JMIR Publications

ABSTRACT

Background:

Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the US is not well known.

Objective:

To evaluate the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period.

Methods:

This observational study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and three months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states: 192 initiated estrogen and 150 initiated testosterone therapy. The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past two weeks.

Results:

Before GAHT initiation, 40% of participants reported depression (PHQ-9 ≥ 10), 36% reported anxiety (GAD-7 ≥ 8), and 25% reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (−2.4; 95% CI, −3.0 to −1.8) and GAD-7 scores (−1.5; 95% CI, −2.0 to −1.0). Among those with elevated symptoms, 40-42% achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27-28% achieved remission (PHQ-9 or GAD-7 < 5). Of those with suicide ideation at baseline, 60% had none at follow-up.

Conclusions:

This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care.