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

Psychol Med. 2018 Oct;48(14):2329-2336. doi: 10.1017/S0033291717003853. Epub 2018 Jan 14.


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 affirmation; hormone therapy; suicide; transgender; veteran.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Depression / epidemiology*
  • Depressive Disorder / epidemiology*
  • Female
  • Hormone Replacement Therapy / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Sex Reassignment Surgery / statistics & numerical data*
  • Suicidal Ideation*
  • Transgender Persons / statistics & numerical data*
  • United States / epidemiology
  • Veterans / statistics & numerical data*