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Baseline Mental Health and Psychosocial Functioning of Transgender Adolescents Seeking Gender-Affirming Hormone Therapy

Kuper, Laura E. PhD*,†; Mathews, Stacy BS; Lau, May MD, MPH§,‖

Journal of Developmental & Behavioral Pediatrics: October/November 2019 - Volume 40 - Issue 8 - p 589–596
doi: 10.1097/DBP.0000000000000697
Original Article

Objective: Research suggests that adolescents seeking gender-affirming hormone therapy experience elevated rates of depression, anxiety, and difficulties with peer relationships. Less is known regarding more specific aspects of mental health and psychosocial functioning. Furthermore, few studies have explored variations in mental health and psychosocial functioning by age, gender, degree of physical dysphoria, and informant type (adolescent, mother, and father).

Method: Participants are adolescents (n = 149) and parents/guardians (n = 247) who presented to a multidisciplinary gender clinic in Dallas, TX for an initial assessment before initiation of gender-affirming hormone therapy. Adolescents completed the Youth Self-Report (YSR) and the Body Image Scale (a measure of physical dysphoria), and parents/guardians completed the Child Behavior Checklist (CBCL).

Results: Approximately half of participants reported clinically significant difficulties with internalizing symptoms and psychosocial functioning (particularly engagement in activities), with approximately one-third indicating significant difficulties with depression, anxiety, obsessive compulsive, and posttraumatic stress symptoms. Parents reported fewer symptoms than adolescents across several subscales, but differences were generally small. By contrast, gender differences were found across all internalizing subscales and were generally large. Age and body dissatisfaction were not independently associated with broadband measures but, in combination with gender, were strongly associated with variance in YSR and CBCL reports of internalizing symptoms.

Conclusion: Elevated rates of depression, anxiety, and competency difficulties were broadly consistent with the previous literature and demonstrate the need for investment in the clinical training and infrastructure to provide comprehensive care to this population. Differences in mental health and psychosocial functioning by gender and clinic location appear to be less straightforward.

*Division of Endocrinology, Children's Health Texas, Dallas, TX;

Department of Psychiatry, University of Texas Southwestern, Dallas, TX;

Paul Foster School of Medicine, Texas Tech University Health Sciences, El Paso, TX;

§Adolescent and Young Adult Medicine Program, Children's Health Systems of Texas, Dallas, TX;

Division of Behavioral and Developmental Pediatrics, Department of Pediatrics, University of Texas Southwestern, Dallas, TX.

Address for reprints: Laura E. Kuper, PhD, Children's Health Systems of Texas, 1935 Medical District Drive, Dallas, TX 75235; e-mail:

Disclosure: The authors declare no conflict of interest.

The present study was made possible by support from Children's Health Texas.

Received September 13, 2018

Accepted April 24, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.