2021 saw 17 anti-LGBTQ bills enacted into law, the majority of them specifically targeting Transgender Americans. The 2022 legislative session will feature a large number of states considering pointedly transphobic bills, including bans on gender-affirming hormone therapy (GAHT).

With this in mind, researchers at the Trevor Project published a peer-reviewed study that demonstrates positive links between such therapy and the mental health of Transgender and Nonbinary youth. The study's results serve as important evidence rejecting long-standing notions of when children are "old enough to know" their gender identity.

Methods
The Trevor Project's researchers utilized an "online nonprobability sample collected between October and December 2020 of 34,759 youth aged 13-24 who resided in the US and identified as LGBTQ," recruited "via targeted ads on Facebook, Instagram, and Snapchat."

Youth who indicated they identified as Transgender or Nonbinary were asked if they were currently taking gender-affirming hormones, with response options of "(1) "No, and I do not want to take them," (2) "No, but I would like to take them," and (3) "Yes." The survey gauged depression symptoms with a patient questionnaire, followed by questions about suicidal ideation and attempts.

To study the intersections of youth relationships between GAHT and suicidality, researchers examined sociodemographic covariates of age, socioeconomic status, race, and census region. Additional factors included parental support for the youth's gender identity, reports of victimization based off gender identity, receipt of puberty blockers, and exposure to gender identity conversion efforts.

The researchers also addressed the lack of focus on gender-affirming medical care for Transgender and Nonbinary youth who are minors by conducting separate analysis of those aged 13-17.

In synthesizing their data, the researchers used adjusted logistic regression to assess statistical significance.

Amy Green, VP of research at the Trevor Project, explained the method in simpler terms. "An adjusted logistic regression is a statistical model used to predict the odds that a certain outcome might occur (e.g., attempting suicide in the past year) based on the presence or absence of a certain factor (e.g., access vs. no access to GAHT) after accounting for other related factors within that same model (e.g., age, parental acceptance)." This model allowed for an understanding of the impact of GAHT accessibility on Transgender and Nonbinary youth in conjunction with differing personal situations indicated in the data collection.

Results
Unsurprisingly, the results found that those who had parental support for their gender identity comprised close to 80% of youth who received GAHT. Youth who wanted GAHT but did not receive it had a 38% rate of parental support.

In the subset of 13-17-year-olds, receipt of GAHT was linked with around 40% lower odds of recent depression and suicide attempts in the past year.

Disparities in access to and receipt of GAHT included difficulties for youth in the South, which, the researchers noted, is where the most bills to restrict access to GAHT have been introduced. LGBTQ youth of color reported lower rates of obtaining GAHT. Additionally, survey results indicated that Nonbinary youth had lower rates of accessing GAHT compared to youth who reported a binary identity.

Implications
The Trevor Project's researchers identified a few reasons for the disparities in Transgender and Nonbinary youth's access to GAHT and support for their receiving it.

Widespread misunderstanding of gender identity's impact on psychological distress is one cause of hesitation to support GAHT for LGBTQ youth.

The researchers note that "high rates of depression, suicidal ideation, and suicide attempts among Transgender youth are sometimes used by anti-Transgender politicians and activists to erroneously suggest that Transgender identity is a mental health condition that can be treated through counseling and conversion efforts." This stems from ignorance of the effect of gender dysphoria and minority stress (a higher level of stress faced by minority groups) on Transgender and Nonbinary youth.

With reputable data linking youth access to and support for GAHT to lower rates of suicidality and depression, harmful arguments over potential future regret (over choices to transition, take puberty blockers, and/or receive GAHT) and childhood naivety become even more difficult to justify.

Large-scale longitudinal data collection is one road future studies could take. The researchers contend that that could "better elucidate the risks and benefits of individual treatment options so that youth and their families can make evidence-informed decisions regarding care."

Green explained that the Trevor Project's 2022 National Survey on LGBTQ Youth Mental Health has an added question "to better understand how the age at which a young person starts GAHT is associated with outcomes," along with "a question to assess how often concerns about being denied access to GAHT negatively impact the mental health of Transgender youth."

These survey results will undoubtedly pave new ways to support Transgender and Nonbinary youth in making medical decisions that are right for them.