Gender-affirming care improves mental health — and can save lives

Midst Spencer Cox, the Republican governor of Utah, passionately appealed to his state’s legislature over a series of anti-trans laws proposed earlier this year when he attempted to veto a law targeting trans youth would prevent her from competing in girls’ sports. “I want them to live,” he wrote of trans athletes in his state, citing the astronomical attempted suicide rates in the trans community. Several surveys have estimated that around 40 percent of trans people will attempt suicide at some point in their lives; in the population it is around 5 percent.

But despite the governor’s attempted veto, the Utah law passed, as did several across the country banning gender-affirming medical care for children and adolescents. Many more such calculations are currently in the works. These treatments — mainly drugs that delay the onset of puberty and hormone treatments like testosterone and estrogen — help trans people achieve the body and appearance that feels right for them. Experts fear the bans will have catastrophic effects. “Teens are going to die,” says Dallas Ducar, CEO of Transhealth Northampton, a western Massachusetts medical center that provides gender-affirming health services.

Because such treatments for adolescents are relatively new and access to them is limited, the pool of studies on their impact on mental health is both small and timely. But WIRED spoke to half a dozen academics who have published studies on transition and suicidality in peer-reviewed journals, and they all agree – gender-affirming medical care appears to lower this risk in trans youth. There is not a single study that proves this once and for all, no bracket that can end every dispute without further ado. Researchers say they cannot ethically pursue the type of randomized controlled trial that is the gold standard for most medical research: that would involve giving a person a placebo in a potentially dangerous situation. Overall, however, these studies 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 point suggests that they reduce suicidality,” 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 difficult because it deals with small numbers: trans people are a minority of the population, and those who received gender-affirming treatment as minors are an even smaller subgroup. Some of these minors may be on puberty blockers, some just hormones, and some both. It takes a lot of time and money to collect enough participants to get statistically significant results.

Studies limited to people who have attempted suicide would be even smaller. As such, researchers often focus on suicidality, a term that encompasses a wide range of behaviors, including thoughts of ending one’s life. Critics have claimed that this research shows no evidence of a crisis – after all, thoughts are not actions. But imagination is a strong predictor of a suicide attempt and a “marker of really serious mental distress,” says Turban. And because it’s more common, it’s easier to learn.

To do this, researchers have two primary tools at their disposal. The first is the longitudinal study, which follows people over a period of time to assess the effectiveness of a medical intervention. In the context of trans healthcare, these studies typically begin in the clinic: patients who wish to pursue a specific intervention will be recruited into the study, and then researchers will follow them through the course of their treatment.

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