Table 4.

Associations of gender confirmation, gender identity, and procedures aimed at changing secondary sex characteristics with high CESD-10 depression and anxiety scores

Variables of interest	Total N	N (%) within treatment category	Unweighted analyses			Weighted analyses
			PRa	95% CIb		PRa	95% CIb
CESD-10 score above 10c
Gender confirmation category
Definitive bottom surgery	141	50 (35%)	1.00	(reference)		1.00	(reference)
Partial bottom surgery	75	34 (45%)	1.19	0.84	1.67	1.18	0.84	1.68
Top surgery	158	66 (42%)	1.00	0.73	1.38	0.96	0.69	1.34
HT only	198	113 (57%)	1.40	1.07	1.83	1.38	1.05	1.81
No treatment	26	20 (77%)	1.94	1.42	2.66	2.01	1.51	2.68
Gender identity
Transfeminine	293	139 (47%)	1.00	(reference)			(reference)
Transmasculine	305	144 (47%)	0.92	0.74	1.15	0.91	0.73	1.12
Changes in secondary sex characteristics
Yes	71	30 (42%)	1.00	(reference)			(reference)
No	527	253 (48%)	0.91	0.69	1.18	0.93	0.72	1.21
Anxiety score above 21d
Gender confirmation category
Definitive bottom surgery	139	8 (5.8%)	1.00	(reference)		1.00	(reference)
Partial bottom surgery	73	13 (18%)	1.93	0.82	4.53	1.41	0.57	3.46
Top surgery	159	34 (22%)	1.90	0.86	4.18	1.51	0.68	3.37
HT only	195	47 (24%)	2.59	1.21	5.54	2.15	1.02	4.51
No treatment	26	11 (42%)	4.33	1.83	10.54	2.74	1.10	6.80
Gender identity
Transfeminine	296	42 (14%)	1.00	(reference)		1.00	(reference)
Transmasculine	296	71 (24%)	1.26	0.81	1.94	1.38	0.87	2.20
Procedures to change secondary sex characteristics
Yes	72	6 (8.3%)	1.00	(reference)		1.00	(reference)
No	520	107 (21%)	1.00	0.48	2.11	1.05	0.49	2.25

^aPR, prevalence ratio adjusted for age, race, study site, and all variables listed in the table.

^bCI, confidence interval

^cModel based on 598 observations

^dModel based on 592 observations