Anger, Aggression, and Irritability in Transgender and Gender Diverse Youth Following Testosterone Initiation: A...

To examine anger, irritability, and aggression in transgender and gender diverse adolescents and young adults (AYAs) initiating testosterone treatment over 12 months.

Participants were 178 transgender and gender diverse AYA across four major gender care centers in the United States who initiated testosterone therapy. Participants completed the NIH Toolbox Anger scale and the Youth Self-Report, including Aggressive Behaviors, Irritability, Conduct Problems, Oppositional Defiant Problems, and Externalizing Problems. Change over time following testosterone initiation was examined using repeated-measures analysis of variance. Post hoc mixed-groups analysis of variance was used to explore outcomes in two subgroups: AYA with and without scores in the "elevated concerns" range for Anger and/or Youth Self-Report Externalizing Behaviors at baseline. Frequency of elevated versus normative concerns was also examined by measure and timepoint.

Participants were ages 12-20 years (M = 16.1, standard deviation = 1.6). For the overall sample, mean T-scores for all outcomes were within normative ranges at all timepoints, and there were no significant changes in mean T-scores over time. Post hoc analyses revealed a subgroup of participants with elevated Anger and/or Externalizing Behaviors scores at baseline (45.5%, n = 81), who demonstrated significant decreases (p < .05) in mean scores for Anger (-3.78), Aggression (-2.62), Irritability (-.40), and Externalizing Problems (-2.62) from baseline to 12-month follow-up.

This study found no significant increases in anger or aggression across 12 months following testosterone initiation. Most participants either remained within normative ranges or demonstrated a reduction in scores from elevated to normative ranges over time. These findings may inform decision-making and address families' concerns about the effects of testosterone on externalizing symptomology.