OBJECTIVES: Gender-affirming hormone replacement therapy (HRT) has been shown to be safe and is associated with positive health outcomes for transgender and nonbinary (TGNB) people. TGNB adults face many barriers to care which may lead to nonprescribed hormone (NPH) use. While studies have analyzed correlates of NPH use, less attention has been paid to health outcomes among TGNB adults who use NPHs. We seek to investigate psychological distress rating among TGNB adults by source of hormones.

METHODS: We analyzed the data of the 19,624 respondents of the 2015 wave of the United States Transgender Survey who indicated a desire for hormones. We utilized the Kessler 6 (K6) psychological distress scale to measure psychological distress and TGNB adults who desire but have not used hormones as a reference category. We compared the distribution of scored by source of hormones, and then estimated logistic regression models in favor of serious psychological distress (K6 score>13) adjusting for sociodemographic correlates.

RESULTS: The mean K6 score for respondents who used hormones was lower when compared with those who haven’t received them (8.00 vs 11.81, p<0.001). Respondents who exclusively use prescribed hormones (PHs) had the lowest mean K6 score (7.81) among current hormone users; respondents who supplement with NPHs had a significantly higher mean K6 score compared to those who only use PHs (10.36, p<0.001). The adjusted odds ratio (aOR) of experiencing serious psychological distress for those who exclusively use PHs compared to those who do not use hormones after controlling for sociodemographic characteristics was 0.50 (p<0.005). The aORs for the supplemental or exclusive NPH categories were not statistically significant.

CONCLUSIONS: We find that TGNB adults who utilize NPHs may have higher levels of psychological distress than those who exclusive use PHs. Further studies are warranted to explore health outcomes following NPH use in TGNB adults.