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JAMA Network Insights
April 20, 2022

Psychopharmacologic Considerations for Transgender and Gender Diverse People

Author Affiliations
  • 1Division of Child & Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California
  • 2Department of Psychiatry, Massachusetts General Hospital, Boston
  • 3The Fenway Institute, Fenway Health, Boston, Massachusetts
  • 4Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
JAMA Psychiatry. 2022;79(6):629-630. doi:10.1001/jamapsychiatry.2022.0662

Transgender and gender diverse (TGD) people have a gender identity beyond societal expectations based on their sex assigned at birth.1 TGD communities encompass not only identities within a binary gender paradigm but also gender diversity that includes nonbinary, genderfluid, agender, and bigender identities.1 TGD people may choose to undergo gender-affirming medical care, such as hormone therapy or surgical intervention.1

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1 Comment for this article
Research on Transgender Mental Health: our patients deserve better
Sarabeth Broder-Fingert, Associate Professor | UMASS Chan Medical School
I was excited to read the recent article by Turban et al1 on psychopharmacology for transgender and gender diverse patients. As noted in the article, transgender individuals experience high rates of mental health challenges, particularly transgender youth who attempt suicide a rate 10 times higher than the general population2,3, and experience more depression, anxiety, and substance use compared to their cisgender peers4.

While I applaud Turban and colleagues for sharing recommendations on psychopharmacology, I want to use this paper as an opportunity to highlight another critical barrier to mental health care for transgender individuals: the limited depth, breadth, and
quality of the existing research on mental health treatment in this population.

As an exemplar, a current search of the words “transgender” and “mental health” in Pubmed yields only 1,871 results, of which only five are fully powered mental health intervention clinical trials. Given the extremely high rates of mental health concerns in the transgender population, we desperately need more research and data on how to best support these individuals. As a health services researcher, pediatrician, and parent I feel compelled to use Turban’s paper as an opportunity to call upon the field to support a more robust research enterprise in this space. Unfortunately, the lack of funding opportunities creates a barrier to such a call. The NIH currently has no active funding announcements to directly address the mental health of transgender youth. Neither does the CDC, SAMHSA, or HRSA.

Thus, I suggest that if we really want to improve the mental health of transgender individuals, Turban’s article is a very preliminary first step. We must advocate for more funding dedicated to researching this topic, including some substantial government investments. I hope that articles like the one by Turban et al. in this journal will both guide clinicians within its scope, and inspire researchers and funders to fill its gaps by engaging in high-quality research to support the mental health of the transgender population.

1) Turban JL, Kamceva M, Keuroghlian AS. Psychopharmacologic considerations for transgender and gender diverse people. JAMA Psychiatry. Published online April 20, 2022. doi:10.1001/jamapsychiatry.2022.0662
2) Grossman AH, D’Augelli AR. Transgender youth and life-threatening behavior. Suicide and Life-Threatening Behavior. 2007;37(5):527-537. doi:10.1521/suli.2007.37.5.527
3) Mustanski B, Liu RT. A longitudinal study of predictors of suicide attempts amongst lesbian, gay, bisexual, and transgender youth. Archives of Sexual Behavior. 2013;42:437-448. doi: 10.1007/s10508-012-0013-9
4) Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality. 2006;51(3):53-69. doi: 10.1300/J082v51n03_04.