TOPICS

For those new to this issue it’s best to know these terms before reading.

15) “Transition your child without question or they will kill themselves”; A common Mantra; Suicide Stats Reviewed

The above section talks about extremist trans activist behavior and its effect on public discourse around the medical transition of minors and young adults. Discussions around suicide are also highly politicized and used to argue against anything other than the affirmation model may risk some young people’s safety. This dynamic is important to address but first:

Please Read: Trans youth and trans adults are at higher risk for suicide. Multiple studies show that trans people without supportive families are at much higher risk for suicide than trans people with supportive families. Most of these studies are cited below. We do not advocate for any rejection or behavior that indicates a parent (or anyone else) will reject a young person if they decide they are transgender or promote the idea they will be less valued if they ultimately decide to transition. We only call for proper screening to prevent medical harms to both desisters and trans youth who are being exposed to intense medical treatments at younger and younger ages. And to point out that suicide ideation in trans youth may be in reaction, in some cases, to homophobic and transphobic parents, which may differ from those under the support of loving, supportive parents, who want the youth to have proper mental health screening and a chance to mature before permanently altering their bodies. The website Transresearch.info has some good resources for phone numbers and websites for suicide prevention for trans people.

A bullet point review of this data can be found here.

Having acknowledged suicide risk in trans people and the increase of it without supportive loved ones, it is necessary to discuss the politicization of suicide and its constant use to silence any debate around the safety of transitioning young people. There is also a need to understand the causes behind suicide ideation in young dysphoric people because it appears to not always be prevented by familial and community support alone. Furthermore, there is a need to examine the ethics of mental health professionals, doctors, trans activists, LGBT orgs and media who tell parents their child will kill themselves if they don’t adhere to immediate affirmation.

Given that trans suicide rates and ideation are high and that we don’t know all of the reasons; topics most important for the discussion here are:

1) Does early transition reduce teen suicides?

2) Does medical transition reduce suicides in adults? 

3) Is it ethical and justified for affirmation models to advocate telling parents they need to transition their minor children or they will kill themselves?

Answering all of these questions perfectly is very difficult given the complexity of mental health issues and the fact that some studies and anecdotal examples present a contradictory picture of suicide in trans people.

A. Suicide is socially contagious

Anyone who questions the safety of the affirmative model will often get accused of “causing the deaths of trans kids.” While actual suicide risk and the circumstances around it are important to discuss, it is well known young people and adults are prone to suicide contagion, so much so that there are media reporting guidelines around reporting suicides for both teens and adults as discussed in this NY Times article.

Mental illness is not a communicable disease, but there’s a strong body of evidence that concludes, suicide is still contagious. Publicity surrounding suicides has been repeatedly and definitively linked to a subsequent increase in suicide, especially among young people. “Analysis suggests that at least five percent of youth suicides are influenced by contagion.”

Here are the media reporting recommendations from the CDC in the U.S.

And more media suicide reporting guidelines from American Foundation for Suicide Prevention.

And some suggestions on Reportingsuicide.org.

B. Adult suicide stats: does medical transition reduce suicide risk?

It is actually very difficult to answer this question due to the fact that follow up studies on trans people are usually low-quality due to short time span of follow up, loss to follow ups, failing to ask if the suicide attempt/ideation took place before or after medical transition and lack of control groups of people with equal levels of gender dysphoria who have not medically transitioned. There is also a section on regret rates that indicates regret data suffers from the same problems.

This overview study, Marshall et al. (2015): “Non-suicidal self-injury and suicidality in trans people: A systematic review” shows very high numbers of suicide ideation (as well as self-harm) and attempts in most studies. It also highlights that few studies isolate post transition statistics or compare them with pre-transition numbers.

Suicide rates in trans people post-treatment. There are few studies looking at suicide rates within the trans population, particularly focusing on post-treatment. One of those studies, by Van Kesteren et al. (1997): found that although total mortality rates after hormone treatment was no higher than in the general population, the number of cases of suicide was higher compared with the expected mortality rates for suicide, particularly among the trans female sample. The number of suicides for trans men was similar to that expected in the cisgender population. These findings were confirmed in an impressive follow-up study of post-treatment trans people (Dhejne et al., 2011). The authors found that the overall mortality rate for sex-reassignees was higher than for controls of the same birth sex, particularly death from suicide. They also reported that sex reassignees had an increased risk for suicide attempts, suggesting that the suicide risk for the trans population may not be reduced after treatment and transition. These results confirm those from a Dutch study of a transgender population on long-term sex hormones. In this study Asscheman et al. (2011): found that mortality by suicide was increased by sixfold among the trans female sample compared to the cisgender population. There were no significant differences of mortality rates in the trans men compared to the cisgender population, possibly due to the small number of trans men compared to trans women. 

…Studies investigating prevalence rates of suicidality among trans people showed an increase of suicide ideation, suicide attempts and suicide rates, even after transition and sex reassignment surgery when compared to the cisgender population (De Cuypere et al., 2005; Eldh et al., 1997; Walinder & Thuwe, 1975), suggesting that although NSSi rates may decrease from pre-transition to transition (Claes et al., 2015; Davey et al., 2015) suicidality and more worryingly, suicide rates are still significantly greater than in the cisgender population (Dhejne et al., 2011, Asscheman et al., 2011). Although some of these findings require replication, it may indicate a correlation to that vulnerability to mental health problems and suicidality may increase with age in the trans population, possibly linked to a lack of social support, loneliness, victimization and discrimination, as these factors have been found to be associated with poor quality of life in trans people (Davey et al., 2014, 2015). 

There were a few studies relevant to suicide risk missed in the Marshall study covered by Adams et al., (2017) review: “Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature”

What studies indicate medical transition in adults reduces suicide risk?

The large majority of studies of mental health outcomes (with and without questions about suicide) on trans adults indicate that overall psychological functioning improves, the gender dysphoria is significantly reduced, and regret rates are low. A recent review of 56 studies by Cornell University done in 2018 confirms this:

This search found a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals. The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender.

They address the suicide issue:

2. Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence and reductions in anxiety, depression, suicidality and substance use.

And in relation to lack of social and medical support:

6. Transgender individuals, particularly those who cannot access treatment for gender dysphoria or who encounter unsupportive social environments, are more likely than the general population to experience health challenges such as depression, anxiety, suicidality and minority stress. While gender transition can mitigate these challenges, the health and well-being of transgender people can be harmed by stigmatization and discriminatory treatment.

Here the researcher admit the problems with the studies:

7. An inherent limitation in the field of transgender health research is that it is difficult to conduct prospective studies or randomized control trials of treatments for gender dysphoria because of the individualized nature of treatment, the varying and unequal circumstances of population members, the small size of the known transgender population, and the ethical issues involved in withholding an effective treatment from those who need it.

Over all 52 studies reported positive results and four studies showed “mixed or null” findings.

Below is one of the very few studies that compared pre and post transition statistics on suicide and showed a very significant reduction in suicide, post transition for a small group of Belgian transsexuals.

The most relevant quote from the study:

Suicide attempt rate 
Although the suicide attempt-rate dropped significantly from 29.3% to 5.1% (McNemar test, N = 58, P = 0.004), it was definitively higher than in the average population (0.15%) (Van Heeringen et al., 2002). 

Problem: A large percentage of participants were lost to follow ups and individuals who refused to participate.

Of those eligible 107 individuals, 30 people could not be reached (28%, 22 male-to-females and eight female-to- males). Fifteen people (14%, six male-to-females and nine female-to-males) refused to cooperate because they did not wish to be confronted with their past, six agreed to co- operate on the condition they were not required to come to the clinic. 

Another one of the 52 studies they cited in the Cornell review that indicates transition reduces suicide is below.

The Bailey et al., 2014 study above is a review of the Trans Mental Health Study in the UK (this was a self-selected survey).

Suicidal ideation and actual attempts reduced after transition, with 63% contemplating or attempting suicide more before they transitioned and only 3% thinking about or attempting suicide more post-transition. 7% found that this increased during transition, which has implications for the support provided to those undergoing these processes (N=316). 

So, while 63% had a decrease in suicide ideation, from this chart it appears around 25% had no change or got worse post transition. And that some suicide ideation was unrelated to the trans issue. This study follows the patterns of others while overall transition may reduce suicide risk, for many it doesn’t. It also states suicide ideation is due to reasons beyond trans identity.

The below study from the Trans PULSE survey in Canada is one of the few studies that measured pre-transition individuals and post-transition individuals and found a positive effect of access to medical transition. It did however, show an increase of suicide risk mid-transition (possibly due to that being at a tumultuous time as the UK survey and seems to show).

Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed)…

Medical transition variables, but not social transition or being perceived as cisgender, were associated with suicidality. Among those who desired medical transition, those on hormone therapy were about half as likely to have seriously considered suicide (RR = 0.52; 95 % CI: 0.37, 0.75). The process of medically transitioning overall was more complex, with a monotonic reduction in suicide ideation from planning to transition vs. being in process, vs. completing. However, among the sub-group with ideation, being in the process of transitioning was significantly associated with increased risk of an attempt (RR = 2.91; 95 % CI: 1.48, 5.76) in comparison with those who were planning to transition but had not yet begun. We did not observe an increased risk in this sub-group among those who completed a medical transition (RR = 0.51; 0.07, 3.74). Completing a medical transition had beneficial individual and population effects. It was associated with a 62 % relative risk reduction (RR = 0.38; 95 % CI: 0.22, 0.66) in ideation. On a trans population level, to facilitate completion of medical transition (when desired) would correspond to preventing 170 cases of ideation per year per 1,000 trans persons (cPAR = 0.17), representing 44 % of ideation (c%PAR = 0.44), and further preventing 240 attempts per 1,000 with ideation (cPAR = 0.24) or 69 % of attempts in this group (c%PAR = 0.69).

Our use of past-year suicide-related measures represents an improvement over studies that used lifetime measures, as we are able to analyse impact on recent or current risk, which is most relevant to prevention. However, temporality remains a concern.

Overall research data on this topic is poor quality due to short time period post transition, no control groups, self-selection, loss to follow ups, and no pre/post transition comparison. But the overall picture from the research on trans adults would indicate suicide risk is reduced post transition since the majority of studies show improved mental health, decreased dysphoria and very low regret rates. Many studies show transition does not solve all problems for trans people, but helps. A minority of individuals may not be helped at all by transition in regards to suicide ideation.

Below studies indicate transition may not reduce suicide risk in adults: 

It should be noted that without a control group of people not able to access medical transition, or good pre and post transition data, knowing the effects of transition perfectly on suicide is impossible. 

While studies showing an overall improvement in mental health in the Cornell review, would indicate there should be a reduction in overall suicide attempts, Adams et al. (2017): a meta-synthesis analysis, indicates this assertion may not be correct. When combining averages across 42 of the more recent studies (relevant because being trans was likely more difficult and unaccepted in the past) they found very high suicide ideation rates, even within the last year. Post transition numbers were not better than pre. The biggest problem with this study is the design, as they are combining averages from studies with differing methodologies, but almost all studies have problems.

“Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature”

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Results: Across these 42 studies an average of 55% of respondents ideated about and 29% attempted suicide in their lifetimes. Within the past year, these averages were, respectively, 51% and 11%, or 14 and 22 times that of the general public. 

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The studies in this review don’t have clear comparisons between pre-transition averages and post-transition averages within the same studies. But it is interesting to note that the two studies that focused on pre-transition suicide ideation show lower averages than past year study data averages (indicating worsening). 

Past years stats also are not much better than lifetime stats in this review. And these are individuals accessing “gender affirming” medical care, yet numbers are still very high. 

A bias in Adams seems to appear in their discussion of finding section because they emphasise studies that contradict this review.

By contrast, evidence is mounting that barriers to transition-related healthcare contribute to suicidality among those who desire such measures 63,78 and though it sometimes increases during transition,78 it typically decreases once desired transitional goals are completed.30,102 Indeed, a recent qualitative inquiry into suicide protective factors among trans adults identified several important protective factors among this population, one of which was socially and/or medically transitioning (for those who seek it).103

And

For example, as noted above, there is growing evidence for the role of both antitransgender discrimination and transitional services in suicidality among this population, with the former implicated in heightened suicidality and the provision of the latter in its reduction. 

This is true for the PULSE study but was not true for Williams, where passing is not shown to improve mental health for females. 

“Suicide Attempts Among Transgender and Gender Non-Conforming Adults: FINDINGS OF THE NATIONAL TRANSGENDER DISCRIMINATION SURVEY.”

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The Williams Institute reported some data for suicide attempts but did not distinguish if they took place pre or post transition. The survey found a tragically high incidence of suicide attempts, 41%. It should be noted the researchers themselves pointed out that without individual follow up, suicide stats can be significantly inflated in studies like this. 

This study is commonly used by trans activist to shut down discussion of medically transitioning minors, insinuating they will kill themselves if encouraged to explore alternatives to transition until they mature. 4thwavenow, a website for parents skeptical of the affirmation only model, reviewed this study and found some information that indicates medical transition does not alleviate suicide risk for many individuals. This is particularly true of bad outcomes for biological females.

-The authors note that the survey was flawed because only one binary, Yes/No question was asked: “Have you ever attempted suicide?” More careful and rigorous studies always follow up with in-person interviews, and when self-harming behaviors (not intended to end life) are controlled for, the actual suicide attempt rate is typically halved—meaning the suicide attempt rate could be as low as 20%.

-The highest suicide attempt rate of all–60+%–was GNC and trans people who self-report a mental disability. No big surprise there; it’s well known that having certain mental conditions is a risk factor for suicidality. But by the authors’ own admission, the survey made no effort to ask for further details about these mental health issues. The status of having a mental condition was self reported, with no corroboration from medical records or a provider. Nor was there any attempt to discover whether the actual rate of mental illness was objectively higher (via diagnosis by a mental health provider) than reported by the subjects.

-People who had either sought or received transition-related services had a higher suicide attempt rate than people who have not. And the survey did not ask whether suicide attempts occurred before or after services were sought or received.

-The data suggest that natal females seem not to be helped at all, in terms of self harm, by being either “stealth” trans or passing as male.  (This is the opposite finding from that of natal males.)

 Another observation by 4thwavenow:

And now to one of the more interesting findings in the Williams Institute report: natal females (in contrast to natal males) who say other people generally don’t recognize them as trans or GNC have the same or higher suicide attempt rate as females who are more often recognized by others.

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Another chart here:

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A quote from the researchers, indicated hormonal and surgical protocols to achieve passing did not improve suicidality.

Importantly, our analyses suggest that the protective effect of non-recognition is especially significant for those on the trans feminine spectrum. For people on the trans masculine spectrum, however, our data suggest that this protective effect may not exist or, in some cases, may work in the opposite direction.

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The suicide attempt rate is still very high among trans people who do not view their trans status as negative. This indicates comorbid conditions, found to be high in all trans studies.

One study oddly showed improved mental health post medical transition but, not suicide risk. This thought process is counter intuitive.

“Effects of Different Steps in Gender Reassignment Therapy on Psychopathology: A Prospective Study of Persons with a Gender Identity Disorder.” 

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In this study one person committed suicide and suicide ideation remained high, even though patients reported less dysphoria and depression. 

Transresearch.info:

At this point, all we know is that we cannot rely on medical transition to prevent or reduce suicide attempts among transgender people.

The results of this study are somewhat confusing. People reported that their symptoms of depression and psychological distress went down after transition. In addition, the vast majority of people who had transitioned said that they felt better; they were happier (93%), less anxious (81%), more self-confident (79%) and their body-related experience improved (98%). Only two people said they were more anxious and one less self-confident. Only two said that their overall mood was similar.

So why did seven people (17.6%) report that they had suicidal thoughts? Why were there four suicide attempts?

Here is another study from Japan showing extremely high suicide rates but not comorbid conditions. There may be cultural differences in mental health reporting across cultures. There is no pre to post comparison.

“Psychiatric comorbidity among patients with gender identity disorder”

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The study is contradictory because patients aren’t reporting anxiety and depression, but there are high suicide rates and rates of self-harm.

Transresearch.info reviews this study, “Psychiatric comorbidity among patients with gender identity disorder – Partial Review:”

 “Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579).”

The horrifying part has been bolded. I’m putting off talking about it until another day when I can deal with it.

I’ll just add that the authors suggested that “the harsh circumstances in which most GID patients have lived in Japan might influence the high rate of suicidal ideation or self-mutilation in GID patients.”

Registry Studies

Paul Dirks, a Christian activist, reviews studies on trans mental health. He does not appear to support LGBT issues or medical transition at all but makes some accurate points in this video on the subject.  

Here are some of them:

Three empirically defensible generalizations: 1] The long-term studies show vastly worse outcomes than the short-term studies 2] The studies with more objective measures show worse outcomes than those with more subjective measures 3] The studies with little or no loss-to-follow-up show significantly worse outcomes than those with greater loss-to-follow-up. 

There are 3 registry studies (Dhejne 2011, Asscheman 2011, and Simonsen et al., 2016) that avoid problems of loss to follow ups and they show high rates of poor transition outcomes. 

“Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden.” 

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There are some comments on the study’s findings from a Christian anti-LGBT blog post called “Transgender Mortality Rates.” It’s a pro LGBT conversion website (a position not supported by this website) but the quotes below are a good summation:

The poorer outcome in the present study might also be explained by longer follow-up period (median 10 years) compared to previous studies. In support of this notion, the survival curve (Figure 1) suggests increased mortality from ten years after sex reassignment and onwards. In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.

And that leaves us with a curious question still to be answered – is the higher rate of psychiatric hospitalization simply due to societal-imposed (and self-imposed) neurosis or is there something intrinsic to those who are transgendered that means that they will have higher rates of psychiatric disturbance regardless of how affirming the environment they are in? Remember, the research is on Swedish post-ops. Scandinavia is arguably one of the most liberal and affirming parts of western society.

The research doesn’t answer that question, but it does tell us very clearly the simple fact that despite the advances in surgery and societal support, post-op transgenders are still far more likely to undergo psychiatric hospitalization than the general population.

An article, critical of medical transition, points out that these mortality rates are very high, even in the most trans friendly and medical transition friendly countries in the world.

Buzzfeed adds that Sweden “was the first country in Western Europe to adopt a procedure to allow people to change their legal gender marker in 1972, and its gender identity law became a model for other nations.”

In other words, next to Spain, Sweden is the nation most willing to accept transgender individuals and their lifestyles, and has been for quite some time. Given this, the best place to study the lives of pre and postoperative transgender individuals would be Sweden…

In one of the most accepting nations in the world, the suicide rates in the transgender community are still astronomically higher than those in the non-transgender community.

Although Dhejne (2011) shows very poor overall outcomes, Dhejne herself points out that there is no pre-transition control group of people denied medical transition in a similar culture. This may (or may not) have shown worse mental health without transition.

For the purpose of evaluating the safety of sex reassignment in terms of morbidity and mortality, however, it is reasonable to compare sex reassigned persons with matched population controls. The caveat with this design is that transsexual persons before sex reassignment, might differ from healthy controls (although this bias can be statistically corrected by adjusting for baseline differences). It is therefore important to note that the current study is only informative with respect to transsexual persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia.[39][40] This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.

There is an interesting possible bias here in this conclusion. Dhejne has said (allegedly, according to a presenter at a Gender Odysee conference in 2017) herself she wouldn’t have published her 2011 research the way she did if she had known medical transition critics were going to use it to paint a negative picture of medical transition. She states, “Things might have been even worse without sex reassignment.” She doesn’t consider without medical access the situation may be better or the same. In regards to her reference to other mental health conditions, it is known that culture does influence mental health. This may be true of gender dysphoria, which appears to be increasing significantly (see here and here)

Cultural and social factors contribute to the causation of mental illness, yet that contribution varies by disorder. Mental illness is considered the product of a complex interaction among biological, psychological, social, and cultural factors. The role of any one of these major factors can be stronger or weaker depending on the disorder (DHHS, 1999).

In the interest of accurate analysis, it is very important to note that a longer study may have a cohort of older individuals who transitioned at a time when coming out and being trans was more difficult than it is today. We do not dispute that older cohorts would have worse outcomes. It is good thing that things are likely getting better for trans people than they were for those who started transition 40 years ago. Dhejne mentions the younger trans population have better outcomes. 

This study has been used by many on the left and right to discredit medical transition altogether, without mentioning this important point. However, what this long-term study does show is that short-term studies have limitations on lifetime positive impacts of medical transition. Since long range outcomes appear worse, we include it in the negative outcomes section. There are also long-range negative health effects of transition.

Another important point around Dhejna’s comments that recent medical transitioners have better mental health: In the last three years gatekeeping has been drastically reduced or even eliminated, including for minors who are getting double mastectomies at age 13 in the United States. Studies of human populations are complex and must consider many factors if they have no proper control group. The sex ratio for younger people has also reversed drastically to skew female so it is difficult to tell if these recent improvements will hold true for more teenager and young adults transitioning. 

The below studies show negative outcomes:

“A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones.”

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The above study involved over 1300 individuals. The external causes of death were increased almost eight times controls. There were 18 suicides, a 6-fold increased suicide rate for MtFs (but not FtMs). Like several of the other studies (Dhejne 2011, Lindqvist 2017) outcomes may get worse over time. Suicides start happening two to five years after transition. This indicates that there is a honeymoon period.

We suspect that our negative finding are due to a long follow up time.

Another study with high suicide rates:

“Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death.”

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Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately one in ten had died. 

Somatic morbidity (ie, official cause of death) included two suicides (19 and 26 years after SRS, respectively)

What’s most relevant about this study, aside from almost no loss to follow up, is that they compare psychiatric morbidity before transition and after transition. It found no improvement in mental health post treatment. The mental health portion of this data review (presented in a separate paper) shows little improvement in mental health pre to post transition.

“Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality.”

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Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant)…

These results indicate that overall individuals undergoing sex reassignment in the Danish public health system hold considerable psychiatric morbidity besides gender identity disorder both pre-and post SRS. 

So, this is another registry study with a very high mortality rate, poor mental health outcomes, and is one of the more recent studies from a very liberal country with socialized health care, Denmark. This study does not support the idea that transition has strong benefits.

Studies below do not address suicidality but show poor outcomes related to medical transition

“Psychological functions in male-to-female (MtF) transsexual people before and after surgery.”

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The title of the above study seems to imply a bias to present this study as positive, even though the longer-term results were clearly not positive.

Conclusions

To our knowledge, this is the largest prospective study to follow a group of transgender patients with regards to QoL over continuous temporal measure points. Our results show that transgender women generally have a lower QoL compared to the general population. GRS leads to an improvement in general well-being as a trend but over the long-term, QoL decreases slightly in line with that of the comparison group. Level of evidence: Level III, therapeutic study.

A review was done in the United States by the Centers for Medicare and Medicaid Services called “Decision Memo for Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N).” The study ultimately concluded that there are very few good quality studies on the trans population and that the outcomes may not be positive enough to justify the health risks and costs of medical transition.

Dr. William Malone, an endocrinologist, posted the main points of the study on social media:

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The below chart does not address suicide, but shows that measures are unchanged and a few worse, after longer periods after transition.

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The outcomes for this study were exceptionally poor in terms of mental health and surgery regret. It was a good study in terms of having a longer period post transition. However, it had major problems with a 75% loss to follow up. This is also an older study when stigma and poor surgical techniques had more of an effect on outcome. 

“Results of long-term follow-up of transsexual patients.” 

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C. Will children & teenagers commit suicide if their parents don’t immediately affirm them as trans, a common claim?

In reality, delaying a youth’s medical transition is unlikely to cause their suicide. But this question cannot be answered with certainty in regards to every individual child/teen. Every child is different. It also can’t be answered with certainty, generally because there has never been a study done with socially and medically “affirmed” minors compared to a control group of children with parents who are loving, supportive, and non-rejecting but support the child in waiting. The purpose of waiting is to avoid potentially damaging drug side effects, to reach a decision with more maturity and to preserve fertility. 

Before going into suicide risk for children and teenagers, first some general information on suicide and young people: 

Suicide hotlines: Please get support and help if needed.

Suicide is known to be contagious for young people.

The numbers of young people who commit suicide is very small.

4thwavenow has a relevant review of suicide data in “Suicide or transition: The only options for gender dysphoric kids?” that notes very low suicide rates in youth.

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Teenagers are more likely to attempt suicide but completions are extremely rare

According to data from the Centers for Disease Control (CDC), the rates of intentional but non-fatal self-injury peak during adolescence at about 450 per 100,000 girls and a bit fewer than 250 per 100,000 boys. These rates are much higher than the 13 per 100,000 American completed suicides per year (and remember that suicide is more common among adults than adolescents). So it is reasonable to assume that most adolescent self-injury is not intended to end one’s life. We are not suggesting that parents ignore children’s self-injury. We simply mean that self-injury often has motives besides genuinely suicidal intent.

The Williams Institute published a survey tracking suicide risk in trans people but had this to say about the rarity of suicide completions in teenagers:

Adolescents, who overall have a relatively low suicide rate of about seven per 100,000 people, account for a substantial proportion of suicide attempts, making perhaps 100 or more attempts for every suicide death. By contrast, the elderly have a much higher suicide rate of about 15 per 100,000, but make only four attempts for every completed suicide. Although making a suicide attempt generally increases the risk of subsequent suicidal behavior, six separate studies that have followed suicide attempters for periods of five to 37 years found death by suicide to occur in seven to 13 percent of the samples (Tidemalm et al., 2008). 

But research does show transgender minors have an increase in suicide ideation and attempts. There are high rates of self-harming and a 9.3 suicide attempt rate in the population of this gender clinic in Boston.

“Children and Adolescents With Gender Identity Disorder Referred to a Pediatric Medical Center.

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Below are several other studies cited from Tishelman (2015) that confirm higher suicide risk in trans minors:

However, such youth often struggle for acceptance within their families and communities. We know from prior research (Dean, et al., 2000Fitzpatrick, Jones, & Schmidt, 2005Gibson & Catlin, 2011Grossman & D’Augelli, 2007Hass, et. al., 2010Spack et al., 2012) that many children with GD become deeply anxious and depressed, and resort to suicide attempts. Others are at risk of leaving home and living a life with high costs and risks, including of exploitation, abuse, and as victims of violence, while obtaining hormones illicitly without the oversight of a qualified medical professional.

This Canadian study also notes that minors with gender dysphoria have higher suicidality. 

“Self-Harm and Suicidality in Children Referred for Gender Dysphoria.”

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There may be differences in suicide risk in teenagers between males and females with gender dysphoria. Self-harming and suicide risk may be higher in young females.

“Characteristics of children and adolescents with gender dysphoria referred to the Hamburg Gender Identity Clinic”

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A higher percentage of the girls were referred to the clinic at the beginning of adolescence (over 12 years old), although more girls reported an early onset of gender dysphoria.

 More of the girls talked about their “(same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions.”

More of the girls reported self-mutilation in the past or present.

More of the girls reported suicidal thoughts and/or attempts.

The referral rate of girls with gender identity disorder was higher than the rate for boys. They give the ratio 1:1.5. (I am not sure what this means; this is a translation of an abstract.)

Another study shows females have higher suicidality than males.

“High rates of suicide and self-harm among transgender youth”

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More patients transitioning from female to male reported a history of suicide attempts and self-injury than those transitioning from male to female.

A more recent study shows very high suicide ideation in biological females. However, there are aspects of this study that indicate it has more to do with a homosexual orientation.

“Transgender Adolescent Suicide Behavior”

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Below studies indicate social & medical transition in minors alleviates suicide risk

In this video Norman Spack states the suicide attempt rate for untreated 16-25-year-olds is 45% in the United States. He claims transition reduces risk in the cohort treated at his clinic. 

The study that shows the strongest positive effect of parental support and access to medical transition on reducing suicide risk is this Trans Pulse survey, (Travers et al., 2012) from Canada. 

“Impacts of Strong Parental Support for Trans Youth.”

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This shows positive influence of parental support in other measures besides suicide risk as well.

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2015 data analysis on this survey (also discussed in adult section) sums up parental support this way:

Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10th versus 90th percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10th percentile…

Among sources of strong support for gender, only support from parents was statistically significantly associated with reduced risk, with RR = 0.43 (95 % CI: 0.26, 0.73) for past-year ideation, and no additional statistically significant effect on the risk of attempts among those with ideation. At a population level, this corresponds to potential prevention of 170 trans persons per 1,000 (cPAR = 0.17) from seriously considering suicide (and thus also reducing the risk of attempt through lowering the proportion at risk). Interestingly, strong support from leaders such as supervisors or teachers was significantly associated with an increased risk of attempts among those with ideation (RR = 5.24; 95 % CI: 2.20, 12.46).

It’s interesting to note from this study (see above graph) that parents who are not supportive of their child’s gender identity appear to be extremely unsupportive of the youth in general. Only 45% of the teen and young adult children of unsupportive parents have adequate housing, indicating rejection and abandonment. The study states “25% indicated their parent(s) were ‘somewhat supportive’ and 42% ‘not very’ or ‘not at all’” indicating many more very negative parents than ones taking a middle position.

It is not surprising young people with parents like this would be suffering intensely in numerous ways. Many of these parents may be homophobic and transphobic. It is well known LGBT young people are more likely to wind up homeless than their heterosexual peers. This study is often used by affirmative model advocates such as Diane Ehrensaft to enforce affirmation and medical transition of minors among parents seeking advice. But it is not necessarily a proper comparison to LGBT supportive parents who want to encourage proper time for identity exploration, mental health support, and body maturation in children and teenagers. 

Another issue regarding parental support is that at times the relationships may be strained because of the mental health problems and behavior of the trans youth, not the parents. Not every strained relationship is due to abusive mothers and fathers. A parent with a trans-identified teen touches on this issue in this blog post:

…but I certainly won’t disown her or ask her to leave my home. In fact, of all the many gender-critical parents I know who have trans-identified children, I know absolutely no one who has disowned their child or kicked them out of the house. I’m sure it must happen, but I don’t know any. Of course, all parents say things they regret – especially during the highly charged arguments with teens who are demanding immediate medical interventions. In one such argument, one of my best friends even told her then-trans-identified daughter to get out, but she immediately regretted it, took it back, apologized, and asked her daughter to stay (which she did). I also know at least three mothers who have lost contact with their trans-identified children, but in those cases, the kids themselves severed the relationship, not the parents. In fact, the mothers continue to try to reconnect with their children, despite being repeatedly rebuffed.

The Pulse study is also not a perfect comparison to children and tweens because the age range is 16-24. If a person has been dysphoric since childhood and reaches adulthood and is still dysphoric, the likelihood of them changing their trans identification is very small. This isn’t the case for prepubescent children. 

In addition, rapid onset cases, that mostly involve teenage girls, are less understood. This data is from 2009-2010. It is missing the increasing numbers of females that has happened in the last 5 years, exposed to social media and a medical transition positive culture. More longer-term data is needed to see if transition will be beneficial. Anecdotally, regret rates appear to be increasing in this group

The Pulse study, like most, is self-selected, which is not as accurate as a complete follow up of transitioned individuals. But most trans studies have problems. The study also doesn’t designate between trans identities or if they have medically transitioned yet or plan to. It only measures parental support for gender identity and found a strong effect of reduction of risk. Study outcomes tend to get poorer over time for individuals who have medically transitioned (see above). These individuals are all still very young.

One point is clear. Strained parental relationships negatively impact trans youths’ mental health.

Russel (2018) shows respecting a youth’s chosen pronouns decreases suicide risk.

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Another study that doesn’t address suicide risk specifically, but shows improved overall mental health (inferring reduced risk) with early social transitioning in the Trans Youth Project study. It is following socially transitioned children.

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There are some issues with this study. The main ones are that the results are an outlier when compared to most gender clinic data, temporary relief of GD through transition may lead to prevention of desistance, and it is a self-selected group of parents recruited from online affirmative model environments.

Information indicating that the threat of a child/teen committing suicide is exaggerated & that parental support & access to medical support don’t prevent suicides in many cases 

Michael Bailey and Ray Blanchard wrote an article addressing suicide risk in young people and the use of the suicide threat by affirmation models advocates who want parents to immediately affirm their child’s transgender status. Here are some generalizations they made:

We provide a more detailed essay below, but here’s the bottom line:

1.   Children (most commonly, adolescents) who threaten to commit suicide rarely do so, although they are more likely to kill themselves than children who do not threaten suicide.

2.   Mental health problems, including suicide, are associated with some forms of gender dysphoria. But suicide is rare even among gender dysphoric persons.

3.   There is no persuasive evidence that gender transition reduces gender dysphoric children’s likelihood of killing themselves.

4.   The idea that mental health problems–including suicidality–are caused by gender dysphoria rather than the other way around (i.e., mental health and personality issues cause a vulnerability to experience gender dysphoria) is currently popular and politically correct. It is, however, unproven and as likely to be false as true…

They further comment on adolescents:

According to data from the Centers for Disease Control (CDC), the rates of intentional but non-fatal self-injury peak during adolescence at about 450 per 100,000 girls and a bit fewer than 250 per 100,000 boys. These rates are much higher than the 13 per 100,000 American completed suicides per year (and remember that suicide is more common among adults than adolescents). So it is reasonable to assume that most adolescent self-injury is not intended to end one’s life. We are not suggesting that parents ignore children’s self-injury. We simply mean that self-injury often has motives besides genuinely suicidal intent.

Bailey and Blanchard discuss a case study on trans youth suicide in the gender clinic for minors where Dr. Ken Zucker worked. In a subsequent follow up, there appears to have been no suicides related to gender dysphoria or any delayed access to medical transition.

The Dutch and Swedish studies were of adults whose gender dysphoria may or may not have begun in childhood. No published study has focused only on childhood onset cases. However, psychologist Kenneth Zucker has tracked the outcome of more than 150 childhood onset cases treated at the Centre for Addiction and Mental Health into adolescence and young adulthood. He has generously shared with us (in a personal communication) his outcome data for suicide. Out of those more than 150 cases followed, only one had committed suicide. Furthermore, Dr. Zucker’s understanding (based on parent report) is that this suicide was not due to gender dysphoria, but rather to an unrelated psychiatric illness. On the one hand, one suicide out of 150 cases is more than we’d expect by chance. On the other hand, it is a rare outcome among gender dysphoric children and adults.

Many trans activists dislike Dr. Zucker for his more cautious approach and attempts to have the child align with their natal sex, considered by them conversion therapy. He took this approach due to the reality that children may outgrow GD and the harshness of the medical treatments involved. Activists often claim his methods will cause trans children to kill themselves (see here and here). But this follow up data doesn’t seem to indicate that. 

Dr. Zucker has noted that suicide ideation in trans youth should be a concern of parents and mental and medical health professionals involved in treatment of dysphoric youth. However, it is no different than the concern for the elevated suicide risk for all youth seeking mental health treatment.

Dr Polly Carmichael at Tavistock in Britain has indicated the same thing. That young people referred to the mental health service (CAMHS) have similar rates of suicide risk as youths with other mental health issues overall 

Other evidence that the risk for a completed suicide in a dysphoric child or teen is extremely low comes from the Gender Identity Development Service portion of the NIH in Britain, their public medical health system. 

Similarly, suicide is extremely rare.

As noted through this website, comorbid conditions are common in children with GD. It makes understanding what is driving the suicide risk more difficult. For example, there seem to be much higher suicide risk rates in autistic youth in general and who are also over represented in gender dysphoria clinics (see here and here and here).

Nor does the study consider the significance of autism it found in 12.2 to 17.1 percent of its children. Elsewhere, 14 percent of children with autism aged from one to sixteen have been reported to experience suicidal ideation or attempts, suggesting a rate twenty-eight times greater than that for typical children (0.5 percent) [22].

Suicide risk and the Trans Youth Project study.

The Trans Youth Project study cited above indicates improved anxiety and depression in transitioned children. This report has good results but, they are expected results. A child struggling with gender dysphoria would be happier being socially transitioned in the short term. The difficulties around intense body modification, anxiety around passing, and sometimes shifting dysphoria come later. It also may be that social transition leads to persistence as the Steensma study possibly indicates. Without a control group, there is no way to know the effects of social transitions on desistance. Michael Bailey and Ray Blanchard also make these and other points about the Trans Youth Project’s positive outcomes and other studies that show very high rates of suicide ideation even post transition.

This research falls far short of negating or explaining the findings we have reviewed above. First, it was relatively small, including only 73 gender dysphoric children. Second, families were recruited via convenience sampling, increasing the likelihood of various selection biases. For example, it is possible that especially mentally healthy families volunteer for this kind of research. Third, the assessment was a brief snapshot; we would expect socially transitioned gender dysphoric children to be faring better at that snapshot compared with children struggling with their gender dysphoria. (There is little doubt that at first, gender dysphoric children are happier if allowed to socially transition.) Young gender dysphoric children do not show that many psychological or behavior problems, aside from their gender issues. The aforementioned study by Kenneth Zucker’s research group showed that mental health problems, including suicidality, increased with age. Perhaps this won’t happen with Olson’s participants, but it’s too soon to know.

Tragic suicides of transgender youth have happened and everything should be done to stop them. Several of the suicides involved youth from families with rejecting attitudes towards LGBT people, often for religious reasons. Highlighting these cases specifically appears to only fuel suicide contagion and so won’t be the focus here as media reporting standards discourage it. Their stories are readily available on the internet and highlight how religious intolerance can harm LGBT youth and even adults

The affirmative model may not always help suicide risk. There have been several suicides reported in the media, including a suicide cluster involving young people who had full parental and community support and access to medical care. These examples are not scientific data. They are anecdotal. They only highlight that gender dysphoria may be comorbid with other conditions that may not be completely alleviated by affirmation and medical transition. There were three cases in the San Diego area involving teens attending support groups and receiving parental gender affirmation. The people around them appeared to be doing all the right things to support the youths’ gender identities. It is inappropriate to use these stories to promote unquestioned social and medical transition, but that does not stop it from happening, even among gender dysphoria expert PhDs.

There was another case of a teen suicide in Philadelphia involving a young person with community support and parental love. And another sad case in Florida where the young person committed suicide despite having a family who supported transition and seemed very loving.

There is evidence of other factors contributing to mental health issues and suicidality in trans-identified young people, from the NIH in Britain.

Most empirical studies around mental health of gender variant young people show that adolescents are at higher risk of other co-existing difficulties than the general population (Coates & Spector Person, 1985). Adolescents, who present with gender dysphoria and cross-gender identification well after the onset of puberty, are more likely to also have significant psychopathology and broader identity confusion than gender identity issues alone (Kaltiala-Heino et al. 2015).

More information on co-factors in gender dysphoria can be found here.

D. Use of suicide threat to enforce the affirmative model

Transgendertrend:

Suicide is contagious.  Suicidal ideation is incredibly dangerous, especially for young people.  There are guidelines in place for reporting of suicide for a reason and, in the main, the press seem to follow them with one glaring exception – transgender people. Surely transgender people would be better served with a positive movement like It Gets Better rather than seeing their advocates and support organizations constantly telling people that they are a danger to themselves. 

Almost all articles on trans youth quote high suicide statistics in the context of stories of parents who are in the process of socially and medically transitioning their children. It is presented as a warning to parents who would dare question transition for their children and teens. This narrative is also promoted by LGBT organizations, parents in trans youth support groups, and even mental health and medical professionals.

Media promoting the transition or suicide narrative

There are so many articles on trans youth that mention suicide and insinuate youths will commit suicide if not socially and medically affirmed, there are too many to list here. It’s the norm in reporting on trans youth. Suicide risk in trans youth is a very important topic but none of these articles talk about the nuance of this complicated subject matter. Some of this includes cases of teens with serious GD desisting, risks of false positives, the reality that medical transition isn’t a panacea that solves all problems, and that there may be serious medical consequences.

Spiked magazine gives a couple of examples of this and provides some rare skepticism:

Some trans activists use emotionally blackmailing statistics, including against parents of children facing gender-dysphoria issues. They say 41 percent of trans people attempt suicide. Caitlyn Jenner cited this stat when she accepted the Arthur Ashe Courage Award. This suggests to parents that they will push their kids to kill themselves if they don’t let them transition at as young an age as possible. In the BBC documentary, politician Cheri DiNovo says that if parents say, ‘It’s my way or the highway’, they will lose their child: ‘That child will kill themselves if they’re trans because many trans children do.’ Where is the criticism of these quite cruel tactics?

What’s more, analysis by the Williams Institute of the US National Transgender Discrimination Survey, which came up with the 41 percent statistic, suggests that it is those who transition or consider transitioning who are more likely to attempt suicide, rather than those who don’t. The study also notes that, due to a lack of follow-up questions in the survey, the rate of suicide might actually be inflated, possibly to double what it really is. Expertise is lacking here, too.

Most data does show improved mental health post transition. However, with no control group it is impossible to know for sure. The article should have mentioned that for balance. But their observation that suicide stats are used to enforce the affirmation only model on parents, the public and heath care professionals is accurate. 

Quadrant, a site in Australia, also notes the use of suicide threat in the media to enforce the affirmation only model:

It is no wonder this drama is repeated on the media, especially as its players may be toddlers whose future is in the hands of the audience. Accept the pathways of “medicine”, we are urged. Welcome transgender as but one hue in a natural rainbow. Or the children will kill themselves [2]

Risk of self-harm has been reported in gender-dysphoric children and is the argument for “treatment” and against inaction. Is self-harm another manifestation of an underlying disorder, or is it due to frustration from gender dysphoria alone, or due to ostracism? Proponents of affirmative treatment proclaim the latter and declare an “alarmingly high rate” of self-harm and suicide attempts, exemplified by highly publicized and tragic youth suicides in the US [20].

The below comment from a skeptical parents website post addresses the media’s current interest in pushing the suicide narrative to imply they need immediate medical transition. This is despite suicides involving youths whose identity was supported by the parents and who had access to care. The Guardian in Britain apparently manipulated this story for this effect:

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In another example, The Advocate, an LGBT news site, uses suicide to promote the affirmative model with easy access to medical transition. This youth was supported by parents who stated they supported medical transition. 

About he teen:

In the wake of Riley's death, which has drawn national attention to suicide among transgender teens, Philadelphia's Trans-Health Information Project has pointed to factors that can contribute to tragedies they consider largely "avoidable."

"By continually denying young people the resources to access competent and sensitive care in an environment where they feel both safe and validated, we are conspiring with the systems of social marginalization that push these kids to their breaking point," said a statement from the organization, adding that there is a need for more positive representations of transgender people in the media.

This journal article called, “Responsible journalism, imitative suicide and transgender populations: a systematic review of UK newspapers,” points out that reporting on suicide and the trans community violates ethics standards in how suicide should be reported in order to minimize copy-cat incidences.

Here a sentimental story of a trans youth in the television drama Butterfly is used to promote the idea that trans children will kill themselves in order to promote the affirmative model. The show brought criticism from the clinic in Britain:

The NHS’s only gender clinic for children and teenagers has criticised a new ITV drama that shows a transgender 11-year-old trying to commit suicide as “not helpful,” saying it “would be very unusual” for a child of that age to attempt suicide.

Affirmative model professionals who promote the “transition or suicide” narrative

Dr. Deanna Adkins, affirmative model advocate:

This is almost more deadly than anything else I treat. 

Affirmative model advocates, including some PhD psychologists and medical doctors, use suicide as an argument to compel parents to socially and medically transition their children. The transition or die narrative is often repeated by them in the media and at gender conferences. Below are just a few examples.

Stacey Karpen

This clinician promotes the concept death is a very likely alternative to the affirmative model. It is not important for the parent to have concerns that their minor child will have a sterilized and medically defaced body they could have avoided if given alternative support and time: 

Stacey Karpen, PhD, senior manager of behavioral health at Whitman-Walker Health, Washington, DC, says that clinical preoccupation with desisters misses the point of gender-affirming care. "I can't tell you how your child will identify in 10 years, or even tomorrow. If you're looking for someone to tell you concretely about your child's identity, then I'm not a good fit. But I say, look I want your child alive. If they feel differently at 18 then they do at 14, at least we got them to 18."

Diane Ehrensaft

Diane Ehrensaft is one of the most enthusiastic supporters of early social transition and medical intervention (along with Norman Spack and Johanna Olson-Kennedy). She believes parents and clinicians should “let the child lead” on how society deals with gender. She does not believe in making any attempts to help a child to align with their natural body.

In the below television interview, she is asked about the increased risk of regret with younger and younger people medically transitioning, the protocol she recommends and even successes.

And if we can facilitate a better life by offering these interventions, I weigh that against, there might be a possibility that they will change later, but they will be alive to change. 

“Let’s call it a possibility.” Here she admits risk of regret. She is in fact aware that this is not just a possibility but appears to be happening more and more despite never addressing this in her talks and interviews. She is aware of stories of young desisters and regretters. She has commented on transition critical websites that tell these stories, likening them to the Ku Klux Klan, despite their liberal generally pro-gay leanings. 

Some affirming therapists appear to downplay risks of false positives or feel they will be few enough to be an acceptable outcome to fully supporting gender identity in children and teens. 

Here again she advocates for social and medical transition at very young ages that result in loss of fertility as a “life-saving” intervention. This appears to run counter to parental fears about sterilizing their minor children at an age where it is questionable if they can truly consent.

As you communicate this fertility information, call to mind, I should say my other hat is assisted reproductive technology. So, that’s a field I work in. There are very few people who commit suicide because they are infertile. It’s not unheard of. People can get really depressed but it doesn’t have a high rate of suicidality, being infertile. However, there’s a lot of people who become suicidal about severe gender dysphoria…gender stress. So, you have to balance that on the scales in terms of going back to life saving intervention.

In this clip at a Conference in 2015, she likens not medically transitioning a tween (resulting in sterilization, possible permanent sexual dysfunction, possible lower IQ, and possible serious long-term side effects) to denying a child medical treatment for a deadly cancer:

And the other issue that’s a show stopper now for many parents around giving consent to puberty blockers is the fertility issue. That is a child goes straight to puberty blockers directly to cross-sex hormones they, at this point in history are pretty much forfeiting their fertility. And so, they will not have a genetically related child. There’s a lot of parents who have dreams of becoming grandparents. And it’s very hard for them not to imagine those genetically related grandchildren. And so, we have to work with parents, “So these aren’t your dreams. You have to focus on your child dreams. And what they want.  And what I will say about many of the youth who want puberty blockers is: I have never met such an altruistic group of kids around adoption! Never! “I will adopt because there are so many children who need good homes.” And I think that’s both heartfelt but also, they’re trying to tell us the most important thing to me right now is being able to have every opportunity to have my gender affirmation be as complete as possible. Anything else is secondary. The question is, can an 11-year-old, 12-year-old at that level of development, be really thinking and know what they want at age 30 around infertility?

Can they? Might it be ok to wait and allow this child to mature to adulthood before making such momentous decisions?The answer to that is: We don’t think twice about instituting treatments for cancers for children that will compromise their fertility. We don’t say, we’re not going to give them the treatment for cancer because it’s going to compromise their fertility.For some of the youth, having the gender affirmation interventions is as life-saving as the oncology services for children who have cancer.

Michelle Forcier

Michelle Forcier is an affirmative model advocate and medical doctor. She has this to say on NBC about any parent who may waiver from immediate transition:

The biggest harm is to not do anything.
What’s the risk of waiting?
Suicide.

Here is a blog post about Forcier’s involvement in promoting the affirmative model at Brown University:

Dr. Forcier is passionate about transgender medical care: “Should we let them die when we have medicine for diabetes?” she said. “And we’re really talking about the same level of intervention. When gender non-conforming, transgender kids and adults are not supported (and) are stigmatized, then they can’t be healthy.

Norman Spack

In a “Ted Talk” in 2014, endocrinologist Dr. Spack said this about children and adolescents who are gender dysphoric: 

The risks of not doing anything for them not only puts all of them at risk of losing their lives to suicide, but it also says something about whether we are a truly inclusive society.

While it is reasonable to highlight the higher suicide ideation rate in trans youth and that access to care seems to help, the issue with the quote lies in medical transition being presented as a panacea for gender dysphoria. Many other stories clearly indicate it is not and that suicide ideation can still remain high post medical transition after an initial honeymoon period. These details are often not communicated to parents or the public. The other details that are not provided is that even in teens suicide is rare and that early transition sterilizes the youth, may destroy sexual function, and has other negative side effects. There hasn’t been enough research to truly justify “the risks are worth it” at this point in time nor is this a consensus across the board among mental health professionals and doctors.

Johanna Olson-Kennedy

Johanna Olson-Kennedy frequently references trans suicide in her talks. There are just two of many examples below.

At a Gender Odysee conference in Seattle (2017) she dismisses any concerns about the rapidly rising numbers of children being diagnosed as trans, concerns about false positive, or concerns about social contagion:

And as a lot of people go on their nonsensical rages how being trans is trendy people are dying and that’s real. 

She also lists a number of suicides in this same talk, however several of these individuals actually had support for the protocol she proscribes from their families.

When a youth was asked about whether or not the parents should have let the youth live as a boy she said they said:

I don’t think I’d be here.

At a USPATH, 2017 conference in Los Angeles she relayed a story of a patient suicide where one parent was supportive and the other parent wasn’t. She stated if they were supportive the:

child might be alive today 

Kristina Olson

Kristina Olson is head of one of the most well-funded studies on gender dysphoric youth, The Trans Youth Project.

She and co-researcher Lily Durwood say in a Slate article:

Many transgender adults recall having had this knowledge as children, and many suffered through years of therapy in which they were told they weren’t who they knew they were. The causal influence of denial of a deeply held identity and the staggeringly high levels of depression, anxiety, and suicidality observed in unsupported transgender young people—punctuated by the suicides of teens like Leelah Alcorn and Skylar Lee—remains untested, though correlational studies indicate that support is related to better outcomes. This new generation of parents of transgender children—who see statistics on these outcomes and have decided to try social transitions to avoid them—are pioneers.

In the above quote, they praise parents who have socially transitioned their children as likely preventing future suicides. But, the two examples they provide, are parents with bigoted religious views towards LGBT people. This is not necessarily a proper comparison to parents who support their child but want time to mature and receive proper mental health screening. Also, why are Olson and Durwood using an example when the article they link states this:

Before his death, Skylar wrote a blog post saying he wasn't committing suicide because he's transgender, and he doesn't want to be a sob story. 

Michelle Angello

Michelle Angello is a LCSW and affirmation model advocate. She and a parent of a trans-identified youth made some statements in a ThinkProgress article (critiqued here on Medium) around desistance statistics that were not accurate and also pushed suicide fear:

[Michele] Angello and [Alisa] Bowman explain why this assumption is so misguided: They might have switched doctors, moved, or worse, committed suicide. Also, it’s common for transgender people to express their true gender, face an abundance of ridicule and harassment, and then repress it.

It’s the equivalent of a dentist who assumes that if patients stop coming back, that means that they’re no longer getting cavities.

The above statement downplays that some youth outgrow gender dysphoria, as shown in studies such as Steensma (2013). It appears the goal is to facilitate more social transitions of young children.

Jesse Singal breaks down their argument:

The problem is, Angello, Bowman, Keo-Meier, Ford, and, unfortunately, myself… we’re all wrong. Completely wrong. Steensma and his colleagues never simply assumed those 80 kids had desisted — they got in touch with most of them, and, true to that ‘assumption,’ they weren’t dysphoric.

Now, we could be forgiven for thinking they simply assumed those 80 kids were desisters — that paragraph above really is written in a confusing way. But if you read the study closely — always read the study closely! — it’s clear this isn’t what happened. Here’s what’s in the very next paragraph: “All 47 persisters participated in the study. Of the 80 desisters, 46 adolescents sent back the questioners (57.5%) and 6 (7.5%) adolescents refused to participate, but allowed their parents to fill out the parent questionnaires. Twenty-eight adolescents were classified as nonresponders: 12 (15%) did not send back the questionnaires despite follow-up contacts, another 12 (15.0%) were untraceable. In 4 cases (5.0%), the adolescents and the parents indicated that the GD from the past remitted, but these individuals refused to participate.

While suicide risk is real and something to be discussed, this highlights how affirmation models advocate reference suicide whenever they can with the goal of getting parents and society to except the affirmation only model. The above examples are only just a few, as this is a common occurrence.

Support Groups, LGBT organizations, & trans activists who promote the “transition or suicide” narrative

Trans support groups have become bastions of the affirmation only model. Several stories and blog posts (here and here and here) indicate that anything less than total affirmation of the child’s stated gender identity is viewed as “cis sexism” and “transphobic” and is aggressively condemned. They often use the “transition or suicide” narrative. 

Mermaids is Britain’s main transgender charity. Susie Green often says her child would be dead had she not received medical treatment. The below quotes are from her and another Mermaid parent. Transgendertrend has done several articles exposing major problems with how trans activist organizations are reporting suicide risk:

Mermais, trans youth suicide

They appear to be intentionally misusing suicide statistics to promote the affirmative model.

Green reels off shocking figures from a 2014 study by the mental health charity Pace which surveyed 2,000 young people with gender issues: 48% attempt suicide, 58% self-harm. “It’s really common.” She pauses. “You can see why we’re worried.”

When analysing the responses relating to suicidal ideation the study only looked at respondents under the age of 26.  This reduced the sample size to 485 people.  Of these, 27 identified themselves as trans*.  That’s TWENTY SEVEN.  Not 2,000 trans* people, 58% of whom had considered suicide, but 27 trans* people, 15 of whom had considered suicide.

It is tragic when anyone considers suicide but it’s also unfortunately extremely common.  According to the same study a third of young LGB people have, but this fact is not emblazoned on every leaflet or proclaimed loudly by Stonewall in every media discussion.

With no adjustment for co-morbid mental health issues or the fact that the respondents may well have found out about or been attracted to completing the survey because of their interaction with mental health services or history of suicide attempts, these figures should really not be extrapolated to apply to the entire transgender population.

Whether or not you think a sample size of 27 people is representative of an entire group and justifies the entire group being labelled according to the findings of such a small study, there is a glaring issue here.  Mermaids, the support group for transgender children and their families, effectively lied in its presentation to a roomful of legal professionals.   The survey was not of 2,000 trans people at all.  Saying it was lends credence to a trope that is already incredibly emotive and potentially dangerous.

 And here:

There is also disturbing evidence that the transgender charity Mermaids has misrepresented the study to make it appear stronger than it really is. This occurred during a presentation at a conference in front of an audience of lawyers, press, NHS representatives and government officials. See article here.

We contacted the lead academic who conducted the research and asked him these questions. He agreed with the limitations of the study that we pointed out. We then asked whether he was aware that his data had been misrepresented by others and presented without making these limitation clear. He agreed it was unfortunate when “research is used by non-scientists in the context of their own agendas” and that he would “continue to clarify the nature and breadth of the RaRE study findings.”

There isn’t corroboration of the below claims, as well as others, written in response to those expressing concern over the increasing numbers of medically transitioned minors.

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There is another article on Transgendertrend about the misuse of suicide statistic by LGBT organizations (Stonewall UK in this case). The below article reviews how suicide stats in young people may have a connection to increasing self-harm and suicide ideation in female tweens and teenagers, happening to females in general. And how failing to clearly define biological sex prevents proper empirical understanding of these trends.

The whole post should be read for a clear understanding of these issues:

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Joel Baum is the head of Gender Spectrum in the United Sates. He is involved in doing gender trainings in schools in California. Here he references suicide to squelch parents’ concerns about sterilizing their children at young ages:

You can either have grandchildren or not have a kid anymore because they’ve ended the relationship with you or in some cases because they’ve chosen a more dangerous path for themselves.

Here is a link with very typical examples of the suicide discourse from promoters of the affirmative model on social media.

Janice Turner has written several articles questioning the large rise in females identifying as trans (as well as other topics). She has been accused by a prominent trans activists in Britain of causing the death of trans teenagers for writing these articles

When probed on Twitter she said: “I have heard reports of four trans suicides in the past few months, two in the past month. The media reporting was referenced in three of them.” Later, trans activist Paris Lees added that she held “individual journalists who stigmatize trans people personally responsible for the suicides of young trans people in this country”. No further detail was given.

Below is a medical doctor tweeting to the public that a child will die if the child isn’t given binder. It was in response to this article that discusses the dangerous practice of binding and trans charities support of it in minor females. In a video (see 14:30), by a young lesbian who desisted from a trans identity, she discusses the damage binding did to her growing body:

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breast binders, suicide

Toby Sinbad Walker, states FtMs will kill themselves if they have to wait for cancer patients to have their surgeries:

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Here a trans activist recommends bypassing protocols to parents so the child won’t die:

Worryingly, the website Transit.org.uk openly advocates bypassing the NHS to buy blockers and hormones online.

One of the site’s pages reads: “You have a moral responsibility as a parent to ensure the safety and happiness of your child… If you allow them to go through their genetical puberty, you could very well end up with a dead child.”

The suicide narrative is highly effective in pushing parents & professionals into rapid gender affirmation & medical transition of minors 

This fairly extensive research paper, “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study,” demonstrates suicide fear influences immediate support for social or medical transition in minors. In this review study, the responders themselves working in this area cite that worries of suicidality influence them in administering medical treatments. As we have seen elsewhere, rapid social and medical transitions are happening with no psychological assessments with fears of suicide being one of the major reasons why:

For several informants, a reason to use puberty suppression was the fear of increased suicidality in untreated adolescents with GD. Research shows that transgender youth are at higher risk of suicidal ideation and suicidal attempts [3,36]. Nevertheless, caution is needed when interpreting these data because they do not show causality or directionality. 

Parents are often made terrified by affirmation model proponents use of suicide fear:

Penny explains her concerns about the approach taken by organizations such as Mermaids and GIRES: “I believed that I had to affirm my daughter’s identity or risk driving her to suicide. My fear is that there are many gender non-conforming kids being medicalized at young ages and set on a path of infertility, surgery, and lifelong hormone injections when, if given the time to grow up, would be health happy gay and lesbian adults. Or even straight adults who just don’t happen to be gender-conforming.”

The spokesperson for the skeptic parents website 4thwavenow also speaks about the power of this over parents:

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This comment is about a Facebook affirmative group:

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Youths online are actually encouraged to threaten suicide to be transitioned rapidly.

In Lisa Littman’s study, “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports” there seems to be a lot of evidence that trans-identified youths, who often had no serious signs of GD as children, providing scripted narratives, including suicide threats, to get the parents to immediately support their gender transitions. 

To assess AYA exposure to existing online content, parents were asked what kind of advice their child received from someone/people online. AYAs had received online advice including how to tell if they were transgender (54.2%); the reasons that they should transition right away (34.7%); that if their parents did not agree for them to take hormones that the parents were “abusive” and “transphobic” (34.3%); that if they waited to transition they would regret it (29.1%); what to say and what not to say to a doctor or therapist in order to convince them to provide hormones (22.3%); that if their parents were reluctant to take them for hormones that they should use the “suicide narrative” (telling the parents that there is a high rate of suicide in transgender teens) to convince them (20.7%); and that it is acceptable to lie or withhold information about one’s medical or psychological history from a doctor or therapist in order to get hormones/get hormones faster (17.5%). Two respondents, in answers to other questions, described that their children later told them what they learned from online discussion lists and sites. One parent reported, “He has told us recently that he was on a bunch of discussion lists and learned tips there. Places where teens and other trans people swap info. Like to use [certain, specific] words [with] the therapist when describing your GD, because [they are] code for potentially suicidal and will get you a diagnosis and Rx for hormones.” Another parent disclosed, “The threat of suicide was huge leverage. What do you say to that? It’s hard to have a steady hand and say no to medical transition when the other option is dead kid. She learned things to say that would push our buttons and get what she wanted and she has told us now that she learned that from trans discussion sites.”

 And:

Although it is still unknown whether transition in gender dysphoric individuals decreases, increases, or fails to change the rates of attempted or completed suicides [48] this study documents AYAs using a suicide narrative to manipulate parents and doctors into supporting and providing transition services. Despite the possibility that the AYAs are using a suicide narrative to manipulate others, it is critical that any suicide threat, ideation or concern is taken seriously and the individual should be evaluated immediately by a mental health professional.

Is it possible social contagion, media exposure, & an online culture negatively impacting all youth could be increasing suicide ideation in gender nonconforming youth? 

There has been a lot of information coming to light about increases in anxiety, depression, self-harming, and body hatred, particularly in female teenagers, in recent sociological research. A lot of these increases seem to have happened with the rise of social media use in young people. In light of this reality, it is worth asking if gender nonconforming youth are actually more dysphoric, more likely to be self-harming, and more likely to be suicidal that in the past, despite increased visibility and support. 

Research shows intense difficulty in the past among the trans population and that support and treatment seem to improve things on average. The hope is increasing destigmatization and health care will have positive effects. But the whole picture of increasing mental illness in children and teens, alongside of apparently increasing gender dysphoria, has to be examined:

London (CNN) Nearly a quarter of 14-year-old girls in the United Kingdom have self-harmed, with many facing overwhelming pressures over how they should look, their sexuality and how they behave, according to a new report by The Children's Society.

The same thing is happening in the United States:

The percentage of younger children and teens hospitalized for suicidal thoughts or actions in the United States doubled over nearly a decade, according to new research that will be presented Sunday at the 2017 Pediatric Academic Societies Meeting.

A steady increase in admissions due to suicidality and serious self-harm occurred at 32 children's hospitals across the nation from 2008 through 2015, the researchers found. The children studied were between the ages of 5 and 17, and although all age groups showed increases, the largest uptick was seen among teen girls.

Increasing suicide rates among children mirror adult numbers, Plemmons said. Children's numbers more than doubled over the study period, increasing from 0.67% of children admitted to hospitals in 2008 to 1.79% in 2015. Annually, the 15-to-17 age group averaged an increase of 0.27%, the 12-to-14 age group averaged 0.25%, and the-5 to-11 age group averaged 0.02%...

The reason children think about or attempt suicide is the "million-dollar question," Plemmons said. "Family history of depression or suicide, family violence, child abuse, gay and lesbian youth, history of bullying -- those are all risk factors that have been reported. We didn't look at any of those specific factors in our study."

They point to the online environment for youth to being a major cause:

One of the predominant theories behind teen suicide is cyberbullying, Plemmons said. "It's anonymous today, I think that's a big difference. Years ago, you knew who (the bullies) were." 

Additionally, girls are entering puberty about a year earlier "than they historically have, and puberty in itself is a risk factor for suicide."

Psychologists Dr. Blanchard and Dr. Bailey

Research to understand the link between gender dysphoria, various mental problems (including suicidality), and completed suicides will take time. There is already plenty of reason, however, to doubt the conventional wisdom that all the trouble is caused by delaying gender transition of gender dysphoric persons. We have already mentioned the fact that transitioned adults who had been gender dysphoric (i.e., “transsexuals”) have increased rates of completed suicide. Their transition did not prevent this, evidently. Suicide (and threats to commit suicide) can be socially contagious. Thus, social contagion may play an important role in both suicidality and gender dysphoria itself. Autism is a risk factor for both gender dysphoria and suicidality. No one, to our knowledge, believes that gender dysphoria causes autism.

Other discussions of social contagion can be found here and here.

Professionals, journalists, & parents concerned about members of the therapy & medical community pushing the “transition or die” narrative

Not all gender clinicians agree with promoting the “transition or die” narrative. Dr. Wren from the Tavistock gender clinic in England states:

It troubles me that parents of very young children are already in terror that their child is going to kill themselves,” Wren says. “The energy has to go into changing how these people are seen by their peers, not into physical intervention alone. You don’t want these kids to have to make themselves over at a very early stage because otherwise they’ll be tormented to death.

At a conference on October 2017, Dr. Polly Carmichael, Director and Consultant Clinical Psychologist at the Tavistock, addresses the problem of incorrect reporting of suicide risk and misuse of statistics by trans activist support groups. She mentions that the PACE survey (used by Mermaids) is “deeply flawed” and that rates of self-harm, distress and suicidal ideation are similar to CAMHS figures overall. That discussion is available on this page and Transgendertrend covered the topic in this thread.

Jesse Singal, one of the few journalists to actually report on this issue in depth, writes in The Atlantic:

But the existence of a high suicide rate among trans people—a population facing high instances of homelessness, sexual assault, and discrimination—does not imply that it is common for young people to become suicidal if they aren’t granted immediate access to puberty blockers or hormones.Parents and clinicians do need to make fraught decisions fairly quickly in certain situations. When severely dysphoric kids are approaching puberty, for instance, blockers can be a crucial tool to buy time, and sometimes there’s a genuine rush to gain access to them, particularly in light of the waiting lists at many gender clinics. But the clinicians I interviewed said they rarely encounter situations in which immediate access to hormones is the difference between suicide and survival. Leibowitz noted that a relationship with a caring therapist may itself be an important prophylactic against suicidal ideation for TGNC youth: “Often for the first time having a medical or mental-health professional tell them that they are going to take them seriously and really listen to them and hear their story often helps them feel better than they’ve ever felt.”

The conversations parents are having about gender-dysphoric children online aren’t always so nuanced, however. In many of these conversations, parents who say they have questions about the pace of their child’s transition, or whether gender dysphoria is permanent, are told they are playing games with their child’s life. “Would you rather have a live daughter or a dead son?” is a common response to such questions. “This type of narrative takes an already fearful parent and makes them even more afraid, which is hardly the type of mind-set one would want a parent to be in when making a complex lifelong decision for their adolescent,” Leibowitz said.

Psychologists Dr. Blanchard and Dr. Bailey

Parents with gender dysphoric children almost always want the best for them, but many of these parents do not immediately conclude that instant gender transition is the best solution. It serves these parents poorly to exaggerate the likelihood of their children’s suicide, or to assert that suicide or suicidality would be the parents’ fault.

E. Suicide ideation in LGB youth is similarly high indicating access to medical technology is not the only important issue.

One interesting comparison to make is the suicide risk between trans youth and LGB youth. It is a useful exercise in determining possible levels of suicide ideation caused by minority stress and the amount of suicide ideation related to medical transition. Almost all studies on LGBT youth actually show similarly high suicide risk in LGB youth compared to trans youth. Below are several citations.

American Foundation for Suicide Prevention

Studies in recent years have indicated a higher prevalence of suicide attempts among lesbian, gay, bisexual and transgender people. 

-Compared to straight people, gay and lesbian people are more likely—and bisexual adults are more likely still—to report having made a suicide attempt in the past year and/or over their lifetime. 

-Transgender people report higher prevalence of suicide attempts in the past year, and over their lifetime, than LGB or straight people. However, direct comparisons for these populations are limited because no single study has surveyed and reported findings for all of these populations. 

In a report on self-harm and same-sex attracted youth:

However, boys and girls who were attracted to teenagers of the same gender or both genders were much more likely to harm themselves, the survey found, with almost half -- 46% -- reporting that they had done so in the past year.

The Trevor Project:

LGB youth seriously contemplate suicide at almost three times the rate of heterosexual youth.

-LGB youth are almost five times as likely to have attempted suicide compared to heterosexual youth.

-Of all the suicide attempts made by youth, LGB youth suicide attempts were almost five times as likely to require medical treatment than those of heterosexual youth.2

-Suicide attempts by LGB youth and questioning youth are 4 to 6 times more likely to result in injury, poisoning, or overdose that requires treatment from a doctor or nurse, compared to their straight peers.

-LGB youth who come from highly rejecting families are 8.4 times as likely to have attempted suicide as

-LGB peers who reported no or low levels of family rejection.

Some of these recorded levels of suicide risk are almost as high as trans youth.

A Stonewall UK survey report indicates averages for same sex attracted youth are almost as high as trans youth:

“Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations” covers many studies on suicide risk in LGB youth and adults. Some studies don’t show an increase of deaths by suicide versus heterosexuals. One has attempt rates eight times as high as heterosexuals.

The fact that other gender nonconforming minority youth have much higher suicide risk relative to heterosexuals and rates and rates that can alarmingly so (Stonewall report T=92% non T=70%) It appears that the stresses around LGBT youth have to do with being different and not represented by the norm not just due to access to hormone blockers and surgery alone.

Many studies show the bisexuals have more mental health issues than homosexuals. Suicide risk for bisexuals may be closer to that of trans people in some studies. Here is one from the HRC. There are also a lot of trans people who identify as bisexual.

Bisexuals face striking rates of poor health outcomes ranging from cancer and obesity, to sexually transmitted infections to mental health problems. Studies suggest that bisexuals comprise nearly half of all people who identify as lesbian, gay or bisexual, making the bisexual population the single largest group within the LGBTQ community –– yet, as a community, we are doing little to address the needs of bisexual people.

Moreover, transgender people and people of color comprise large portions of the bisexual community –– with more than 40 percent of LGBTQ people of color identifying as bisexual, and about half of transgender people describing their sexual orientation as bisexual or queer –– making these groups vulnerable to further disparities that occur at the intersections of biphobia, racism and transphobia.

This pattern exists for adults and youth.

Michael Biggs is Associate Professor of Sociology at the University of Oxford and Fellow of St Cross College. In this article, he discusses how LGBT research is becoming more complicated with so many more females identifying as trans and non-binary, and how the association with suicide risk in recent studies may have more to do with sexual orientation then being a biological female.

In the recent Toomey (2018) study bisexual females are at a comparable suicide risk to FtMs. All female categories are higher than that of biological males. Rates are higher for all biological females.

Biggs also summarizes a similar problem (exposed by Transgendertrend) regarding unclear data and the elevated risk for biological females in trans youth suicide research here:

Stephanie Davies-Arai and Nic Williams’ critique of Stonewall’s School Report suggested that “[t]he ‘transgender’ category may just serve to cover up the scale of suicide attempts and self-harm rates of girls and young women.” Their conjecture is vindicated by this survey evidence from the United States. Over two thirds of the girls who identified as boys were sexually attracted to females (inferred from the proportion calling themselves heterosexual or bisexual), and so arguably are most similar to lesbian and bisexual girls. In sum, then, gender-nonconforming females were the group most likely to report attempted suicide, regardless of whether they identified as male or nonbinary—or as bisexual or lesbian.

Here he addresses the poor quality of much of this even recent research.

Previous evidence on suicide attempts among trans-identified youth has been methodologically flawed, even ignoring the most egregious examples. First, surveys have recruited respondents haphazardly—rather than sampling from a population. Second, respondents have not been asked for their sex, but only for their gender identity. In the United Kingdom, Stonewall’s School Report was marred on both counts.

These studies on LGB youth and Trans youth in New Zealand show similar mental heal risks. 

A New Zealand commentator compares the data:

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These studies indicate that a lot of the increased mental health risks in trans youth are not directly related to rapid access to medical transition but to other mental health issues and social pressures. In addition, recent data also appears to show biological gender nonconforming females are most at risk regardless of how they identify.

F. Conclusion, suicide risk: is it ethical & justifiable for LGBT orgs, the media, mental & medical health professionals to use suicide to promote the affirmation model?

A trans woman addresses the use of suicide as a political tool and a tool to rush transition in children and teens:

Let’s be clear: it is not transphobic to respectfully question someone’s self-determined gender identity while giving them a robust process to help them transition with optimal mental health, but it is certainly cisphobic to guilt parents into believing that if they don’t support their child’s gender transition, that the child will end up suicidal. Not treating gender dysphoria with medical transition can lead to suicide, however, this entire process is fraught with complexity and a gender dysphoria patient could commit suicide for other reasons that also must be addressed. Playing the suicide card as a means to win a political debate is just plain gross. 

Discourse is violating reporting standards recommend for discussing suicide in LGBT youth

Given that there is an established increase of risk for suicide in trans youth, and that most studies on adults indicate improved mental health with access to support and medical transition the question is, “Is it ethical for mental health and medical health professionals to use this to enforce an affirmation model approach in minors, that fails to explore other mental health care alternatives?”

One good way to answer this question is to review how the American Foundation for Suicide Prevention’s own page recommends handling the issue of increased risk of suicide in the LGBT community:

1.   DO broadly emphasize individual and collective responsibility for supporting the well-being of LGBT people. 

2.   DO help people understand the relationship between mental health and suicide risk. 

3.   DO encourage discussion about suicide prevention strategies. 

4.   DO emphasize the vital importance of resilience— not just as a factor that can help protect against suicide, but also as a crucial priority when it comes to developing emotional and psychological well-being among LGBT people. 

5.   DO help people identify warning signs of suicide, so they can support and provide help to those who might be at risk. 

6.   DO point people toward, and provide information about, resources that provide intervention and support for people who may be thinking about suicide.

Highlighting the scientific data in trans youth, raising awareness around increased suicide risk and discussing things that may reduce this risk falls under these suggestions.

Here is the list of the don’ts with commentary about how affirmation model advocates are violating them:

7.   DON’T attribute a suicide death to a single factor (such as bullying or discrimination) or say that a specific anti-LGBT law or policy will “cause” suicide. 

Affirmation model advocates, including some actual gender clinicians do this as shown above.

8.   DON’T risk spreading false information by repeating unsubstantiated rumors or speculation about suicide deaths or why they occurred. 

Affirmation model advocates have done this by citing suicides where the youth were actually supported by the protocol they are trying to enforce by citing these suicides. They also cite suicides where there appears to be other factors that caused it, not related to immediate access to medical transition.

9.    DON’T talk about suicide “epidemics” or suicide rates for LGBT people.

Trans suicides are constantly framed as an epidemic, including by gender clinicians, during conversations with parents at gender conferences used to train professionals and to the media.

10. DON’T use social media or e-blasts to announce news of suicide deaths, speculate about reasons for a suicide death, focus on personal details about the person who died or describe the means of death. 

This is commonly done by LGBT and trans organizations and media.

11. DON’T idealize those who have died by suicide or create an aura of celebrity around them. 

Several trans youths have been held up as martyrs by activist, media, and gender clinicians themselves. Leelah Alcorn is a common example.

12.  DON’T use words like “successful,” “unsuccessful” or “failed” when talking about suicide.

So here we have psychologists and doctors handling suicide in a way that is not recommended by mental health professionals with expertise in suicide prevention.

There are some other very serious downsides to promoting the “transition or suicide” narrative other then spreading suicide contagion which the above points address.

1) The risk of an actual suicide completion is exaggerated to parents and likely terrorizes them.

2) It’s causing parents, schools, mental health professionals, and medical professionals to immediately affirm children and teens as trans without exploring other mental health issues or ways of coping with negative feelings. This greatly increases risks of false positives by an unknown, unstudied amount.

3) Young people themselves are modeling this behavior, making diagnostics more difficult.

4) It appears to be having the effect in young people’s (and others’) minds that medical transition will be the panacea to all problems, something the research does not support.

5) It is presenting a false dilemma where there are other helpful options that are not being explored.

6) Immediate medical affirmation may have very serious consequences. There may be health benefits to supporting the trans youth but waiting to medically alter their bodies due to side-effects. Those side effects include sterilization, possible loss of sexual function, possible lowering of IQ, and bone density loss.

The benefits to youths experiencing intense distress need to be weighed against the other potential damage and harm to youths who may have other mental illnesses or desist with the permanent consequences of Lupron, cross-sex hormones, and now surgeries performed on minors who will not receive proper mental health care. These youths are being treated the same way under the affirmative model and this is becoming the norm rapidly.

Regardless of treatment, for the sake of mental health of all LGBT youth, it is best to emphasie resilience, strength, and how to learn to regulate difficult emotions and outside ill treatment.

From the American Foundation for the Prevention of Suicide:

suicide prevention
 

Contents

15) “Transition your child without question or they will kill themselves.”

A. Suicide is socially contagious

B. Adult suicide stats: does medical transition reduce suicide risk?

-What studies indicate medical transition in adults reduces suicide risk?

-Below studies indicate transition may not reduce suicide risk in adults

-Studies below do not address suicidality but show poor outcomes related to medical transition

C. Youth suicide stats

-Below studies indicate social & medical transition of minors alleviates suicide risk

-Info indicating that the threat of a child/teen committing suicide is exaggerated & that parental support & access to medical support doesn’t prevent suicides in some cases

D. Use of suicide threat to promote social & medical transition of young people

-Media promoting the “transition or suicide” narrative

-Affirmative model professionals who promote the “transition or suicide” narrative

-Support Groups, LGBT organizations, and trans activists who promote the “transition or suicide” narrative

-The suicide narrative is highly effective in pushing parents & professionals into rapid gender affirmation & medical transitions

-Youths online are actually encouraged to threaten suicide

-Is it possible social contagion, media exposure, & online culture (negatively impacting all youth) are increasing suicide ideation in gnc youth?

-Professionals, journalists, & parents concerned about members of the therapy & medical community pushing the “transition or suicide” narrative

E. Suicide ideation in LGB youth is similarly high indicating access to medical technology is not the only important issue

F. Conclusion, suicide risk: is it ethical & justifiable for LGBT orgs, the media, mental & medical health professionals to use suicide to promote the affirmative model?

-Discourse is violating reporting standards recommend for discussing suicide in LGBT youth

Back to Outline

More

1. Do children outgrow gender dysphoria?

2. Permanent side effects

3. Are children & teens old enough to give consent?

4. Comments safety / desistance unknown

5. Gender dysphoria affirmative model

6. Minors transitioned without any psychological assessments

7. Conversion therapy laws

8. Regret rates & long term mental health

9. New World Order

10. Nature versus nurture

11. Why are so many females coming out as trans / nonbinary?

12. Cultural ripple effects

13. Why is gender ideology being prioritized in educational settings?

14. Problems with a politicized climate (censorship, etc)

16. Trans rights / risks of false positives on minors

17. Moral Dilemmas