The most powerful argument for gender-affirming care for children with gender dysphoria is the threat of suicide. “Would you rather have a live son or a dead daughter?” is the brutal alternative presented to parents.
This view has been strongly backed by the Biden Administration as well as many journalists and doctors. A statement from Health and Human Services released in March declared that: “A safe and affirming healthcare environment is critical in fostering better outcomes for transgender, nonbinary, and other gender expansive children and adolescents.”
However, a report from the conservative Heritage Foundation written by Jay Greene argues that claims of elevated suicide rates for young people who are denied gender-affirming care are weak.
Only a handful of studies examine the relationship between cross-sex hormone treatments and suicide risks that compare outcomes for teenagers who received such care to those who sought it but did not receive it. No study uses a causal research design, such as a randomized controlled trial, which is typically required for approving drugs. Instead, many of these studies compare minors who received interventions to those who were unable to get them and find lower rates of contemplating suicide.
The report claims that there are fundamental defects in some of the trans-friendly research. Supportive studies have relied upon surveys of trans adults recruited from advocacy groups, which are unlikely to be representative. Furthermore, a condition of receiving this care is psychological stability. If people were denied care, it may have been that they already had a mental health condition.
“So really, all they’re finding is that people are thinking about suicide more if they begin with more severe mental health problems,” Greene told The Hill. “They’re not finding that the drugs are protective.”
In fact, Greene claims that “easing access to cross-sex treatments without parental consent significantly increases suicide rates”.
We compare annual youth suicide rates in states that allow minors to access care without parental consent to states that do not. The data clearly show no difference in youth suicide rates between these two groups of states for over a decade before 2010, when this use of puberty blockers and cross-sex hormones begins. Around that time, a difference in suicide rates emerges and the gap accelerates after 2015 when cross-sex treatments become more common.
There is a 14% increase in suicide rates among young people by 2020 in states that have a provision allowing minors to access care without parental consent relative to states that do not. Easier access to puberty blockers and cross-sex hormones by minors actually exacerbated suicide rates.
The report concludes that “science does not demonstrate that puberty blockers and cross-sex hormones are necessary to prevent suicides. In fact, if anything, it demonstrates the opposite.”
The report was battered by LGBTQI+ activists. Jack Turban, a child and adolescent psychiatry fellow at Stanford University School of Medicine, described it as “absurd”. “This entire report is based on the incorrect assumption that minors can easily access hormones without parental consent,” he tweeted.