Kerry B. O’Leary, MD, MPHa; Marco Marcelli, MDa,b Correspondence: Kerry O’Leary (kerry.o’leary@bcm.edu)
aBaylor College of Medicine, Houston, Texas bMichael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Author disclosures
The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Very few studies included SUDs in their measurements, but it was found that transgender veterans were more likely than cisgender veterans to have any drug and alcohol use disorder.29,41 In addition, transgender veterans were more likely than transgender service members to be diagnosed with an SUD, again showing that over time and after time of service, mental health may worsen due to the burden of stigma and discrimination.31 Studies that examined MST found that transgender veterans were more likely than cisgender veterans to report MST, which replicates previous data that found high rates of sexual assault experienced among transgender individuals.1,28,29
There is a lack of literature surrounding transgender veterans and active-duty service members, especially with regard to gender-affirming care provided to these populations. To the best of our knowledge, there exists only one original study that examines the effect of gender-affirming hormone therapy and surgery on mental health outcomes among transgender veterans.52 Further research in this area is needed, specifically longitudinal studies examining the effects of gender-affirming medical care on various outcomes, including mental health. Few longitudinal studies exist that examine the mental health effects of gender-affirming hormone therapy on transgender individuals in the general population.53-60 Most of these studies have shown a significant improvement in parameters of depression and anxiety following hormonal treatment, although long-term large follow-up studies to understand whether these improvements persist over time are missing also in the general population. However, as previously described, transgender veterans and service members are a unique subset of the transgender population and require separate data collection. Hence, further research is required to provide optimal care for this population. In addition, early screening for symptoms of mental illness, substance use, and MST is important to providing optimal care.
Limitations
This review was limited due to the lack of data collected from transgender veterans and service members. The studies included did not allow for standardized comparisons and did not use identical measures. Some papers compared transgender veterans with transgender nonveterans, some transgender veterans and/or service members with cisgender veterans and/or service members, and some transgender veterans with transgender service members. There were some consistent results found across the studies, but some studies showed contradictory results or no significant differences within a certain category. It is difficult to compare such different study designs and various participant populations. Additional research is required to verify and replicate these results.
Conclusions
Although this review was limited due to the lack of consistent study designs in the literature examining the mental health of transgender veterans and active-duty service members, overall results showed that transgender veterans and service members experience worse mental health outcomes than their cisgender counterparts. With this knowledge and exploring the history of discrimination that this population has faced, improved systems must be put into place to better serve this population and improve health outcomes. Additional research is required to examine the effects of gender-affirming care on mental health among transgender veterans and service members.
