Investigating the association between gender-affirming treatment intentions and choices on mental health among transgender individuals

Gender-affirming treatments, including gender-affirming hormone therapy and gender-affirmation surgery, aim to align transgender individuals’ physical appearance with their intrinsic gender identity. However, one-third of 7,576 participants (mean age: 21.61) in the Chinese Transgender Health Survey reported no intention of pursuing these treatments. This study examines the associations between sociodemographic, treatment-related factors and mental health across four groups: no intention for treatment (n = 2,523), intending treatment not started (n = 2,576), gender-affirming hormone therapy (n = 2,369) and gender-affirmation surgery (n = 290). Notably, the surgery group reported the highest gender dysphoria, while the hormone group exhibited the highest levels of anxiety, depression, post-traumatic stress disorder, self-harm and suicide risk. Multivariate regression models revealed that sociodemographic factors, such as education, were differently associated with mental health statuses across groups, showing a complex mosaic effect. Here we show that these differences do not imply treatment effects but rather highlight the need for personalized clinical considerations in gender-affirming care. This study analyzes associations between sociodemographic factors, treatment intentions and mental health among transgender individuals. Utilizing multivariate regression, findings reveal distinct mental health challenges across treatment groups, emphasizing the necessity for personalized approaches in gender-affirming care.