Gender-affirming hormone therapy is strongly linked to a lower risk of suicide and depression for transgender youths, according to the first large-scale study to examine the issue. 

The research, published Tuesday in the Journal of Adolescent Health, was based on a sample of more than 9,000 transgender and nonbinary youths from the ages of 13 to 24 who provided data on hormone therapy as part of an online survey conducted last year by The Trevor Project, an LGBTQ youth suicide prevention and crisis intervention group.

Young people receiving gender-affirming hormones reported a lower likelihood of experiencing recent depression and considering suicide compared to those who wanted but did not receive hormone therapy. For people under age 18, receiving hormones was associated with nearly 40 percent lower odds of recent depression and of a past-year suicide attempt. 

“It’s clear that gender-affirming care has the potential to reduce rates of depression and suicide attempts while banning this vital care and exposing young people to harmful political rhetoric can cause real harm,” Amit Paley, CEO and executive director of The Trevor Project, said in a statement. “It’s critical that all transgender and nonbinary youth across the country have access to medical care that is affirming, patient-centered, and evidence-based.”

More than 20 states have considered bills aiming to ban gender-affirming health care for transgender minors this year alone. Only Arkansas has passed a law completely banning access to gender-affirming health care, including puberty blockers and hormones, for trans minors, but a judge blocked that law from taking effect in July pending the outcome of litigation. Tennessee enacted a more limited law that bans doctors from providing gender-affirming hormone treatment and surgery to prepubescent minors.

Some transgender and nonbinary people receive hormone therapy — which can include hormones such as estrogen, testosterone and other medications — to align their appearance and secondary sex characteristics with their gender identity. Hormone therapy is also used to treat many other conditions and illnesses, including cancer, precocious puberty and the symptoms of menopause.

The World Professional Association for Transgender Health, widely considered the leading international body in transgender health care, doesn’t recommend starting hormone therapy until an individual reaches the age of legal majority, usually 18. In some cases, the association recommends hormone therapy for younger teens. 

On average, the young people sampled in The Trevor Project’s study were just over 17 and a half years old.

This latest study adds to growing evidence that gender-affirming care can improve transgender youths’ mental health. A study published in the journal Pediatrics last year found that transgender people who received puberty blockers during adolescence had a lower risk of suicidal thoughts as adults than those who wanted but could not access the medication.

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Another study, also published in Pediatrics last year, found that trans children who receive gender-affirming medical care earlier in their lives are less likely to experience poor mental health, such as depression and anxiety.

The Trevor Project has previously found that transgender and nonbinary youths have an elevated risk of depression, thoughts of suicide and attempting suicide compared to youth who are cisgender and straight. A survey that the group conducted last year found that 52 percent of trans and nonbinary youths seriously considered suicide in the past year, and 20 percent reported attempting suicide, compared to 32 percent and 10 percent of cisgender LGBQ youth.

“This study emphasizes the potential benefits of gender-affirming hormone therapy as a mechanism to reduce feelings of gender dysphoria and minority stress among transgender and nonbinary youth — thereby working to improve mental health outcomes and prevent suicide,” Amy Green, a clinical psychologist and the vice president of research at The Trevor Project, said in a statement. “These data should serve as a call to action to resist blanket bans on gender-affirming medical care and to invest in more research on this topic so that youth and their families can make evidence-informed decisions regarding care.” 

Though more research is finding that access to gender-affirming health care such as puberty blockers and hormone therapy is beneficial to trans youths’ mental health and overall well-being, not all who want it are able to access it.

Half of the transgender and nonbinary youth surveyed by The Trevor Project said they were not receiving gender-affirming hormone therapy but would like to, while 36 percent were not interested in receiving it and 14 percent were already receiving it. The research found that young people living in the South, youth of color and nonbinary respondents were underrepresented among those who received gender-affirming hormone therapy when they desired it.

Whether a youth has parental support also affects their access: The study found that 80 percent of those who received hormone therapy reported that they had at least one parent who supported their gender identity. 

If you or someone you know is at risk of suicide, please call the National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.