Endocrine Abstracts

Objective: Transgender persons often experience low socioeconomic status. Gender affirming treatment aims to improve gender dysphoria. We assessed employment rates in transgender persons compared to controls and demographic, health and treatment-related factors associated with unemployment in transgender persons.

Methods: National register-based cohort study in Danish transgender persons with diagnosis code of gender identity disorder during year 2000-2021. Five age-matched controls of the same sex at birth and five age-matched controls of the other sex at birth were included. The date of study inclusion was the first date of transgender diagnosis. Employment was the primary study outcome.

Results: The cohort included 3812 transgender persons with median age (interquartile range) 19 (15; 24) years for persons assigned female at birth (AFAB, n=1993) and 23 (19; 33) years for persons assigned male at birth (AMAB, n=1819) and 38,120 controls. Mean (standard deviation) follow up was 4.7 (4.6) years. The proportion of employment the year before study inclusion was 78.1% in transgender persons AFAB vs 91.6% female controls, and 56.2% vs 85.5% were employed after 5 years follow up. In transgender persons AMAB vs male controls, 69.1% vs 88.0% were employed the year before study inclusion and 50.4% vs 85.5% were employed after 5 years follow up. In transgender persons AFAB compared to control women, the OR (95% confidence interval) for unemployment was 2.99 (2.63; 3.40) before study inclusion and 4.14 (3.42; 5.00) in the fifth calendar year after index. In transgender persons AMAB compared to control men, corresponding ORs were 3.30 (2.93; 3.72) and 4.77 (4.04; 5.64). Use of gender affirming hormone in persons AFAB decreased probability of unemployment at all time points with OR after 5 years 0.62 (0.41; 0.93), P=0.02 (odds ratio (95% confidence interval). In persons AMAB, use of hormone treatment was not associated with changed employment rates, 5 years OR: 0.77 (0.55; 1.07), P=0.11.

Conclusion: Unemployment was more prevalent in transgender persons compared to controls. Masculinizing hormone treatment was associated with lower probability of unemployment.