Systematic review of prospective adult mental health outcomes following affirmative interventions for gender dysphoria.

Introduction: Many transgender and gender diverse (TGD) people experience high levels of mental health difficulties. Different gender-affirmative interventions exist which aim to alleviate gender dysphoria, with the hope that this in turn will improve the mental health and quality of life of TGD people. Objective: This systematic review aims to examine the effectiveness of affirmative dysphoria-focused interventions for adults in improving mental health outcomes. Methods: Inclusion criteria were published, prospective design studies with pre and post-test intervention mental health outcomes, following a gender affirmative intervention. Single-person case studies and measures of sexual distress and body image were excluded. Database searches were conducted with additional hand-searching (database inception to August 2023). Study quality was double-rated using a validated tool. Results: Twenty-nine studies (2789 total participants) were identified that quantitatively assessed mental health outcomes (including depression, anxiety and self-esteem) following hormone, surgical and/or psychotherapeutic interventions. No eligible qualitative research or studies of voice and communication therapy or hair removal/electrolysis were found. The majority of studies of hormone treatments found that mental health, and in particular depression outcomes, significantly improved post-intervention and at follow-up. Improvements following surgical interventions were reported at follow-up time points beyond 6 months after the end of intervention. The majority of surgical intervention studies at post-intervention to 6-month follow-up showed no significant anxiety change, with mixed results for other mental health conditions. The majority of psychological interventions reported improvements in various mental health outcomes. The majority of included studies were assessed as being 'medium' or 'weak' quality. Conclusion: This review indicates that interventions for gender dysphoria, especially hormone and psychological treatments, may have mental health benefits for TGD people. Further research is required to examine the relationship between mental health post-intervention and minority stressors, visual congruity and intersectional factors.