Transitioning gender identities is not linked with depression

The findings from a team of researchers at The University of Texas at Austin and in Brazil are outlined in a paper in JAMA Network Open.

The study followed 366 LGBTQ+ young people ages 15-21 in two U.S. cities from 2011 to 2015 and measured depressive symptoms periodically, as well as the young people's self-reported gender identity and other factors. During the study period, three-fourths of the participants maintained a gender identity consistent with their sex at birth (known as cisgender) throughout the three years, and another 9% maintained a transgender identity during the study period. Variations in gender identity were observed among other participants, including about 8% who reported a transgender identity earlier on and moved to a cisgender identity by the end of the study.

"Exploring gender identity and gender expression is a normal part of adolescence and growing up for some youth," said André Gonzales Real, a clinical psychiatrist and UT doctoral student in human development and family sciences and corresponding author on the paper. "Depression among transgender youth is a big public health concern, but it's not gender identity or transitioning that is at the root. It's the bullying, rejection and victimization we need to be worried about."

Of the youths who reported a different gender identity during the study, almost one-third did so more than twice. Among these youths, the rate of depressive symptoms was the lowest of the different groups and remained largely stable throughout the study. Specifically, researchers found that young people who transitioned from a cisgender identity to a transgender identity were more likely to experience symptoms of depression than those who maintained a cisgender identity throughout the study.

Importantly, when researchers controlled for bullying and victimization, which is more common for transgender youths, there was no statistical difference in depressive symptoms between groups. The finding lends key context to earlier reports of links between youth depression and gender transition.

"We found that gender identity is not the primary driver of mental health. Mental health is related to the environment young people are living in," said Stephen Russell, the Priscilla Pond Flawn Regents Professor in Child Development at UT and an author of the paper. "Being a transgender young person does not lead to depression on its own, but the social environment that many of these young people experience does."

Researchers also concluded that there was no change in depressive symptoms measured before and after transitions to transgender -- or to cisgender. Finally, the study found that results were the same regardless of participants' use of hormones and puberty blockers. Many studies looking at long-term outcomes for transgender and gender diverse youths come from clinical settings. The study is innovative in using a community-based sample, working with young people involved in community organizations serving LGBTQ+ youths.

Maria Inês Rodrigues Lobato of Universidade Federal do Rio Grande do Sul in Brazil is also a cooresponding author on the paper. The research was supported by the National Institute of Mental Health.