Timely access to hormone therapy critical: Study

Timely access to hormone therapies leads to a significantly reduced risk of poor mental health in transgender adults, according to a world-first Australian study.
 
The randomised clinical trial found that among transgender and gender-diverse adults wanting the therapy, those who were given immediate access were less likely to suffer gender dysphoria, depression and suicidality.
 
Published in JAMA Network Open on Friday and led by the University of Melbourne, the research included 64 transgender adults, aged between 18 and 70, who were seeking the initiation of testosterone.
 
After completing a mental health questionnaire, half of the group began testosterone treatment within one week following extensive clinical assessment with an experienced clinician.
 
The other half had standard care, which involves a typical waiting period of three months.
 
At the conclusion of the testing period, researchers found there was a significant decrease in gender dysphoria in those who began treatment immediately.
 
There was also a significant decrease in depression, and a more than 50% drop in participants with suicidality.
 
Chair of the newly endorsed RACGP Specific Interests Transgender and Gender-Diverse Healthcare Dr Michelle Dutton told newsGP the study comes as wait times for initial appointments are ballooning, with some people waiting more than a year.
 
‘The timeframe between when people realise they want to access medical information and when they actually get it, that’s actually one of the times of higher distress,’ Dr Dutton said.
 
‘That gap in services is very sad, it’s very concerning.
 
‘Research like this might help pave the way, it shows how important it is to have those services and it makes it much easier to advocate for improved access to services.’
 
Statistics show there has long been disproportionate rates of mental health comorbidities among transgender and gender-diverse individuals.
 
In recent years, almost three quarters of those individuals reported a history of depression, while 67% reported a history of anxiety.
 
In the study, a gender-affirming model of care was described as a ‘respectful, shared decision-making approach where a doctor supports a person in their gender in a way tailored to individual needs’.
 
That included the use of affirming language, references to social and mental health support, and education on therapy’s risks.
 
But senior author Associate Professor Ada Cheung said there needs to be improved training, including for GPs, to better support their patients.
 
‘Providing gender affirming hormone therapy has immense benefits on reducing suicide risk and improving the mental health of trans people,’ she said.
 
‘This is critical given the alarming rates seen in the trans community in Australia.
 
‘Improving awareness about the benefits of hormonal therapy in trans people and better supporting GPs to provide gender affirming care will be lifesaving for many.’
 
Dr Dutton agrees, saying GPs are often the first point of call for transgender individuals seeking hormone therapies.
 
‘The prescriber of the hormone therapy, their job isn't to assess whether the patient is trans, only the patient knows that,’ she said. 
 
‘The job of the prescriber is to make sure the person has a good understanding of what their options are, including hormone therapy, and weigh up the pros and cons of going ahead with treatment or deciding not to, and then being able to safely prescribe and monitor them.
 
‘Then for some patients, they might be referred to other services through the GP, but the GP still remains a really important part of that team.’
 
Researchers acknowledged there were several limitations in their analysis, including its short follow-up period of three months.
 
Despite this, they hope the study will go on to have a positive impact on the Australian healthcare system.
 
‘These findings have critical implications for service access and delivery to ensure timely access to gender-affirming hormone,’ they concluded.
 
Dr Dutton’s advice to GPs helping introduce hormone therapies is to be open with patients. She cited standard of care guidelines on the Australian Professional Association for Trans Health (AusPATH) website as the most useful resource for general practice.
 
‘Be willing to engage and ask questions about what the person needs and try not to be focused on figuring out who the person is, in terms of what’s going on with their gender, just really listen to what the person needs,’ she said.
 
‘Then thinking about what we can offer as the GP, and be willing to say, “I don't know about that, but I’ll try and find out”.’
 
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gender diversity gender-affirming care LGBTQI health transgender health