What Science Doesn't Know About Gender Care & Suicide Risk

Transgender activists claim that gender treatment (including puberty blockers, hormones, and surgery) is “life-saving care,” in that it reduces suicide. But a review of scientific research suggests that this relationship might be best compared to intoxication, in that alcohol also produces a desired, measurable effect – it reduces anxiety – and yet its medical consequence clearly argues against its use as a front-line anxiety medication.

This is the dilemma surrounding the gender treatment debate. Scientists can’t isolate what’s causing suicidal behavior within the transgender community to begin with – which means, even in cases where suicidal behavior is shown to decrease after gender treatment, they can’t explain why. All they know is that a high-risk variable, with life-altering side effects, is correlated with a desired, measurable result.

But if you wouldn’t prescribe alcohol to treat anxiety – even though one appears to help the other – why would you accept that chemical or surgical castration is the best way to prevent transgender suicide, when scientists can’t even pinpoint the connection?

Transgender individuals do have an increased risk of suicide. So if you care about fixing that problem, you need to be willing to step back and look at the whole board. No matter how much you support “gender care,” promoting a treatment should never become more important than protecting a patient. And right now PR campaigns are misleading patients into thinking we know way more than we do and misdirecting them from getting help for other serious risk factors.

What Causes Transgender Suicide?

Ok, so let’s tackle our first problem:

Suicide is a super complex issue, with a ton of influencing factors – or, in science-speak: confounding variables – including psychiatric disorders, psychiatric treatment, trauma, and substance abuse. So you’d assume that studies on gender treatment and suicide would control for those variables, right?

Wrong.

In a review of 23 of the best studies out there – meaning they’re quantitative, peer-reviewed, and frequently cited by The Washington Post (kidding on that last one) – researchers found that only three even considered whether the participants had psychiatric diagnoses or mood disturbances. Which is crazy, since 1) mental illness is one of the most commonly cited risk factors for suicidal behavior, and 2) transgender patients have a significantly higher rate of mental illness than the general population.

Same thing with psychiatric treatment. Only three studies made any attempt to factor it in and only one considered psychotropic medication. Which again, seems like a pretty big omission, since in a meta-analysis of 23 placebo-controlled clinical trials and one multicenter trial, spanning nearly 4,600 patients, the FDA found that antidepressant use in pediatric patients is associated with an increased risk of suicide.

Oh, and that one study? In a review of 3,753 transgender youth, researchers found that over 75% were on psychotropic medication (including antidepressants, anti-psychotics, and lithium). They were also six times more likely to have a mood disorder, and over five times more likely to have a psychotic disorder, than their siblings. Researchers also reported that mental healthcare visits were not significantly changed and psychotropic medication use actually rose following gender treatment.

And, despite a meta-analysis confirming that transgender individuals have a higher prevalence of substance use than the general population, only two of the studies accounted for that variable. Again, a major problem since, as the Journal of Public Health explains, “there is a strong association between substance use disorder and suicide outcomes.”

So, no. Scientific studies do not prove that restricting access to gender treatment promotes suicidal behavior – because they can’t. There’s way too many variables clouding the water.You can’t claim a specific treatment saves lives by fixing X, when you don’t even know if X is the main problem. And you certainly can’t claim a cause-and-effect relationship between two events – like gender treatment and reduced suicide risk – simply because they’re associated.

What’s that saying?

Correlation Does Not Imply Causation

Consider some of these other data points:

• One recent study found a quarter of transgender participants experienced childhood sexual abuse.
• Another study of over 25,000 transgender patients found the presence of personality disorders and psychosis – so we’re not just talking depression or anxiety – was over 20 times and 3 times higher, respectively, than cisgender patients.
• Research also shows transgender individuals are more likely to experience chronic health conditions.

These are all well documented suicide-risk-enhancing factors. So why aren’t they part of the mainstream dialogue? If the goal is to genuinely reduce harm, we should be addressing every single variable – not pretending that one course of action (gender treatment) is a cure-all, simply because it’s politically en vogue.

But back to our studies. What about the papers that actually controlled for psychiatric diagnosis/treatment and substance use?

In one study that factored in mental health therapy and substance abuse, researchers found that puberty blockers and hormones were associated with lower odds of suicidality over twelve months. However, buried down in the last paragraph of the paper, the authors acknowledge: