Health

In order to get around the ethical problems of withholding care, the researchers studied only adults, and opted for a shorter follow-up period. The researchers point out that by doing this, the control group would not be disadvantaged for very long, and that such a wait period would be deemed acceptable for transgender people who want to contribute to such important research. This means that such a trial could be conducted ethically.

See their statement on this decision:

This short period was designed for participant acceptability and feasibility so that transgender and gender-diverse participants would not be disadvantaged by waiting longer than standard care waiting times of 3 months for an initial consultation. Second, participants were not blinded to their intervention group. Therefore, it is possible that the effect of testosterone or patient knowledge of treatment has been evaluated. However, randomization of participants to no treatment or placebo over longer follow-up is unethical, particularly given preexisting barriers to accessing GAHT

The improvement in depression and suicidality underscores the substantial benefits of gender-affirming care. The reduction scores align with the much longer observational studies, which typically report a 40-73% decrease in suicidality. While this study alone doesn't confirm long-term advantages, when viewed alongside the extensive clinical experiences of physicians and numerous other studies indicating long-term benefits of such care, it establishes the importance of this care.

Question What is the effect of testosterone therapy compared with no treatment on gender dysphoria, depression, and suicidality in transgender and gender-diverse adults seeking masculinization?

Findings In this 3-month open-label randomized clinical trial of 64 transgender and gender-diverse adults, there was a statistically significant decrease in gender dysphoria in individuals with immediate compared with delayed initiation of testosterone therapy. A clinically significant decrease in depression and a decrease in suicidality also occurred with immediate testosterone therapy.

Meaning The findings of this trial suggest that testosterone therapy significantly decreases gender dysphoria, depression, and suicidality in transgender and gender-diverse individuals desiring testosterone therapy.