In the middle After a slew of proposed anti-trans legislation earlier this year, Spencer Cox, the Republican governor of Utah, made an impassioned plea to his state legislature as he tried to veto a bill that would bar trans youth from competing in female sports. “I want them to live” wrote about trans athletes in his state, referring to the astronomical rates of suicide attempts among the trans community. Multiple surveys they have estimated that around 40 percent of trans people may attempt suicide in their lifetime; among the general public, this figure is about 5 percent.
But despite the governor’s veto attempt, the Utah bill passed, as did some across the country banning gender-affirming health care for children and teens. Many other similar bills are currently in the pipeline. These treatments, primarily medications that delay the onset of puberty and hormonal treatments such as testosterone and estrogen, help trans people achieve the bodies and appearances that make them feel good. Experts worry that the bans will have catastrophic effects. “Young people will die,” says Dallas Ducar, executive director of Transhealth Northampton, a medical center in western Massachusetts that provides gender-affirming health care services.
Because such treatments for adolescents are relatively new and access to them is limited, the body of studies on their effects on mental health is small and recent. But WIRED spoke to half a dozen academics who have published studies on transition and suicide in peer-reviewed journals, and they all agree: gender-affirming health care appears to reduce that risk among trans youth. There is no single study that proves it once and for all, no deciding factor that can summarily end every argument. The researchers say they cannot ethically follow the kind of randomized control trial that is the gold standard for most medical research: That would involve giving a person in a potentially dangerous situation a placebo. Still, taken together, these studies tell a consistent story, strong enough to convince their authors of the vital importance of these medical treatments. “All the data we have right now suggests that suicidal tendencies decrease,” says Jack Turban, an incoming assistant professor of child and adolescent psychiatry at the University of California, San Francisco.
Research in this area can be complicated because it deals with small numbers: trans people are a minority of the population, and those who receive gender-affirming treatment as minors are an even smaller subset. Some of those kids may get puberty blockers, some get hormones only, and some get both. Gathering enough participants to obtain statistically significant results requires a lot of time and money.
Studies limited to people who have attempted suicide would be even smaller. Therefore, researchers often focus on suicidality, a term that encompasses a wide range of behaviors, including thoughts of ending one’s life. Critics have argued that this investigation shows no evidence of a crisis; after all, thoughts are not actions. But ideation is a strong predictor of attempted suicide and a “marker of really serious psychological distress,” says Turban. And, because it’s more common, it’s easier to study.
To do that, investigators have two main tools at their disposal. The first is the longitudinal study, which follows individuals over a period of time to assess the effectiveness of a medical intervention. In the context of trans health care, these studies typically begin in the clinic: patients who want a particular intervention will be recruited into the study and then followed by researchers throughout the course of their treatment.
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