Gender-affirming care may lower depression risk, study finds, but many are losing access
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(NEW YORK) — Transgender adults who received gender-affirming hormone therapy had a significantly lower risk of moderate-to-severe depression over four years compared to those who did not receive such care, according to a new study published in the journal JAMA Network Open.
The study tracked 3,592 transgender, nonbinary, and gender-diverse adults and found that those prescribed hormones like estrogen or testosterone had a 15% lower risk of depression symptoms, reinforcing the mental health benefits of this treatment.
The findings “support the mental health-promoting role of hormones” and their status as “a medically necessary treatment,” said Sari Reisner, an associate professor of epidemiology at University of Michigan School of Public Health and one of the study’s authors. “Hormones play a vital role in the mental health of trans people who need them.”
The study acknowledges that other factors, such as mental health treatment, social support and other influences on mood, could have affected the findings. It also did not track the duration patients received gender-affirming hormone therapy or whether they underwent other forms of gender-affirming care, such as surgery.
Transgender people in the U.S. are two to three times more likely to have a history of depression, according to the Centers for Disease Control and Prevention. The study warns that mental health disparities continue to worsen in transgender and gender diverse communities, as access to gender-affirming care becomes more difficult.
Dr. Alexes Hazen, a New York City plastic surgeon specializing in gender-affirming procedures, says she has seen a rise in depression among her patients in recent months. Many have expressed concerns over the wave of state laws restricting or banning gender-affirming care, which has made finding treatment more difficult and left many feeling hopeless.
“Unfortunately, some states are not as friendly to patients and care providers,” Hazen said. “Some states have publicly stated their allegiance to trans and nonbinary folks, and those places will become safe havens for care.”
As barriers to gender-affirming care grow, the new study underscores its importance for mental health in transgender patients. These services “address the pervasive mental health inequities that trans people experience,” Reisner said, emphasizing that access to this care is both medically necessary and essential for reducing depression risk.
“Our findings underscore the importance of protecting and upholding the right to accessible healthcare for trans people,” Reisner said,
Hazen recommended community-based health centers that cater to LGBTQ+ patients as a key resource for gender-affirming care. The study also reinforced the importance of these clinics, arguing that the gender-affirming treatment they provide improves access and supports mental health, particularly for those in underserved communities.
Alice Gao, MD, MPH, is a family medicine resident at Temple Northwest Community Family Medicine and a member of the ABC News Medical Unit.
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(NEW YORK) — Temperatures are beginning to warm up, indicating the arrival of spring — and of allergy season for millions of Americans.
Research shows that allergy seasons may be hitting people harder by starting earlier, lasting longer and creating more pollen.
Growing seasons — the time of year that conditions allow plants to grow — start earlier and last longer than they did 30 years ago, according to a report from the Allergy and Asthma Foundation of America.
Additionally, pollen concentrations have increased up to 21% across North America over the last three decades, data from the USA National Phenology Network shows.
Allergists told ABC News a mix of climate change and more carbon emissions has led to plants in many areas having longer growing seasons and higher pollen counts.
“Research has definitely shown that the seasons are indeed expanding,” Dr. William Reisacher, an otolaryngic allergist at Weill Cornell Medicine and New York-Presbyterian Hospital, told ABC News. “We’re seeing longer pollinating seasons. We’re seeing higher levels of pollen.”
What causes seasonal allergies?
Allergies occur when the immune system views food, medicine, plants or something else as a harmful substance and overreacts.
Some seasonal allergies, also known as allergic rhinitis or hay fever, occur due to pollen, which are tiny grains that are dispersed from certain flowering plants.
“Allergies are essentially your immune system overreacting to things that you’re exposed to in your environment,” Dr. Thanai Pongdee, a consultant allergist-immunologist at Mayo Clinic in Rochester, Minnesota, told ABC News. “So, for example, if you have hay fever and are allergic to tree pollen or grass pollen this time of year, when you breathe that pollen in, your immune system recognizes it and causes a cascade of events where various chemicals get released — one of the main ones being histamine, and these chemicals cause the symptoms that many experience.”
This leads to symptoms including runny nose, sneezing, congestion and itchy, watery eyes, according to the Centers for Disease Control and Prevention.
Reactions can range from mildly annoying symptoms to life-threatening reactions including anaphylactic shock, which can cause multiple organs to fail.
As of 2021, an estimated 25.7% of U.S. adults and 18.9% of U.S. children have seasonal allergies, according to the CDC’s National Center for Health Statistics.
Why are allergy seasons getting longer?
Allergy season typically begins in the spring, around March, and typically ends in the fall, lasting as late as November.
“When we refer to seasonal allergic rhinitis, we are usually referring to allergic symptoms that occupy a certain time of the year,” Reisacher said.
“So, springtime, at least in the northeast, is typically when the trees are pollinating whereas in the summertime, we see the grass is pollinating, and then in the fall, it’s all about the weeds,” he continued. “Ragweed is the most common pollen present at that time of the year.”
However, research has suggested that allergy seasons are getting longer and worse.
“Allergy season is getting longer — in fact it is an average of 13 days longer compared with 20 years ago,” Dr. Purvi Parikh, an allergist and immunologist at NYU Langone Health, told ABC News.
A 2022 study from the University of Michigan found that, by the end of the century, pollen emissions could begin 40 days earlier in the spring than occurred between 1995 and 2014, meaning there could be an additional 19 days of high pollen counts.
Allergists say climate change is one of the biggest reasons why allergy seasons are getting longer.
A 2021 study found human-caused climate change is worsening North American pollen season, causing them to lengthen by 20 days on average between 1990 and 2018.
Reisacher said that as the globe experiences warmer temperatures each year, more storms are occurring, which kicks up more pollen.
“It travels for many more miles on the wind, and it makes it more allergenic, so it gets deeper into our body, into our lungs and even through the tissues that protect our body,” he said.
The warming planet also means that it’s taking longer to see the first frost, which usually occurs in the fall and hold pollen underground, he said. A longer time to get to the first frost means pollen has a longer time to stay in the air.
Reisacher said greenhouse gases are another reason for the longer allergy season. He said more carbon dioxide has been released into the air due to fossil fuels. Plants feed off carbon dioxide, and this has released more pollen into the air.
“There has been a direct correlation between the levels of [carbon dioxide] in the atmosphere and the amount of pollen that plants, including ragweed, are producing,” he said. “So, it’s hard to deny that that is a factor.”
Reisacher and Parikh say this means there will likely be more people who experience seasonal allergies over the next several years.
How to treat seasonal allergies Allergists said there are a number of over-the-counter medications that people can try as well as nasal sprays and rinses.
Some are tailored to relieve symptoms while others are used to prevent symptoms. Additionally, only certain medications work for certain symptoms.
“Start with 24-hour antihistamines. They last longer with fewer side effects,” Parikh said. “[You] can also add nasal steroid or antihistamine sprays as well as eye drops. However, if you aren’t improving, please see an allergist.”
Pongdee said allergy shots may be effective for those who are looking for long-term solutions and are not relief from daily medication.
Reisacher recommends starting medications a few weeks before allergy season starts because they need time to take effect.
He said there are also steps people can take to at home to prevent pollen from coming indoors including keeping windows closed in the early morning when pollination is higher, using air conditioner filters. separating indoor and outdoor clothing and showeing to get pollen off skin and out of hair.
“You want to create a safe haven, and that’s your bedroom,” Reisacher said. “You want to create a pollen-free environment in your bedroom so that at least you have seven or eight hours that your immune system can rest without having to react to pollen.”
(WASHINGTON) — Five years ago, the World Health Organization declared the COVID-19 outbreak to be a pandemic, leading to stay at-home orders and shutdowns across the U.S. and world.
The nation looks much different since then, and scientists and researchers have learned a lot about the virus, including how it infects people, the best forms of treatment and what puts someone at risk for long COVID.
There are still many questions, however. Health care professionals are working to find answers, such as how many people have truly died, how long the virus spread undetected in the U.S. and its origins.
“We know this emerged in China, around the city Wuhan. That’s very clear,” Dr. Cameron Wolfe, an infectious diseases specialist and a professor of medicine at Duke University School of Medicine, told ABC News. “We know when [the] medical community identified it, but we don’t know quite how long it was circulating before then. I think it’s caused some of the consternation.”
How many people have died of COVID-19?
As of March 6, at least 1,222,603 Americans have died of COVID-19, according to data from the Centers for Disease Control and Prevention.
The U.S. currently has the highest number of deaths of any country in the world, according to the WHO.
Experts, however, believe the true death toll is higher.
“More than a million people is a tragedy into itself, let’s start with that obvious fact,” Wolfe said. “I think the numbers are really hard to pin down for one key reason.”
Determining the exact cause of death can be complicated, Wolfe explained. Someone could die of COVID pneumonia — a lung infection caused by the virus — or die from a heart attack after contracting COVID.
Another example is an older adult who contracts COVID-19. They may become dehydrated, break a bone — because dehydration negatively impacts bone health — and suffer fatal complications, Wolfe said.
“How you count those outcomes is really important because, to me, that person wouldn’t have had their heart attack or that person wouldn’t have become dehydrated and fallen over and landed in the hospital if not for COVID triggering that event in the first place,” he said. “So, I actually think it’s really important to count those as COVID-associated mortalities, but they’re hard to count. They’re hard to track.”
Globally, more than 7 million people have died due to COVID-19, WHO data shows, although the agency says the pandemic caused an estimated 14.83 million excess deaths around the world in 2020 and 2021.
What is the mechanism behind long COVID
Scientists are not sure what causes long COVID but have identified certain risk factors such as an underlying health condition. Long-COVID symptoms can last for weeks, months or even years and can include — but are not limited to — fever, fatigue, coughing, chest pain, headaches, difficulty concentrating, sleep problems, stomach pain and joint or muscle pain, according to the CDC.
Research has found that patients with long COVID tend to have lower cortisol levels and lower testosterone levels.
“There are several questions that we still do not have answers for. What is the mechanism of the disease? Why do some people get more sick than others?” Dr. Fernando Carnavali, an internal medicine physician and a member of the team at Mount Sinai’s Center for Post-COVID Care, told ABC News.
Carnavali said scientists are using machine learning to study groups of long COVID patients in an attempt to determine the mechanisms that cause the condition.
“Do we have a single answer? Not as of yet, and most likely, perhaps we’ll have more than one answer,” he said.
Carnavali said the mechanism may not be the same for every long COVID patient. Additionally, people may have different symptoms due to different genetic predispositions.
“Some of the deficits that we have five years ago still remain, but I think that we should all understand and be hopeful that … researchers using machine learning will [provide] us some of the answers that we need as clinicians,” he said.
When did COVID enter the United States?
It’s still not exactly clear when the virus first entered the U.S. The first confirmed case in the country was Jan. 20, 2020, in a man in his 30s in Washington state, who developed symptoms after a trip to Wuhan.
However, studies have suggested the virus may have been circulating undetected for months beforehand.
Although the WHO was first notified on Dec. 31, 2019, about the mysterious pneumonia-like illness that originated in Wuhan, experts say it is likely that in an age of global travel, the virus was in the U.S. before then.
“It’s more likely circulated before Jan. 1 [2020]. It doesn’t seem unreasonable, November, December,” Dr. Lisa Olson-Gugerty, an associate teaching professor for Syracuse University and practicing family nurse practitioner in emergency medicine, told ABC News. “COVID masquerades itself as a flu-like illness, upper respiratory-like illness, like many other viral illnesses. It’s not easy to say, ‘Hey, I think this must be a new thing, and I’m going to tell everyone.'”
She went on, “I think it takes a bit of collective time to recognize a new viral strain, and it doesn’t seem unreasonable [there were] cases that could have been recognized as COVID before the date of release of information.”
Where did the virus come from?
There are two theories about where the virus, known as SARS-CoV-2, originated.
At least four U.S. agencies believe the virus was a result of natural transmission and that the virus jumped from animals to humans at a wet market.
The FBI, the CIA and the Department of Energy – the latter with “low confidence” — believe the COVID-19 pandemic “most likely” was the result of a laboratory leak in China.
Additionally, an April 2023 report from Senate Republicans conceded that “both hypotheses are plausible” but that the evidence points to the virus emerging from an accidental lab leak in Wuhan — and there may even have been multiple leaks.
If the virus did come from an animal, there are questions about which species may have spilled the virus over from animals to humans.
“I’ve seen a lot of conflicting information,” Olson-Gugerty said. “Did it come from a bat? Did it get into raccoon dogs or civet cats? Or was it a lab-created virus in Wuhan, China There does seem to be a jury that’s out.”
Wolfe said we may never know the true origins of SARS-CoV-2, but trying to answer the question helps scientists and public health professionals learn how to mitigate the spread so a pandemic — or even widespread illness — doesn’t happen again.
“This was the same question that happened during the Ebola pandemic, when we had to say, ‘Where did this come from? How can we educate people to minimize this future risk?'” he said. “It was important to examine where COVID-19 came from to try and put things in place that would stop that happening.”
He added, “We certainly, I would say, have better safety mechanisms now in place … so there are some good things that have come out of this.”
(WASHINGTON) — The battle over taxpayer funding for Planned Parenthood takes center stage at the U.S. Supreme Court on Wednesday in a dispute over South Carolina’s exclusion of the group from the state Medicaid program because it provides abortions.
On the line is the ability of Medicaid beneficiaries to freely choose a healthcare provider, including physicians at Planned Parenthood who provide services other than abortion, like contraception treatments and cancer screenings.
South Carolina’s two Planned Parenthood clinics have served mostly low-income, minority women for more than 40 years. Hundreds of their patients are Medicaid recipients.
The case also implicates the millions of federal dollars Planned Parenthood receives in the form of reimbursements for treating Medicaid patients each year.
According to Planned Parenthood, 34% of its overall revenue, or $699 million, comes from government grants, contracts, and Medicaid funds.
In 2018, South Carolina’s Republican governor Henry McMaster issued executive orders disqualifying Planned Parenthood from receiving Medicaid reimbursements for non-abortion services.
Julie Edwards, a Medicaid beneficiary and type-1 diabetic who sought medical care at a Planned Parenthood clinic in Columbia, SC, sued the state alleging a violation of the Medicaid Act, which guarantees a “free choice of provider” that is willing and qualified.
“Medicaid beneficiaries often face significant barriers to obtaining care, particularly in South Carolina. Twenty-five percent of state residents live in medically underserved areas,” the plaintiffs wrote in their brief to the high court.
“[Congress] enacted the free-choice-of-provider provision to ensure that Medicaid patients, like everyone else, can choose their own doctor,” they wrote. “Congress specifically enacted this provision in response to some States’ efforts to restrict Medicaid patients’ choice of provider.”
The state argues that Congress never intended to give individuals the right to sue over access to a particular provider and that there are plenty of other clinics available to serve Medicaid recipients.
“Congress wanted states to have substantial discretion to innovate with their Medicaid programs,” the state wrote in its brief to the high court. Allowing individuals to sue over access to specific providers would “subject the state to unanticipated (and expensive) lawsuits.”
While federal law already prohibits any government funding of abortions, South Carolina contends it has the right to target non-abortion funding to abortion providers. “Because money is fungible, giving Medicaid dollars to abortion facilities frees up their other funds to provide more abortions,” the state told the court.
“[Planned Parenthood] can restore Medicaid funding if it stops performing abortions— but it has chosen not to do so,” South Carolina wrote.
If the justices allow the suit to go forward, Edwards and Planned Parenthood can continue to challenge the clinics’ exclusion from the state’s Medicaid program in a lower court.
If the justices side with the state, they would bolster efforts to cut off Planned Parenthood from sources of government funding and effectively limit the number of providers available to Medicaid recipients.
A decision in the case is expected by the end of the Court’s term in June.
