Hostname: page-component-f554764f5-44mx8 Total loading time: 0 Render date: 2025-04-16T07:07:08.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans

Published online by Cambridge University Press:  14 January 2018

Raymond P. Tucker ,
Rylan J. Testa ,
Tracy L. Simpson ,
Jillian C. Shipherd ,
John R. Blosnich  and
Keren Lehavot
Raymond P. Tucker*
Affiliation:
Louisiana State University, Baton Rouge, LA, USA
Rylan J. Testa
Affiliation:
Rhodes College, Memphis, TN, USA
Tracy L. Simpson
Affiliation:
VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, USA
Jillian C. Shipherd
Affiliation:
National Center for PTSD, VA Boston Healthcare System, Boston University, Veterans Health Administration
John R. Blosnich
Affiliation:
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Keren Lehavot
Affiliation:
VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, USA
*
Author for correspondence: Raymond P. Tucker, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans.

Methods

This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey.

Results

Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks.

Conclusions

Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.

Keywords

Gender affirmationhormone therapysuicidetransgenderveteran
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 14 , October 2018 , pp. 2329 - 2336
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ainsworth, TA and Spiegel, JH (2010). Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Quality of Life Research 19(7), 1019–1024.Google Scholar
Baca-Garcia, E, Perez-Rodriguez, MM, Keyes, KM, Oquendo, MA, Hasin, DS, Grant, BF et al. (2010). Suicidal ideation and suicide attempts in the United States: 1991–1992 and 2001–2002. Molecular Psychiatry 15(3), 250–259.Google Scholar
Bauer, GR, Scheim, AI, Pyne, J, Travers, R and Hammond, R (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health 15(1), 525.Google Scholar
Blosnich, JR, Brown, GR, Shipherd, JC, Kauth, M, Piegari, RI and Bossarte, RM (2013). Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. American Journal of Public Health 103(10), e27–e32.Google Scholar
Brown, GR and Jones, KT (2016). Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the veterans health administration: a case–control study. LGBT Health 3(2), 122–131.Google Scholar
Colizzi, M, Costa, R and Todarello, O (2014). Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology 39, 65–73.Google Scholar
Costa, R and Colizzi, M (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatric Disease and Treatment 12, 1953.Google Scholar
Department of Defense Suicide Event Report (2015). Department of Defense Suicide Event Report Calendar Year 2014 Annual Report. Available at http://t2health.dcoe.mil/sites/default/files/CY-2014-DoDSER-Annual-Report.pdf (Accessed 25 August 2017).Google Scholar
Dhejne, C, Lichtenstein, P, Boman, M, Johansson, AL, Långström, N and Landén, M (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS ONE 6(2), e16885.Google Scholar
Gates, GJ and Herman, J (2014). Transgender military service in the United States. Available at https://escholarship.org/content/qt1t24j53h/qt1t24j53h.pdf (Accessed 30 October 2017).Google Scholar
Glynn, TR, Gamarel, KE, Kahler, CW, Iwamoto, M, Operario, D and Nemoto, T (2016). The role of gender affirmation in psychological well-being among transgender women. Psychology of Sexual Orientation and Gender Diversity 3(3), 336.Google Scholar
Grant, JM, Mottet, LA, Tanis, J, Herman, JL, Harrison, J and Keisling, M (2010). National Transgender Discrimination Survey Report on Health and Health Care. Washington, DC: National Center for Transgender Equality and the National Gay and Lesbian Task Force.Google Scholar
Hayes, AF (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. NY: Guilford Press.Google Scholar
Heylens, G, Elaut, E, Kreukels, BP, Paap, MC, Cerwenka, S, Richter-Appelt, H et al. (2014). Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. The British Journal of Psychiatry 204(2), 151–156.Google Scholar
Kessler, RC, Borges, G and Walters, EE (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry 56, 617–626.Google Scholar
Kroenke, K, Spitzer, RL and Williams, JB (2001). The Phq-9. Journal of General Internal Medicine 16(9), 606–613.Google Scholar
Kroenke, K, Strine, TW, Spitzer, RL, Williams, JB, Berry, JT and Mokdad, AH (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders 114(1), 163–173.Google Scholar
Kuper, LE, Nussbaum, R and Mustanski, B (2012). Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. Journal of Sex Research 49(2–3), 244–254.Google Scholar
Lehavot, K, Simpson, TL and Shipherd, JC (2016). Factors associated with suicidality among a national sample of transgender veterans. Suicide and Life-Threatening Behavior 46(5), 507–524.Google Scholar
Louzon, SA, Bossarte, R, McCarthy, JF and Katz, IR (2016). Does suicidal ideation as measured by the PHQ-9 predict suicide among VA patients? Psychiatric Services 67(5), 517–522.Google Scholar
Manea, L, Gilbody, S and McMillan, D (2012). Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. Canadian Medical Association Journal 184(3), E191–E196.Google Scholar
Manieri, C, Castellano, E, Crespi, C, Di Bisceglie, C, Dell'Aquila, C, Gualerzi, A et al. (2014). Medical treatment of subjects with gender identity disorder: the experience in an Italian public health center. International Journal of Transgenderism 15(2), 53–65.Google Scholar
Millner, AJ, Lee, MD and Nock, MK (2015). Single-item measurement of suicidal behaviors: validity and consequences of misclassification. PloS ONE 10(10), e0141606.Google Scholar
Murad, MH, Elamin, MB, Garcia, MZ, Mullan, RJ, Murad, A, Erwin, PJ et al. (2010). Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology 72(2), 214–231.Google Scholar
Newfield, E, Hart, S, Dibble, S and Kohler, L (2006). Female-to-male transgender quality of life. Quality of Life Research 15(9), 1447–1457.Google Scholar
Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC and Lee, S (2008). Suicide and suicidal behavior. Epidemiologic Reviews 30(1), 133–154.Google Scholar
Osman, A, Bagge, CL, Gutierrez, PM, Konick, LC, Kopper, BA and Barrios, FX (2001). The suicidal behaviors questionnaire-revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 8(4), 443–454.Google Scholar
Padula, WV, Heru, S and Campbell, JD (2016). Societal implications of health insurance coverage for medically necessary services in the US transgender population: a cost-effectiveness analysis. Journal of General Internal Medicine 31(4), 394–401.Google Scholar
Stroumsa, D (2014). The state of transgender health care: policy, law, and medical frameworks. American Journal of Public Health 104(3), e31–e38.Google Scholar
Testa, RJ, Rider, GN, Haug, NA and Balsam, KF (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology 36(10), 927–936.Google Scholar
Tucker, RP, Testa, RJ, Reger, MA, Simpson, TL, Shipherd, JC and Lehavot, K (in press). Current and military-specific gender minority stress factors and their relationship to suicidal ideation in transgender veterans. Suicide and Life-Threatening Behavior.Google Scholar
USA Today (2017). VA Secretary targets veteran suicide rate. Available at https://www.usatoday.com/videos/news/politics/2017/05/31/va-secretary-targets-veteran-suicide-rate/102366542/ (Accessed 25 August 2017).Google Scholar
Vanden Brook (2017). Transgender people can still serve for now, U.S. military says. Available at https://www.nytimes.com/2017/07/27/us/politics/transgender-military-trump-ban.html (Accessed 25 August 2017).Google Scholar
Veterans Health Administration (2013). Providing Health Care for Transgender and Intersex Veterans (VHA Directive 2013-003). Available at http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863 (Accessed 25 August 2017).Google Scholar
White Hughto, JM and Reisner, SL (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health 1(1), 21–31.Google Scholar
Wilson, EC, Chen, YH, Arayasirikul, S, Wenzel, C and Raymond, HF (2015). Connecting the dots: examining transgender women's utilization of transition-related medical care and associations with mental health, substance use, and HIV. Journal of Urban Health 92(1), 182–192.Google Scholar
World Professional Association of Transgender Health (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. Available at https://s3.amazonaws.com/amo_hub_content/Association140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH%20(2)(1).pdf (Accessed 25 August 2017).Google Scholar