Results Summary
What was the research about?
People who are transgender have a gender identity that differs from the male or female sex assigned to them at birth. Some transgender people get gender-affirming therapies to change their bodies to match their gender identity. For example, they may take hormones such as estrogen or testosterone.
Gender-affirming therapies can improve mental health and quality of life for transgender adults. These improved outcomes may help transgender adults focus on other health concerns.
In this study, the research team wanted to learn if gender-affirming hormone therapy improved sexual health outcomes and symptoms of depression in transgender adults.
What were the results?
Compared with transgender patients who didn’t receive hormone therapy, those who did were less likely to have sexually transmitted infections and symptoms of depression.
Transgender adults who did and didn’t receive hormone therapy didn’t differ in:
- Whether they filled a prescription for medicine to prevent HIV. HIV weakens the body's immune system and makes it hard for the body to fight off infections.
- The amount of HIV in the blood being so low that a test can't detect it among patients with HIV.
- New cases of HIV.
Who was in the study?
The study included health records for 6,330 transgender patients from 2016 to 2019. All received care at one of two clinics in Massachusetts and New York. In 2016, 86 percent took hormone therapy and 14 percent did not. Also, 7 percent of patients were living with HIV. Among patients, 63 percent were White, 20 percent Black, 8 percent were multiracial, 7 percent were Asian or Pacific Islander, and 2 percent identified as another race; 21 percent were Hispanic or Latinx. The average age was 28. Also, 47 percent were transgender female, 36 percent were transgender male, 16 percent were nonbinary, and 1 percent identified as another gender identity. In addition, 54 percent had private insurance, 42 percent had public insurance, and 4 percent didn’t have insurance.
What did the research team do?
The research team compared health records for transgender patients who did and didn’t receive hormone therapy over three years.
Transgender adults, researchers, and clinicians, such as doctors and nurses, helped design the study.
What were the limits of the study?
The study used records from two clinics that specialized in gender-affirming therapies. Results may differ for adults receiving care at other clinics. Most patients had public or private health insurance; results may differ for adults without health insurance.
Future research could include adults who seek care at clinics that don’t focus on gender-affirming therapies. It could also include more adults without health insurance.
How can people use the results?
Clinics can use the results when considering how to improve sexual health and mental health outcomes for transgender patients.
Professional Abstract
Objective
To compare the effects of gender-affirming hormone therapy versus no gender-affirming hormone therapy for transgender adults on HIV-related health, sexually transmitted infection, and depression outcomes
Study Design
| Design Elements | Description |
|---|---|
| Design | Observational: cohort study |
| Population | Electronic health record data for 6,330 transgender adults ages 18 and older |
| Interventions/ Comparators |
|
| Outcomes |
Primary: viral suppression among patients with HIV; uptake of preexposure prophylaxis among patients without HIV; diagnosis of gonorrhea or chlamydia sexually transmitted infection; symptoms of depression for last 2 weeks Secondary: HIV incidence in last 12 months among patients without HIV |
| Timeframe | 3-year follow-up for study outcomes |
Transgender adults who have gender-affirming therapy to change their bodies to match their gender identity have improved quality of life and psychological functioning. Questions remain about whether the benefits of gender-affirming hormone therapy can also improve HIV and other health outcomes in transgender populations over time. This observational prospective cohort study compared the effect of hormone therapy versus no hormone therapy on improving HIV, sexually transmitted infection, and depression outcomes among transgender adults.
Researchers collected electronic health record data from adult transgender patients at two health centers in Massachusetts and New York between 2016 and 2019. Researchers compared individuals who received gender-affirming hormone therapy with those who did not receive hormone therapy.
The study included data from 6,330 transgender patients. At baseline, 86% took gender-affirming hormones and 14% did not. Also, 7% of patients were living with HIV. Among patients, 63% were White, 20% were Black, 8% were multiracial, 7% were Asian or Pacific Islander, and 2% identified as another race; 21% were Hispanic or Latinx. The mean age was 28, 47% were transgender female, 36% were transgender male, 16% were nonbinary, and 1% identified as another gender identity. In addition, 54% had private insurance, 42% had public insurance, and 4% had no insurance.
Transgender adults, researchers, and clinicians helped design the study.
Results
Compared with patients who did not receive gender-affirming hormone therapy, patients who received such therapy had a lower probability of a sexually transmitted infection diagnosis (adjusted odds ratio [aOR]=0.64; 95% confidence interval [CI]: 0.46, 0.88; p=0.006) and depression (aOR=0.81; 95% CI: 0.66, 0.99; p=0.039). The two groups did not differ in HIV viral suppression, uptake of preexposure prophylaxis prescriptions to prevent HIV, or rates of new cases of HIV.
Limitations
Most patients in this study had public or private health insurance coverage. Results may not be generalizable to patients without insurance coverage. The study took place at two health centers that specialize in gender-affirming therapies. Results may differ in other healthcare settings.
Conclusions and Relevance
In this study, gender-affirming hormone therapy was associated with improvements in rates of sexually transmitted infection diagnoses and levels of depression, but not with control of HIV, prescriptions for medicine to prevent HIV, or rates of new cases of HIV.
Future Research Needs
Future research about the effects of gender-affirming therapies could use data collected from patients who seek care at health centers that do not specialize in gender-affirming therapies and from patients who do not have health insurance.
