Transgender veterans have high rates of mental health problems

"As more of our active military returns from deployment and transitions to veteran status, the health care system will be faced with treating more transgender veterans who have mental health issues," said principal investigator Marissa Grotzke, MD, an endocrinologist at Salt Lake City Veterans Affairs Medical Center (VAMC), Salt Lake City.

Compared with the general U.S. population, the military and its veterans have a fourfold higher rate of gender dysphoria, according to Grotzke. Formerly called gender identity disorder, gender dysphoria is substantial distress associated with nonconformity to one's assigned sex.

Patients with gender dysphoria have unique health care concerns, Grotzke said. In general, they have high rates of depression, anxiety and suicidal thoughts. Past research also has shown high rates of mental health disorders in military veterans, including PTSD and depression. Less is known, however, about the mental health of veterans with gender dysphoria, she noted.

By examining medical records at Salt Lake City VAMC between January 1, 2014, and October 1, 2015, Grotzke and her colleagues found 39 patients who had a diagnosis of gender dysphoria. Eight transgender patients identified as transitioning from female to male, and the other 39 as male-to-female. They included both combat and noncombat veterans and ranged in age from 21 to 68 years.

The researchers then searched the medical records for mental health conditions that coexisted with the gender dysphoria. They found that PTSD was the most commonly identified mental health diagnosis, affecting 46 percent of these veterans, followed by depression in 41 percent. Tobacco use disorder reportedly occurred in one-third, and anxiety was present in 15 percent. Nine patients (23 percent) had other substance abuse, bipolar disorder or schizotypal personality disorder.

Eighteen patients (46 percent) carried two or more mental health diagnoses, according to the researchers. Only four patients (10 percent) with gender dysphoria had no additional mental health problem.

"These findings highlight the need to improve the quality of care for our transgender veterans," Grotzke said.

To address these concerns, the Salt Lake City VAMC formed a multidisciplinary gender dysphoria team composed of an endocrinologist, mental health professional, pharmacist, speech therapist and vocational rehabilitation providers. Team members meet together twice a month to discuss patients and treatment plans, which Grotzke said already has been "very beneficial" for patients.

Probably multiple reasons exist for the increased rates of mental health disorders they observed in transgender veterans. Grotzke said that traumatic brain injuries sustained in combat, military sexual abuse, and stigma related to gender struggles are common in this population.