in the middle In a flurry of anti-transgender legislation introduced earlier this year, Republican Gov. Spencer Cox of Utah took to the state’s legislature as he tried to veto a bill that would ban transgender youth from participating in women’s sports. an impassioned request. “I want them to live,” he wrote of trans athletes in his state, referring to the astronomical number of suicide attempts in the trans community. Multiple surveys estimate that about 40 percent of transgender people are likely to attempt suicide during their lifetime; among the general public, the figure is about 5 percent.
But despite the governor’s attempts to veto it, Utah’s bill passed, as did a number of bills across the country that would ban gender-affirming medical care for children and teens. Many other such bills are currently in development. These treatments—primarily drugs that delay the onset of puberty, and hormone treatments like testosterone and estrogen—help transgender people achieve a body and appearance that suits them. Experts fear the ban will have catastrophic effects. “Young people will die,” said Dallas Ducal, chief executive of Transhealth Northampton, a western Massachusetts medical center that provides gender-affirming health care.
Because such treatments for adolescents are relatively new, and access to them is limited, the pool of studies on their mental health effects is small and recent. But Wired interviewed six academics who have published research on transition and suicide in peer-reviewed journals, and they all agreed that gender-affirming health care appears to reduce risks for transgender youth. No single study can prove this once and for all, and no single study can put an end to all debates in general. The researchers say they cannot ethically conduct the randomized controlled trials that are the gold standard for most medical research: that would involve giving people in potentially dangerous situations a placebo. Still, taken as a whole, the studies tell a consistent story, one that was enough to convince their authors that these medical treatments were vital. “All the data we have right now suggest that they reduce suicide rates,” said Jack Turban, assistant professor of child and adolescent psychiatry at UCSF.
Research in this area can be tricky because it involves small numbers of people: Transgender people are a minority in the population, and those who received gender-affirming therapy as minors were even smaller. Some of these minors may receive puberty blockers, others only hormones, and some may have both. It takes a lot of time and money to collect enough participants to get statistically significant results.
Studies limited to people who attempted suicide would be smaller. As a result, researchers often focus on suicide, a term that covers a wide range of behaviors, including considering taking one’s own life. Critics argue that the study does not show evidence of a crisis — after all, thoughts are not actions. But thinking is a strong predictor of suicide attempts and a “marker of very serious psychological distress,” Turban said. And, because it’s more common, it’s easier to learn.
To do this, researchers have two main tools at their disposal. The first are longitudinal studies, which follow individuals over time to assess the effects of medical interventions. In the context of transgender healthcare, these studies often start in the clinic: Patients who want a specific intervention will be recruited into the study, and then researchers will follow them throughout their treatment.