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More than half of all transgender youth reported experiencing suicidal thoughts, and a little less than a third had actually attempted suicide, according to research done at a large, urban transgender youth clinic.

Among nearly 100 transgender youth, ages 12 to 24, 51% reported ever thinking about suicide, while 30% had attempted it at least once in their lives. A little less than a quarter (24%) of these young people also exhibited mild to moderate symptoms of depression, with 11% indicating severe to extreme depression, reported, of the Center for Transyouth Health at Children's Hospital Los Angeles, and colleagues.

The study also found that hormone levels were comparable for transgender youth for their assigned sex. Transmasculine youth had levels of testosterone in the normal female range (mean 42.5 ng/dL) and transfeminine youth had estradiol levels within the normal male range (mean 27.8 pg/mL), the authors wrote in .

Olson told MedPage Today she thought that was an important finding, because it seemed to disprove that transgender experiences occur due to an imbalance in hormone levels. She thought it could "put to rest" the idea that both parents and providers have about the causality of trans experiences.

Though not affiliated with the study, , told MedPage Today that the results on suicidality and depression confirmed what most research in the field has found consistently. Grossman owns and operates AlphaBetterCare, an LGBT-friendly primary care practice in New York City.

"Young people who are transgender are bullied and made to feel different and to feel excluded and all these things just compound," he said. "And I think some people have said 'Oh, those are just problems for adolescents' but I think [the study authors] show very clearly that there's a big difference between non-transgender adolescents and transgender adolescents."

, an associate professor of pediatrics at the Saint Louis University School of Medicine, added that one of the main barriers to medical and psychological care for transgender youth has been the lack of data.

"As more and more youth who identify as transgender present themselves for care, their need has exceeded the current knowledge base of medicine and psychology," he told MedPage Today via e-mail. "This study is a crucial milestone in establishing a robust data set over time to determine if current treatments are doing an effective job of helping these youth, and discovering how care for transgender youth can be improved in the future."

Study Details

Eligible participants presented consecutively at the Los Angeles center from February 2011 to June 2013. They completed a computer-assisted survey at the initial study visit.

Physiologic data were taken from medical charts and data were analyzed by descriptive statistics. This limited comparisons between transmasculine and transfeminine participants, the authors explained.

In total, 101 youth were evaluated for physiologic parameters and 96 completed surveys assessing psychosocial parameters.

Demographic characteristics of the sample included 51.5% transmasculine and 48.5% transfeminine individuals, with a mean age of 19.2 years. Half of the sample (52%) was Caucasian and a similar portion (53%) reported living with their parents. Of the participants, 57% of transfeminine and 94% of transmasculine youth were living as their asserted gender.

There was an average of 9 years of difference between the time transgender youth said that they realized their gender was different from assigned (8.42 years) and the time they disclosed their transgender status to their parents. Nearly all (88%) of kids had come out as transgender to their families at an average age of 17.1 years.

Olson said she found that fact to be remarkable, and that it spoke to a bigger issue of the impact on young people having to keep that secret for so long.

"Young people who are sitting on something they perceive to be secretive and shameful during that really critical period of brain development can be really damaging and I think that we under-talk about the impact of that on young people," she said.

The authors also found that about 20% of both transmasculine and transfeminine youth were obese (20% and 21.5%, respectively), with a body mass index >30 kg/m², while more than a third (37%) of transmasculine youth were also overweight (BMI 25-30 kg/m²).

Almost half of transgender youth were also subject to risky behaviors. There were 43% who reported using harder drugs, such as cocaine, inhalants, hallucinogens, opioids, tranquilizers, and stimulants. A similar percentage (45%) reported being sexually active. Six transfeminine and three transmasculine youth even reported trading sex for money, food, drugs, or a place to live.

Intervene Sooner

Not surprisingly, the authors reported that all participants expressed an interest in beginning hormone therapy to assist in their transition. Grossman pointed out how many doctors are afraid or don't feel comfortable giving that kind of therapy to transgender patients.

"Doctors out there are learning to treat diabetes with complicated medications, they're using biologic response modifiers that have all kinds of side effects that you hear about on TV all the time, but they're afraid to give hormone therapy to these kids, and I think that's a point the article makes without being critical of those doctors," he said, adding "Treating transgender patients is easy."

Even if clinicians are not comfortable with hormone therapy, Olson said that simple things like asking a patient if there is a name he or she wants to be called or a preferred pronoun, and instructing all front office staff to use that name or pronoun can help kids who are experiencing gender dysphoria.

Limitations to the study noted by the authors include these results are not generalizable to transgender youth who do not desire a "phenotypic transition" with cross-sex hormones or generalizable to high-risk samples, such as studies of street youth. They also cited potential recall bias for data involving early childhood gender nonconforming feelings.

Ultimately, Olson said she would like to see pediatricians begin to intervene sooner so that gender dysphoria can be detected even earlier.

"I think the biggest thing providers can take away is start having this conversation about gender early on," she concluded. "There needs to be a way for pediatricians to be on the lookout and assessing for gender dysphoria in all pediatric patients."

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