Shown are changes in participant-reported measures over a period of 2 years of treatment with gender-affirming hormones (GAH). Scores on the Appearance Congruence subscale of the Transgender Congruence Scale (Panel A) range from 1 to 5, with higher scores indicating greater appearance congruence. T scores for the Positive Affect measure from the NIH (National Institutes of Health) Toolbox Emotion Battery (Panel B) range from 0 to 100, with higher scores indicating greater positive affect. T scores for the Life Satisfaction measure from the NIH Toolbox Emotion Battery (Panel C) range from 0 to 100, with higher scores indicating greater life satisfaction. Scores on the Beck Depression Inventory–II (Panel D) range from 0 to 63, with higher scores indicating greater depression. T scores on the Revised Children’s Manifest Anxiety Scale (Second Edition) (Panel D), range from 0 to 100, with higher scores indicating greater anxiety. Individual scores are depicted with orange triangles for youth initiating GAH in early puberty (“Yes”) and with blue circles for youth who did not initiate GAH in early puberty (“No”). Lines indicate mean scores for each group, with gray shaded bands for 95% confidence intervals.