Mental health treatment among transgender and gender diverse people following gender affirming hormone therapy: evidence from whole-of-population Australian administrative data.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 41768985.
- Also identified by DOI 10.1016/j.eclinm.2026.103765 and PMC identifier 12947644.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Gender affirming hormone therapy (GAHT) is associated with improved mental health outcomes among transgender and gender diverse ('trans') individuals, yet limited evidence examines how mental healthcare utilisation changes following GAHT initiation. Using Australian administrative data (2012-2024), we identified trans people initiating oestradiol-based GAHT (e-GAHT) or testosterone-based GAHT (t-GAHT). We applied a dynamic difference-in-differences model to estimate within-individual changes in mental health services and prescriptions (antidepressants, anxiolytics), using future GAHT recipients as controls. Effects were estimated separately by regimen and relative to individuals' utilisation three years before GAHT initiation, up to five years post-initiation, and stratified by age (15-24, ≥25 years) and baseline mental healthcare engagement (above/below mean mental health prescription use). 20,358 individuals initiated e-GAHT and 11,883 initiated t-GAHT (mean follow-up 4.1 and 4.9 years, respectively). Prior to initiation, e-GAHT recipients had lower engagement with mental healthcare than t-GAHT recipients. For both regimens, mental healthcare use rose at initiation but declined sharply thereafter, with larger initial increases for e-GAHT recipients. Five years post-initiation, e-GAHT and t-GAHT recipients used 0.29 (95% CI -0.03; 0.60) and 2.59 (95% CI 1.87; 3.31) fewer mental health services, respectively. Mental health prescription use among e-GAHT recipients initially rose and then fell to 0.53 (95% CI 0.20; 0.86) at five years, while t-GAHT recipients used 1.02 (95% CI 0.31; 1.72) fewer prescriptions after five years. Reductions in mental healthcare were more pronounced for individuals with higher baseline mental healthcare engagement as well as older e-GAHT recipients. Consistent with assessment and support requirements, mental healthcare use increases around the time of GAHT initiation-particularly among individuals with limited prior mental healthcare engagement and younger e-GAHT recipients-then declines substantially over time. Altogether GAHT may help address unmet mental health needs and contribute to longer-term reductions in mental healthcare use and associated costs among trans people. This work is supported by the University of Melbourne McKenzie Fellowship (2025MCK182), a Viertel Charitable Foundation Clinical Investigator Award, and a National Health and Medical Research Council Investigator Grant (2034450).