Mental health treatment among transgender and gender diverse people following gender affirming hormone therapy: Evidence from whole-of-population Australian administrative data
Melbourne Institute Working Paper No. 07/25
Date: August 2025
Author(s):
Abstract
Background: Gender affirming hormone therapy (GAHT) is associated with improved mental health outcomes among transgender and gender diverse (TGD) individuals, yet limited evidence examines how mental healthcare utilisation changes around GAHT initiation. Methods: Using Australian administrative data (2012–2024), we identified TGD individuals initiating estradiol-based GAHT (e-GAHT) or testosterone-based GAHT (t-GAHT). We applied a dynamic difference-in-differences model to estimate within-individual changes in mental health services and prescriptions (antidepressants, anxiolytics), using future GAHT recipients as controls. Effects were estimated separately by regimen and relative to individuals’ utilisation three years before GAHT initiation, up to five years post-initiation, and stratified by age (15-24, ≥25 years) and baseline mental healthcare engagement (above/below mean mental health prescription use). Findings: 20,358 individuals initiated e-GAHT and 11,883 initiated t-GAHT (mean follow-up 4.1 and 4.9 years, respectively). Prior to initiation, e-GAHT recipients had lower engagement with mental healthcare than t-GAHT recipients. For both regimens, mental healthcare use rose at initiation but declined sharply thereafter, with larger initial increases for e-GAHT recipients. Five years post-initiation, t-GAHT and e-GAHT recipients used 2.59 (95%CI 1.87;3.31) and 0.29 (95%CI -0.03;0.60) fewer mental health services, respectively. Mental health prescription use among e-GAHT recipients initially rose and then fell to 0.53 (95%CI 0.20;0.86) at five years, while t-GAHT recipients used 1.02 (95%CI 0.31;1.72) fewer prescriptions after five years. Reductions in mental healthcare were more pronounced for individuals with higher baseline mental healthcare engagement as well as older e-GAHT recipients. Interpretation: GAHT initiation is associated with dynamic and heterogeneous changes in mental healthcare use. While use increases around the time of initiation – particularly among individuals with limited prior mental healthcare engagement and younger e-GAHT recipients – use declines substantially over time. Altogether GAHT may help address unmet mental health 2 needs and contribute to longer-term reductions in mental healthcare use and associated costs among TGD individuals.
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