PSUN122 The Missing Link Between Obesity and Depression in Transgender Patients: A Retrospective Review at the Border of the United States.
Authors: Pedraza Lina , Suarez Andres , Cordoba Michelle 
Published: November 2022

Abstract

Introduction
According to the 2015 U.S. Transgender Survey, 81.7% of respondents reported seriously thinking about suicide at least once in their lifetimes. Rates of depression and suicidality were higher in those who had 'poor overall health' and a 'multiracial background'. It is unclear if obesity and metabolic syndrome were contributors to these statistics. However, a meta-analysis has shown that obesity itself increases the overall risk of depression by 55%. Additional risk factors predisposing transgender patients with obesity to depression have not been previously identified.
We studied the prevalence of depression in transgender people along the United States border, where lack of access to healthcare, poverty, and obesity rates are among the highest nationwide. Underlying risk factors might include lack of healthcare access, hormone use, gender reaffirming surgery, age, and ethnicity.

Objectives
Determine the prevalence of depression and underlying risk factors associated with it among transgender adults with overweight/obesity (BMI &gt;24.9) in a gender clinic at Edinburg, TX, from 2018 through 2020.

Methods
We performed a retrospective review of electronic medical records of transgender adults (≥18 years) seeking hormone therapy. Variables collected were: age, ethnicity, insurance, previous hormone use, gender reaffirming surgery, and intention to start feminizing hormone therapy (estrogen) versus masculinizing. We used CDC Body Mass Index cut-offs to determine overweight or obesity.

Results
Median BMI of our sample was 32. The median age at encounter was 25 years old. Median was obtained due to age distribution not being symmetric. In our sample, 82% of patients identified themselves as Hispanic, 47% reported gender-affirming hormone therapy before the first encounter, 34% of patients sought feminizing hormone therapy, and 15% had gender reaffirming surgery in the past.
Depression was reported by 65% of our patients. Interestingly, 73% of insured patients were depressed compared to 33% in the uninsured group. Lack of insurance was the only variable associated with depression showing statistical significance.

Conclusions
Our study aimed to identify factors that might explain the high prevalence of depression in transgender patients with overweight and obesity. Currently, there is minimal information on additional factors other than obesity and sociocultural characteristics.
The majority of depressed patients with obesity were Hispanic; however, only a small number of individuals in our sample were non-Hispanic. Therefore, the characteristics of our population might limit the external validity of our study. Also, we might have missed uninsured patients that could not afford hormone therapy. More extensive studies, including populations with a greater variety of ethnicities and ages, might detect better statistical significance and identify more underlying risk factors. Additional research is required to develop effective public health interventions that improve mental health and wellbeing in the transgender population.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.