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Gender affirmation is linked to improved mental health. There’s no evidence it drives youth suicide.
If Your Time is short
Although youth suicide rates and gender-affirming care are both on the rise, experts say there is no evidence the increases are related.
Research shows that among youth, gender-affirming care is associated with reduced suicidal thoughts and depression.
Experts are still uncertain about the cause of rising youth suicide rates, but it is a complex trend and unlikely to be tied to a single cause.
EDITOR’S NOTE: If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
Supporters see access to gender-affirming care as a life-saving medical intervention for transgender youth. But one critic told Tennessee lawmakers that it comes with tragic consequences.
Daily Wire columnist and conservative podcast host Matt Walsh testified Feb. 8 before the Tennessee House of Representatives’ Health Committee, sharing his views on HB 1. The bill, a version of which was signed into law March 3, prohibits gender-affirming care for transgender youth and bars health care providers from offering any gender-affirming medical treatments "inconsistent with the minor’s sex," as assigned at birth. This includes hormonal treatments and surgical intervention, although the latter is rarely provided to children.
When a Republican lawmaker asked about suicidal tendencies among people who have transitioned, Walsh argued that gender affirmation is harmful to mental health.
"The youth suicide rate has increased exponentially alongside trans affirmation," Walsh said. "Trans affirmation causes the suicide rate, not the other way around."
Suicide rates among adolescents and young adults have increased in recent years. According to the Centers for Disease Control and Prevention, the suicide rate for 10-to-24-year-olds increased 57.4% between 2007 and 2018. In 2019, suicide was the second leading cause of death for that age group.
And the risk of suicide among trans youth, including suicidal ideation and attempts, trends higher than the general population, according to The Trevor Project, a nonprofit LGBTQ advocacy group. But trans youth make up about 1.4% of all U.S. youth — not enough to influence the exponential growth seen in the overall youth suicide rate.
Despite Walsh’s claim, research does not link surging suicide rates to gender-affirming care. Most available research suggests that suicidal behavior is reduced when youth have access to gender-affirming care.
Walsh did not respond to a request for comment.
During his testimony, he referred to a study he said was "commissioned by" the World Professional Association of Transgender Health, that he claimed failed to establish a link between gender-affirming care and suicide rates. We were unable to find a study matching that description. A spokesperson for the association told us the group does not commission studies and was unaware of any such research.
Numerous studies have found a link between access to gender-affirming care and improved mental health for young people experiencing gender dysphoria.
Gender-affirming health care is designed with the goal of supporting a patient’s chosen gender identity. It can include social transitioning such as using a preferred name or wearing certain clothes. As children age, it can extend to medical treatments. Older children can be prescribed puberty blockers, and adolescents can receive hormonal therapies and in rare cases, surgery.
Dr. Jack Turban, assistant professor of child and adolescent psychiatry at the University of California San Francisco, cataloged for Psychology Today 16 studies that examined mental health and gender-affirming care. Thirteen of them showed an association between access to gender-affirming care (including puberty suppression and hormone treatment) and better mental health, including fewer instances of suicidal thoughts and lower rates of depression. Three of the 16 studies did not find statistically significant results. Among the mo
re recent peer-reviewed research:
A 2019 study published in Clinical Practice in Pediatric Psychology assessed 47 adolescent youth before and after the start of gender-affirming hormone treatment. As part of the treatment, patients also received psychotherapy. Researchers observed "a significant increase in levels of general well-being and a significant decrease in levels of suicidality."
A 2021 study published by the Journal of Adolescent Health relied on data from The Trevor Project’s 2020 survey of 34,759 lesbian, gay, bisexual, transgender, queer and questioning youth ages 13 to 24. It found that use of gender-affirming hormone treatment was "associated with lower odds of recent depression … and seriously considering suicide" compared with those who wanted gender-affirming hormone treatment but did not receive it.
A 2022 study published in JAMA, the journal of the American Medical Association, followed 104 trans and nonbinary youth ages 13 to 20. It found that "receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up," compared with youth who had not yet received treatment.
Two weeks ago, a 17th study with 315 participants was published in the New England Journal of Medicine. It looked at people ages 12 to 20 who had received hormones over two years and found that "positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased."
"If there's at least one takeaway, it is that youth who go on blockers or hormones definitely are not experiencing any worsening of symptoms," said Luke Allen, a psychologist specializing in gender-affirming care, who was lead researcher in one of the recent studies. "And in fact, most of the time, most studies show they're getting better."
Even nonmedical intervention such as the use of a preferred name was associated with decreases in suicidal behavior and depression. According to The Trevor Project’s 2022 survey of over 16,000 transgender and nonbinary youth, supportive families, schools and communities also were associated with lower instances of suicidal thoughts and attempts.
We found one report published by The Heritage Foundation, a conservative think tank, comparing suicide rates among youth in states that have policies allowing minors access to any health care (not specifically gender-related) without parental consent with youth in states that do not. It determined that the suicide rate for people ages 12 to 23 was higher in states with more liberal access to health care. This report hasn't yet been peer-reviewed.
Overall data strongly suggests that kids who receive gender-affirming care have better mental health outcomes than their peers who don't, said Jenifer McGuire, University of Minnesota professor of family social science.
Of note, research on this issue is based on correlational studies. Randomized controlled trials, in which some participants are given a treatment and others are not, have been deemed unethical for this area of research.
What explains the rising youth suicide rates? Experts don’t know with certainty, said Dr. Meredithe McNamara, assistant professor of pediatrics at the Yale School of Medicine. Anxiety and depression are on the rise in children, and the mental health community is seeking answers.
"We’re all trying to figure out WHY adolescents aren’t doing well from a mental health standpoint," McNamara wrote in an email to PolitiFact. "We’re just beginning to understand the shape and scope of the problem. So we don’t understand the causes yet."
From a research perspective, it is not always clear why a person opted to die by suicide, or how the decision evolved, said Dr. Carl Fleisher, psychiatrist and co-director of the Boston Child Study Center in Los Angeles.
It is unlikely to be a singular cause, said Rheeda Walker, University of Houston psychology professor. Social media, economic strain, growing academic demands, the opioid epidemic, access to firearms and social isolation during the COVID-19 pandemic were all possible factors highlighted by experts. Experts did not believe that growing access to gender-affirming care was a contributor.
The risk of suicide is consistently higher for LGBTQ youth, with more than half of transgender and nonbinary youth considering suicide in the past year, and 1 in 5 attempting, according to The Trevor Project’s 2022 survey. The age at which LGBTQ youth are coming out or self-identifying is dropping, said Amy Green, head of research at Hopelab and former vice president of research at The Trevor Project. That means that young people are risking exposure to discrimination, rejection and victimization at earlier ages — all stressors associated with increased suicide risk, Green said.
Studying suicide and its causes becomes even more difficult with the LGBTQ population, experts explained. Death records list sex assigned at birth, and the National Violent Death Reporting System has not routinely cataloged sexual orientation and gender identity.
One other note about Walsh’s assertion that gender affirmation is increasing: Experts agree that access to gender-affirming care has increased, but it still falls short of the demand. In 2007, Boston Children’s Hospital opened the nation’s first hospital-based pediatric clinic for transgender youth. Today, the Human Rights Campaign counts at least 59 clinics that offer comprehensive multidisciplinary clinical care programs for transgender or gender-expansive youth.
Green said despite the growth, young people report having trouble finding care. "The Trevor Project consistently found that most transgender young people who wanted to access gender-affirming care weren’t able to access it," she said.
As more states consider legislation that would limit or expand gender-affirming care for youth, access may change.
Walsh told Tennessee lawmakers, "The youth suicide rate has increased exponentially alongside trans affirmation. Trans affirmation causes the suicide rate, not the other way around."
The statement contains an element of truth because suicide rates have risen among all U.S. youth. But the statement also ignores critical facts that would give a different impression, because experts say there is no evidence that increases in suicide and gender-affirming care are related.
Experts have been unable to isolate the cause of rising suicide rates, but say the reasons are likely a confluence of factors, not one issue affecting a tiny percentage of the population. Numerous studies show that gender-affirming care and generally supportive environments improve mental health outcomes among transgender youth.
We rate Walsh’s claim Mostly False.
Correction, March 9, 2023: Jenifer McGuire is a professor at the University of Minnesota. An earlier version of this fact-check misstated her title.
Email Interview with Dr. Meredithe McNamara, Assistant Professor of Pediatrics, Yale School of Medicine, February 28, 2023
Email Interview with Dr. Amy Green, Head of Research at Hopelab and Former VP of Research at The Trevor Project, March 1, 2023
Interview with Luke Allen, licensed psychologist and researcher specializing in gender-affirming care, February 28, 2023
Interview with Dr. Carl Fleisher, psychiatrist and Co-Director of the Boston Child Study Center in Los Angeles, March 1, 2023
Interview with Dr. Rheeda Walker, psychology professor at the University of Houston, March 1, 2023
Interview with Dr. Jenifer McGuire, Associate Professor with CEHD Family Social Science at the University of Minnesota, March 1, 2023
Email interview with Shane Diamond, a spokesperson for the World Professional Association for Transgender Health, March 7, 2023
Email interview with Marguerite Bowling, spokesperson for the Heritage Foundation, March 7, 2023
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PolitiFact | Is all gender-affirming care for children ‘experimental’? Experts say no
PolitiFact | Transition-related surgery limited to teens, not 'young kids.' Even then, it's rare
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Gender affirmation is linked to improved mental health. There’s no evidence it drives youth suicide.
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