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
- این مرور 20 مطالعه در 22 مقاله را شامل شد. فقط یکی کارآزمایی تصادفی بود؛ بیشتر گروه‌های بیمار را در طول زمان پیگیری کردند و چهار مورد تصویرهای لحظه‌ای بودند.
- بیشتر مطالعات کمتر از 60 نفر داشتند، همه از کلینیک‌های تخصصی جنسیت. هشت مطالعه از 20 مطالعه از ایتالیا بودند و فقط 3 مطالعه نوجوانان را بررسی کردند.
- هورمون‌ها با کیفیت زندگی بهتر (7 مطالعه)، افسردگی کمتر (12 مطالعه) و اضطراب کمتر (8 مطالعه) مرتبط بود، اما چند مطالعه تغییری نیافتند.
- مرورگران شواهد را برای کیفیت زندگی، افسردگی و اضطراب کم‌کیفیت ارزیابی کردند و دربارهٔ خودکشی به هیچ نتیجه‌ای نرسیدند.
- تنها مطالعهٔ خودکشی، از کلینیک آمستردام، یافت زنان ترنس با نرخی 5.7 برابر نرخ عموم جمعیت با خودکشی مردند. مرورگران آن را در خطر جدی سوگیری ارزیابی کردند.
- در گروه نوجوانان هلندی، افسردگی در طول بلوکر بلوغ (داروهایی که بلوغ را متوقف می‌کنند) بهبود یافت، اما پس از هورمون‌های جنس مخالف بعدی، بهبود کلی از ابتدا دیگر روشن نبود.
- WPATH این مرور را برای اطلاع‌رسانی به رهنمودهای درمانی‌اش سفارش داد و تا حدی هزینه‌اش را پرداخت.
- اسناد دادگاه منتشرشده در 2024 نشان می‌دهد WPATH حق تأیید مقاله‌های تیم هاپکینز را خواست، و این تنها مقالهٔ منتشرشده پس از آن بود که WPATH آن قاعده را آورد.
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.