Original Articles
Changes in Suicidality among Transgender Adolescents Following Hormone Therapy: An Extended Study

https://doi.org/10.1016/j.jpeds.2025.114883Get rights and content

Objective

To examine changes in suicidality following hormone therapy (HT) among transgender and gender-diverse adolescents and young adults.

Study design

A retrospective chart review was conducted at a multidisciplinary gender health clinic with 432 patients (mean follow-up = 679 days) completing the Ask Suicide-Screening Questions before and after treatment initiation. A repeated-measures ANCOVA assessed within-person changes in suicidality over time, adjusting for age at treatment and treatment duration.

Results

Suicidality significantly declined from pretreatment to post-treatment (F[1, 426] = 34.63, P < .001, partial η2 = 0.075). This effect was consistent across sex assigned at birth, age at start of therapy, and treatment duration.

Conclusions

HT was associated with clinically meaningful reductions in suicidality over time, extending prior findings with a larger sample and longer follow-up. These study findings provide clinical evidence supporting the mental health benefits of timely access to HT in this population.

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Section snippets

Participants

Participants were youth aged 12 to 20 years at baseline, treated for GD at a multidisciplinary pediatric gender specialty clinic in an urban Midwestern academic medical center. Inclusion criteria were receipt of HT for at least 3 months and suicidality data at both baseline and follow-up. Baseline was defined as the date of initial HT prescription. Follow-up was the most recent clinic visit while the patient remained on HT, which could occur in any hospital clinic, not exclusively the gender

Sample Characteristics

At baseline, ages ranged from 12.67 to 20.17 years (M = 16.21, SD = 1.31). Treatment duration ranged from 91 to 1899 days (M = 679, SD = 410, IQR = 364 to 938). Most patients (n = 325; 75%) received treatment for at least 364 days. Thirty patients had received pubertal suppression medication prior to HT. Seven patients discontinued HT: 4 due to a shift in gender identity (all of whom continued to identify as gender diverse), 2 for unknown reasons, and 1 due to concerns about hair loss. Reasons

Discussion

Our findings are consistent with and extend further those from Allen et al, demonstrating reductions in suicidal ideation following HT among transgender and gender-diverse youth.4 Using a substantially larger sample and longer follow-up period, we observed a medium effect size (partial η2 = 0.075), suggesting a stable and clinically meaningful association between HT and reduced suicidality.
Several factors may help explain these improvements. Hormonal changes are known to influence mood, affect

Ethics Approval

The study was approved by the hospital's institutional review board. Data were collected as part of routine clinical care. The institutional review board waived the requirement for informed consent due to the retrospective nature of the study.

Data Statement

Data from this study may be made available to qualified researchers for legitimate scientific purposes. Requests will be reviewed on a case-by-case basis to ensure compliance with any institutional policies.

CRediT authorship contribution statement

Luke R. Allen: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Conceptualization. Cody G. Dodd: Writing – review & editing, Conceptualization. Christine N. Moser: Writing – review & editing, Writing – original draft, Data curation, Conceptualization. Michelle M. Knoll: Writing – review & editing, Writing – original draft, Data curation.

Declaration of Competing Interest

Funding is not applicable, as the authors did not receive support from any organization for the submitted work. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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    • Trial Registration: Not applicable.
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