Social and Medical Gender Affirmation Experiences Are Inversely Associated with Mental Health Problems in a U.S. Non-Pro
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ORIGINAL PAPER
Social and Medical Gender Affirmation Experiences Are Inversely Associated with Mental Health Problems in a U.S. Non‑Probability Sample of Transgender Adults Jaclyn M. W. Hughto1,2,3 · Hamish A. Gunn4 · Brian A. Rood5 · David W. Pantalone3,4 Received: 18 June 2018 / Revised: 27 January 2020 / Accepted: 28 January 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A dearth of research has explored concurrently the associations between multiple forms of gender affirmation (or transitioning) and the mental health of transgender adults. In 2015, 288 U.S. transgender adults completed a cross-sectional, online survey assessing demographics, gender affirmation experiences, and mental health. Adjusting for age and discrimination experiences, we used mixed-effect logistic regression analyses to examine changes in self-reported suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) before and after initiating the gender affirmation process, and linear regression analyses to examine associations between gender affirmation experiences and self-reported depressive, anxiety, and stress symptoms. Overall, 81.3% of participants identified along the female-to-male, trans masculine gender spectrum (of which 20.9% identified as non-binary) and 18.8% identified along the male-to-female, trans feminine gender spectrum (of which 7.4% identified as non-binary). Nearly all participants (98.6%) reported disclosing their gender identity to family or a coworker; 67.4% endorsed recently using hormones, and 31.3% endorsed a gender-affirming medical procedure. In multivariable models, participants were at greater odds of NSSI, contemplating suicide, and attempting suicide before initiating the gender affirmation process compared to after. In additional models, gender identity disclosure and medical procedure engagement were inversely associated with depressive and anxiety symptoms, whereas gender identity disclosure, hormone use, and medical procedure engagement were inversely associated with stress symptoms. Finally, the number of gender affirmation experiences endorsed was inversely associated with depressive, anxiety, and stress symptoms. Findings support the possibility that social and medical gender affirmation experiences may be protective against mental health problems in transgender adults. Keywords Transgender · Gender affirmation · Mental health · Suicide · Self-harm
Introduction
* Jaclyn M. W. Hughto [email protected] 1
Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
2
Center for Health Equity Research, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
3
The Fenway Institute, Fenway Health, Boston, MA, USA
4
Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
5
Research and Development, UnitedHealth Group, Minnetonka, MN, USA
Transgender individuals have a gender identity or expression
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