In the middle of a series of anti-trans legislation proposed earlier this year, Spencer Cox, the Republican governor of Utah, made a passionate plea to his state legislature as he sought to veto a bill that would exclude trans kids from to compete in girls’ sports. “I want them to live” he wrote about the transatletics in his state with reference to the astronomical rates of suicide attempts among the trans community. Many surveys has estimated that about 40 percent of transgender people may attempt suicide in their lifetime; among the general public is this figure about 5 per cent.
But despite the governor’s veto attempt, the Utah bill passed, as did a few across the country banning gender-confirming medical care for children and teens. Many other such bills are currently being drafted. These treatments – primarily drugs that delay the onset of puberty and hormone treatments such as testosterone and estrogen – help transgender people achieve the body and appearance that feels right for them. Experts worry that the bans will have catastrophic consequences. “Young people want to die,” said Dallas Ducar, CEO of Transhealth Northampton, a medical center in western Massachusetts that provides gender-confirming health care.
Because such treatments for adolescents are relatively new and access to them is limited, the pool of studies on their mental health effects is both small and recent. But WIRED spoke with half a dozen academics who have published studies on menopause and suicidality in peer-reviewed journals, and they all agree – gender-confirming medical treatment seems to lower this risk among transgender people. There is no single study that proves it once and for all, no clincher who can summarily conclude any argument. Researchers say they can not ethically pursue the kind of randomized control trial that is the gold standard for most medical studies: It would involve giving placebo to a person in a potentially dangerous situation. Yet these studies as a whole tell a consistent story that is robust enough to convince their authors of the vital importance of these medical treatments. “All the data we have at this time suggests that they reduce suicidality,” said Jack Turban, a prospective assistant professor of child and adolescent psychiatry at the University of California, San Francisco.
Research in this area can be difficult because it deals with small numbers: Transgender people are a minority of the population, and those who receive gender reassignment treatment as minors are an even smaller subgroup. Some of these minors may get puberty blockers, others get only hormones, and some get both. Gathering enough participants to achieve statistically significant results takes a lot of time and money.
Studies limited to people who have attempted suicide would be even smaller. So researchers often focus on suicidality, a concept that captures a wide range of behaviors, including thinking about ending one’s life. Critics have argued that this research shows no signs of a crisis – after all, thoughts are not actions. But notions are a strong prediction of suicide attempts and a “marker of really serious psychological suffering,” Turban says. And because it’s more common, it’s easier to study.
To do this, researchers have two primary tools available. The first is the longitudinal study, which tracks individuals over a period of time to evaluate the effectiveness of a medical intervention. In the trans-health context, these studies typically start in the clinic: Patients who want to pursue a particular intervention will be recruited for the study, and then researchers will follow them during their treatment.