Where is the evidence for transgender youth suicide?

Michael Cook
April 12, 2021
Reproduced with Permission
sex and society

This could be happening in nearly any city in the United States, the United Kingdom, Canada or New Zealand. Let's just use Melbourne as a test case.

The North Western Melbourne Primary Health Network is currently running a campaign, #SpeakingUpSpeaksVolumes , which advises schools to avoid words like "mum", "dad", "boyfriend" and "girlfriend" to help to lower the suicide rates of LGBTQI+ young people. It also wants to bring in unisex bathrooms, non-gendered playing teams and rainbow flags to be more inclusive and make gender non-conforming young people more comfortable.

The key word here is "suicide". The campaign's website cites surveys which claim that "LGBTIQ+ people aged 16-27 are 5 times more likely to attempt suicide" and "Transgender people aged 18 and over are nearly 11 times more likely".

Parents with children who believe that they have been "born into the wrong body" are bound to be horrified by these figures. They love their child and they would be devastated if they committed suicide. Anything is better. Anything.

And when they take their child to a "gender clinic", the parents will almost certainly be advised, first, to affirm the child's chosen gender, then to start him or her on puberty-suppressing drugs, eventually to follow up with drugs to change their sexual characteristics and possibly to have gender-affirming surgery.

This, the gender "experts" will tell them, is going to save their child from suicide.

But is this true? Where is the evidence that drugs and surgery are better options than psychological support or even doing nothing at all?

The latest investigation suggests that the evidence is of very low quality.

A preliminary study by the UK's National Institute of Health and Care Excellence (NICE) has found that the science supporting this view is of low quality .

In relation to body image and psychosocial impact, says NICE, the results "are of very low certainty". "Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance."

Another NICE study asked what is the clinical effectiveness of gender-affirming hormones compared with one or a combination of psychological support, social transitioning to the desired gender or no intervention.

Considering the pressure from transgender supporters in the UK, the answer was astonishingly negative.

The aim of employing gender-affirming hormones is to induce the development of the physical sex characteristics congruent with the individual's gender expression while aiming to improve mental health and quality of life outcomes.

However, the NICE study found that certainty of their impact on gender dysphoria, on depression, on anxiety, on quality of life, on suicidality and self-injury was all "very low".

Why? According to NICE, the studies in its review of the literature were flawed. They were all uncontrolled observational studies, which are subject to bias and confounding; they had relatively short follow-up; most of them did not report comorbidities (physical or mental health); most of the studies were poorly reported and used a confusing variety of scoring tools and methods.

The study concluded that "Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria."

These two documents have been written for an independent review for the UK government health service into gender identity services for children and young people. This will be led by Dr Hilary Cass , a former president of the Royal College of Paediatrics and Child Health.

Obviously, the debate is far from over.

However, NICE's reports back up a consistent scepticism amongst experts about the value of treating gender dysphoria with body-altering drugs. By way of example, Carl Heneghan, Editor in Chief of the journal BMJ Evidence Based Medicine, and a professor at the University of Oxford, published a stinging critique of the "evidence" in 2019 . He said:

[It] is limited by small sample sizes; retrospective methods, and loss of considerable numbers of patients in the follow-up period. The majority of studies also lack a control group (only two studies used controls). Interventions have heterogeneous treatment regimes complicating comparisons between studies. Also, adherence to the interventions is either not reported or inconsistent. Subjective outcomes, which are highly prevalent in the studies, are also prone to bias due to lack of blinding.

Gender dysphoric kids are suffering. We mustn't deny that. But the question is what parents should do about it. It's simply not true that transgender medicine is the only way to keep them from committing suicide.