Gender-affirming hormone therapy reduces depressive symptoms and psychological distress in transgender people, according to a systematic review of research in this field. The study, led by Amsterdam UMC and the University of Exeter, reviewed 46 relevant journal articles and is published today in Nature Human Behaviour. 

The research reviewed included a mix of studies based on interviews, clinical trials, and analysis of data from those who were undergoing hormone therapy. Participants involved in the studies came from a broad range of age groups, but the review focused only on gender-affirming hormone therapy via cross-sex hormones, not the possible effects of puberty blockers or other interventions. 

Gender-affirming hormone therapy is the most common form of medical intervention used by transgender people. It changes a person’s body to better align it with their gender identity. Previous research has shown that transgender people struggle disproportionately with their own mental health and in their social lives. As a result, there is a need to better understand the psychological consequences of hormones, as these may have a biological effect on aspects of psychosocial functioning; such as wellbeing, self-control and trust.  

Psychosocial Functioning

This study focused on the key areas of psychosocial functioning – how people function across well-being, self-control and trust. These areas shape how people relate to themselves as well as others, and better functioning has been shown to lead to healthier experiences in relationships and decrease social isolation and loneliness.  

Dr. David Doyle, lead researcher from Amsterdam UMC says, “This work is vital in trying to achieve health equity for transgender people, who have disproportionately high levels of depression and anxiety as well as other mental health conditions and seek out hormone therapy to become more comfortable in their bodies and often also in their social lives.”  

The studies varied in size and quality and focused on a range of different groups, across varying social demographics. Research findings have often been mixed or inconclusive, and up until now there has been no systematic research into these effects.  

“Overall, we found that the quality of research in this important field, although improving, is generally limited, and studies have largely focused on medical effects of hormones, with little attention given to the psychosocial impacts that are crucial to sense of self and maintaining relationships. The most consistent finding across all studies in our review is that gender-affirming hormone therapy reduces depressive symptoms and psychological distress in transgender people, but we don’t know if this is caused by the biological effects of hormones or other related factors,” adds Doyle.  

Improvements in Quality of Life

The study found inconsistent or ambiguous results across other areas, with some evidence that there may be a difference between masculising and feminising hormone treatment in some areas, that warrants further investigation.  

“While there is also some evidence of improvements in quality of life and a positive change in interpersonal functioning, the findings were more inconsistent. That’s why further high-quality research is crucial, and we have already begun robust studies to isolate the biological effects of hormones from other psychological and sociocultural mechanisms,” says Doyle.  

Co-author Professor Manuela Barreto from the University of Exeter concludes, “As NHS waiting lists for hormone therapy clinics in the UK are extremely long, we need to produce a better and more robust evidence base with urgency, to ensure we are providing the best possible futures for transgender people. Acknowledging and attending to the psychosocial effects of interventions such as hormone therapy can prevent the need to access mental health services, which are also overwhelmed. We need better designed research that involves transgender people from the start, so we can understand both the biological and psychosocial aspects of therapy and improve care.”   

Read here the article in Nature Human Behaviour