Dr. Kuper and colleagues (10.1542/peds.2019-3006) have performed a much-needed study looking at the impact of gender affirming treatments on the mental health of transgender youth. Like most medical therapies, the goal of these treatments is to improve patient wellbeing, and their video abstract nicely outlines the benefits of gender affirmation in this population. However, it would be difficult to overstate the unique nature of gender affirming treatment in children and adolescents. These treatments produce fundamental changes in the appearance and physique of those who use them, which often result in profound impacts on their social interactions with family, friends, and community.
Although body dissatisfaction is ubiquitous in our current culture, transgender and other individuals with gender dysphoria appear to be at markedly higher risk. This is an important, yet understudied, area in transgender youth, and Kuper et al adds greatly to our understanding of this. Body image has been described as “one’s self-concept of physique in relation to the social context,”1 and is a complicated construct with both intrinsic and extrinsic components. Body dissatisfaction is intimately related to issues with self-esteem and mental health, and the social environment is likely an important factor mediating the psychologic effects of the physical changes associated with gender affirming treatment.
Results indicate that the overall mental function of youth in this study was poorer than previously published studies on this topic. The authors discuss how these results may have been affected by the vast cultural difference between their study site in Texas, as compared to previous studies primarily performed in Amsterdam. Within the United States, there is wide geographic variability in how transgender-related concerns are viewed and accepted. For example, many states now permit sex assignment changes on birth certificates of transgender individuals, but Idaho just joined Ohio and Tennessee in prohibiting such changes. The social milieu of transgender youth as they are going through treatment-induced physical and psychological transitions strongly influences social engagement, daily function, and mental health, and therefore it is reasonable to expect significant variability in measured treatment effects between studies performed in different locales. Further investigation with children and adolescents in a wide variety of geographic settings is needed, and this study serves as a solid foundation for additional efforts.
Reference
- van de Grift TC, Cohen-Kettenis PT, Steensma TD, et al. Body Satisfaction and Physical Appearance in Gender Dysphoria. Arch Sex Behav. 2016;45(3):575–585. doi:10.1007/s10508-015-0614-1