Table 4. Association Between GAHs or PBs and Mental Health Outcomes in Multivariable Model 2^a.

Factor	Moderate or severe depression (PHQ-9 ≥10)		Moderate or severe anxiety (GAD-7≥10)		Any self-harm or suicidal thoughts
	aOR (95% CI)	P value	aOR (95% CI)	P value	aOR (95% CI)	P value
PBs or GAHs	0.40 (0.17-0.95)	.04	1.01 (0.41-2.51)	.98	0.27 (0.11-0.65)	.003
Time, mo
0 (baseline)	1 [Reference]	NA	1 [Reference]	NA	1 [Reference]	NA
3 mo	3.22 (1.37-7.56)	.007	1.49 (0.62-3.59)	.37	1.77 (0.76-4.13)	.19
6 mo	1.77 (0.72-4.37)	.21	0.77 (0.28-2.11)	.61	2.76 (1.22-6.26)	.02
12 mo	2.71 (0.82-8.95)	.10	0.95 (0.31-2.93)	.93	2.93 (0.83-10.4)	.10
Mental health & substance use at baseline
Moderate or severe depression (PHQ-9 ≥10)	19.4 (8.64-43.4)	<.001	NA	NA	NA	NA
Moderate or severe anxiety (GAD-7 ≥10)	3.82 (1.87-7.82)	<.001	12.4 (6.25-24.7)	<.001	NA	NA
Self-harm or suicidal thoughts	NA	NA	NA	NA	23.9 (12.9-44.5)	<.001
Any substance use	3.20 (1.49-6.84)	.003	2.21 (1.09-4.50)	.03	2.00 (1.08-3.73)	.03
Resilience at baseline (CD-RISC 10 ≥22.5)b	NA	NA	0.48 (0.24-0.95)	.04	NA	NA

Abbreviations: aOR, adjusted odds ratio; CD-RISC 10, Connor-Davidson 10-item Resilience Scale; GAD-7, Generalized Anxiety Disorder 7-item scale; GAH, gender-affirming hormone; NA, not applicable; PB, puberty blocker; PHQ-9, Patient Health Questionnaire 9-item scale.

^a Model 2 includes a time-varying exposure variable measuring the receipt of PBs or GAHs adjusted for temporal trend (ie, categorical variable for months 3, 6, and 12 relative to baseline) and covariates that were statistically significant in the bivariate models (such that 95% CIs did not contain 1.00) (see Table 2). The unadjusted bivariate associations between PBs or GAHs and mental health outcomes are reported in Table 2. Covariates that were not significant in bivariate models are marked NA.

^b The median (range) CD-RISC score for the cohort is 22.5 (1-38).