Suicidal behavior and unsupervised hormone use in outpatient Brazilian transgender adolescents: health and psychosocial factors

BACKGROUND: Transgender adolescents are at high risk for negative health outcomes resulting from marginalization and scarcity of services, intensified by the lack of epidemiological data addressing their needs. Understanding the sociodemographic, clinical, and behavioral characteristics of trans youths may support strategies to improve healthcare for this vulnerable population. METHODS: In this retrospective cross-sectional study, we used data extracted from the initial assessment of children and adolescents admitted for care from 2010 to 2023 with a diagnosis of gender incongruence in a specialized Brazilian outpatient clinic, investigating sociodemographic, gender identity and sexual orientation, gender-affirming attitudes/procedures, romantic and sexual practices, health data, and mental health symptoms and conditions. We explored factors associated with unsupervised hormone use and suicide attempts using multivariable logistic regression models, causal diagrams, and sensitivity analysis with multiple imputation for missing data. RESULTS: Two hundred and sixty-one youths (10-17 years old), 49.8% transgender boys (assigned female at birth who identifies as boys), 42.5% transgender girls (assigned male at birth who identifies as girls), 7.7% transgender nonbinary. Most (51.6%) identified as non-heterosexual. Compared to trans girls, trans boys had a higher prevalence of anxiety (48.8% vs. 28.6%), self-injurious behavior (52.7% vs. 30%), problematic tobacco use (21.9% vs. 11.9%), and psychoactive substance abuse (17.2% vs. 6.4%); 26.8% reported prior suicide attempts and 20.3% reported unsupervised use of gender-affirming hormone therapy. Factors associated with increased odds of unsupervised hormone use included older age and being a trans girl (compared to trans boys and trans nonbinary), whereas factors associated with increased odds of suicide attempts included older age, presence of a psychiatric diagnosis, and alcohol or other psychoactive substance abuse. CONCLUSION: This study provides data for families and health professionals to support risk prevention, ongoing monitoring, and comprehensive care for this vulnerable population.