AMHERST — Even as a number of states have moved to prohibit gender-affirming medical care for transgender minors through legislation and policy changes, a University of Massachusetts economist has co-authored a just-released report showing that hormone replacement therapy appears to reduce the risk of suicide among such youths.

The paper on which Duc Hien Nguyen collaborated, titled “Hormone Therapy, Suicidal Risk and Transgender Youth in the United States,” appears in the latest American Economic Association’s Papers and Proceedings.

A UMass news release regarding the study noted that gender-affirming medical care for transgender minors, including puberty blockers, hormone replacement therapy and gender-affirming surgery, are shown to reduce gender dysphoria, which is the distress related to a mismatch between an individual’s self-identified gender and their identified sex at birth.

“The science is showing us that gender-affirming care can save lives,” Nguyen said in a statement.

Nguyen, who is pursuing his doctorate in economics, was part of a research team that found that initiation of hormone replacement therapy is associated with a 14.4% decrease in the risk of ever attempting suicide if treatment starts between the ages of 14 and 17. This benefit was largest when such therapy was started at age 14 or 15.

The findings are based on the 2015 wave of the U.S. Transgender Survey, the largest survey of transgender people ever collected. That was made up of more than 27,700 respondents across the country.

There are 20 states that have adopted laws or policies restricting gender-affirming care, both surgical and non-surgical, for young people, and eight additional states are considering such proposals. The arguments in favor of such legislation have focused on protecting youths from what are seen by critics as harmful and permanent medical procedures.

But Nguyen said more harm can befall transgender youths without intervention. This is similar to what other researchers have found.

“Our study is not unusual,” Nguyen said. “There is a robust body of literature showing that gender-affirming care improves health outcomes of transgender patients, and our findings affirm this.” The work also corresponds with the protocols outlined in the 2017 Endocrine Society guidelines and the World Professional Association for Transgender Health Standards of Care, which recommended providing gender-affirming care to trans youth and adults.

“In line with existing scientific evidence, our research clearly indicates that restricting transgender youth’s access to HRT [hormone replacement therapy] could produce harmful, even deadly, consequences,” Nguyen said. “This finding is especially pertinent given the recent surge in state-level GAC [gender-affirming care] bans, many of which purposefully target transgender youth.”

The research, though, finds no statistically significant relationship between hormone replacement therapy and the risk of attempting suicide among transgender adults. Nguyen cautions that better data collection and more studies are needed in this area, hypothesizing that this may be because some of the most at-risk transgender youths have already taken their own lives.

“I think the dark reality is that there is an unknown number of transgender youth who could not access HRT during adolescence and took their own lives, thus never appearing in the data,” Nguyen said.

Nguyen collaborated on the research with lead author Travis Campbell of Southern Oregon University, who earned his doctorate from UMass in 2022, Samuel Mann of Vanderbilt University and Yana van der Meulen Rodgers of Rutgers University.

Nguyen said he and two of the co-authors are following up by working on a study that looks at how insurance coverage of gender-affirming care under Medicaid affects the mental health of transgender people. That work is currently under review for publication with the American Journal of Health Economics.

Nguyen’s doctoral work is supported in part by funding from the UMass Amherst Political Economy Research Institute and the Social Sciences and Humanities Research Council of Canada.

Scott Merzbach can be reached at smerzbach@gazettenet.com.]]>