Gender affirming treatment and employment rate in 3,812 Danish transgender persons and 38,120 controls

Objective: Gender-affirming care could be associated with higher employment rate. We assessed employment rates in transgender persons compared to controls and demographic, health, and treatment-related factors associated with employment in transgender persons. Methods: National register-based cohort study in Danish persons with diagnosis code of gender dysphoria during year 2000-2021. Five age-matched controls of the same sex at birth and 5 age-matched controls of the other sex at birth were included. The date of study inclusion was the first date of transgender diagnosis. Employment was the primary study outcome. Results: The cohort included 3812 transgender persons and 38 120 cisgender controls. The median age (interquartile range) was 19 (15; 24) years for transgender men, n = 1993 and 23 (19; 33) years for transgender women, n = 1819. In transgender men compared to control cisgender women, the odds ratio (OR) (95% CI) for employment was 0.33 (0.29; 0.38) before study inclusion and 0.24 (0.20; 0.29) in the fifth calendar year after index; in transgender women compared to control cisgender men, corresponding ORs were 0.30 (0.70; 0.34) and 0.21 (0.18; 0.25). Similar findings were observed between transgender persons and cisgender controls of other sex. Use of gender-affirming hormone in transgender men increased probability of employment at all time points after 5 years (OR 1.61 [95% CI: 1.08; 2.42], P = .02). In transgender women, use of hormone treatment was not associated with changed employment rates at 5 years (OR 1.31 [0.94; 1.82], P = .11). Conclusion: Masculinizing hormone treatment was associated with higher probability of employment.