender nonbinary (n = 4).
The median age of onset of gender dysphoria symptoms was earlier among affirmed females vs. affirmed males (mean age, 7 years vs. 10 years), as was the mean age at the beginning of social affirmation (mean age, 12 years vs. 14 years).
Within the cohort, 78.5% had psychiatric comorbidities. The most common condition was depression (66.5%), followed by anxiety (33.5%), ADHD (10.1%), bipolar disorder (1.9%), bulimia (1.3%), anorexia nervosa (0.6%) and PTSD (0.6%).
Researchers found that psychiatric comorbidities were more common among affirmed males vs. affirmed females (84.1% vs. 66%). Additionally, a history of suicidal ideation was more common among affirmed males vs. affirmed females (70.1% vs. 49%). Self-injuring was more common among affirmed males vs. affirmed females (56.1% vs. 25.5%).
“Additionally, the degree of suicidal ideation among our patients was twice as high as described in other reports in North America and Europe,” Diaz said. “We believe this may be culturally linked, related to a larger Hispanic population, which is traditionally less open to gender diversity. Also, approximately 50% of our patients consider their sexual orientation to be bisexual or pansexual, which is significantly higher than reported in the general population.”
Mean age at initiation of hormonal therapy was similar in both groups (mean age, 16 years for affirmed males and affirmed females). The degree of gender dysphoria before and after starting hormonal treatment, reported on a scale of 0 (no dysphoria) to 10 (highest possible dysphoria), fell for the overall cohort from a mean of 8.08 to 3.99, and for affirmed females from a mean of 7.87 to a mean of 2.96.
“Pediatricians need to be able to identify children with gender dysphoria,” Diaz said, “This is essential, because early identification and parental support significantly decrease the degree of dysphoria. Among our group of patients, the degree of dysphoria improved significantly after initiating pharmacological treatment and following gender-affirming surgical procedures.”– by Regina Schaffer
Figueredo VM, et al. SUN-062. The Endocrine Society Annual Meeting; 2020 (conference canceled/virtual meeting).
Disclosures: Diaz and Figueredo reports no relevant financial disclosures.