Summary
WPATH, the main international trans health body, part-funded Johns Hopkins to review the evidence for its 2022 treatment guidelines. The reviewers found 20 studies, mostly small European clinic studies. These reported better quality of life and less depression and anxiety after starting hormones, and none reported harm to mental health. But the reviewers rated every conclusion as low-quality evidence, because of biased study designs, small numbers and the effects of surgery being mixed in. Only one study looked at suicide, so no conclusion was possible. The authors still called hormones 'essential' care, a stronger claim than their own ratings support. Court documents released in 2024 showed WPATH tried to control what the Hopkins team could publish. This was the only review published after WPATH brought in an approval rule. It shows weak evidence, not proven benefits.
Key findings
- شملت المراجعة 20 دراسة في 22 ورقة. كانت واحدة فقط تجربة عشوائية؛ وتابع معظمها مجموعات من المرضى عبر الزمن، وكانت أربع لقطات في لحظة واحدة.
- كان لدى معظم الدراسات أقل من 60 شخصاً، جميعهم من عيادات جندر متخصصة. وكانت ثماني من العشرين من إيطاليا، ولم تنظر سوى 3 في المراهقين.
- ارتبطت الهرمونات بجودة حياة أفضل (7 دراسات) واكتئاب أقل (12 دراسة) وقلق أقل (8 دراسات)، لكن عدة دراسات لم تجد تغيراً.
- صنّف المراجعون الأدلة بأنها منخفضة الجودة بالنسبة لجودة الحياة والاكتئاب والقلق، ولم يتوصلوا إلى استنتاج بشأن الانتحار.
- وجدت دراسة الانتحار الوحيدة، من عيادة أمستردام، أن النساء المتحولات متن انتحاراً بمعدل 5.7 أضعاف معدل عامة السكان. وحكم المراجعون بأنها عالية خطر التحيز.
- في مجموعة المراهقين الهولنديين، تحسن الاكتئاب أثناء حاصرات البلوغ (أدوية توقف البلوغ مؤقتاً)، لكن بعد الهرمونات المغايرة اللاحقة لم يعد التحسن الإجمالي منذ البداية واضحاً.
- طلبت WPATH المراجعة وموّلتها جزئياً لإفادة إرشاداتها العلاجية.
- تشير وثائق المحكمة التي أُفرج عنها في 2024 إلى أن WPATH سعت إلى الحق في الموافقة على أوراق فريق هوبكنز، وأن هذه كانت الورقة الوحيدة المنشورة بعد أن أدخلت WPATH تلك القاعدة.
Abstract
We sought to systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people. We searched PubMed, Embase, and PsycINFO through June 10, 2020 for studies evaluating quality of life (QOL), depression, anxiety, and death by suicide in the context of gender-affirming hormone therapy among transgender people of any age. We excluded case studies and studies reporting on less than 3 months of follow-up. We included 20 studies reported in 22 publications. Fifteen were trials or prospective cohorts, one was a retrospective cohort, and 4 were cross-sectional. Seven assessed QOL, 12 assessed depression, 8 assessed anxiety, and 1 assessed death by suicide. Three studies included trans-feminine people only; 7 included trans-masculine people only, and 10 included both. Three studies focused on adolescents. Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide. Future studies should investigate the psychological benefits of hormone therapy among larger and more diverse groups of transgender people using study designs that more effectively isolate the effects of hormone treatment.
Conclusion
Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety, with similar associations across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions; the strength of evidence for each outcome was graded low. No conclusions could be drawn about death by suicide. Despite these limitations, the authors stated that hormone therapy is likely associated with improvements in QOL, depression and anxiety, that no study showed harm to mental health, and that these benefits make hormone therapy 'an essential component of care'. They called for larger, more diverse studies using designs that better isolate the effects of hormones.