(047) Hormone Therapy in Gender Dysphoria with Concurrent Mental Health Diagnoses: National Data

Abstract:

Introduction: The prevalence of patients identifying as transgender is increasing (recent estimate of 0.6% in the U.S.¹). Transgender populations have increased rates of psychiatric diagnoses, and gender-affirming hormonal therapy (HT) can improve the mental health and quality of life of transgender individuals.² This study investigated psychiatric comorbidities in gender dysphoria (GD) and the association of HT and GD across age and lifetime rates of psychiatric diagnoses.

Methods: The national TriNetX database ( >212 million persons) was queried using ICD-10 code F64.X for GD. Sub-group analyses compared GD and HT use by youth (age< 18) vs adults (age >18) across lifetime diagnoses of depressive episode/major depressive disorder (F32.X/F33.X), bipolar disorder (F31.X), psychotic disorder (F20-29), and borderline personality disorder (BPD, F60.3).

Results: TriNetX identified 134,813 GD patients, 54% recorded as female, mean age 35±16[SD], of whom 24,179 (18%) were youth. Overall rates of lifetime disorders were: 37% depression, 13% bipolar disorder, 7% psychotic disorders, and 5% BPD, with 50% having none of these diagnoses recorded. More cases of youth with GD had depression compared to adults (50% vs. 35%). Proportions of bipolar disorder (10% vs. 14%), psychotic disorder (10% vs. 8%), and BPD (4% vs. 5%) were similar between youth and adults. Data on HT showed a minority of all GD patients have lifetime use of HT: 19% androgens, 21% estrogens, and 10% progestins. Among youth with GD, rates of HT were generally lower: 12% androgens, 15% estrogens, and 11% progestins. Youth with BPD had less estrogen use (4%) compared to their adult counterparts with depression (18%), bipolar disorder (19%), and psychotic disorder (18%), but similar proportions in androgen use (10%), compared to those with depression (12%), bipolar disorder (10%), and psychotic disorder (10%). Among adults, similar proportions of HT were seen across different comorbid illness.

Conclusion: While the prevalence of patients identifying as transgender is increasing, these data indicate a minority of patients [10-20%] with GD receive HT. Overall, GD patients with most of the queried lifetime psychiatric co-morbidities show similar overall rates of HT, except for those aged< 18 with BPD. The data suggest some psychiatric co-morbidities affect use or access to HT among younger GD patients, which can be further investigated.

Reference

1. Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T.. How Many Adults Identify as Transgender in the United States? Los Angeles, CA: The Williams Institute. 2016.


2. Mueller SC, De Cuypere G, T’Sjoen G. Transgender research in the 21st century: a selective critical review from a neurocognitive perspective. Am J Psychiatry. 2017;174(12):1155–62