In the midst of a slew of anti-trans legislation proposed earlier this year, Spencer Cox, the Republican governor of Utah, made an impassioned plea to his state’s legislature as he tried to veto a bill that would bar trans youth from competing in girls’ sports. “I want them to live,” he wrote of the trans athletes in his state, in reference to the astronomical rates of suicide attempts among the trans community. Multiple surveys have estimated that about 40 percent of trans people may attempt suicide in their lifetime; among the general public, this figure is around 5 percent.
But despite the governor’s veto attempt, the Utah bill passed, as have a few across the country that ban gender-affirming medical care for kids and teens. Many other such bills are currently in the works. These treatments—mainly drugs that delay the onset of puberty, and hormone treatments such as testosterone and estrogen—help trans people achieve the bodies and appearances that feel right to them. Experts worry that the bans will have catastrophic effects. “Youth will die,” says Dallas Ducar, CEO 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 pool of studies about their mental health effects is both small and recent. But WIRED spoke with half a dozen academics who have published studies on transition and suicidality in peer-reviewed journals, and they all agree—gender-affirming medical care seems to lower that risk among trans youth. There’s no single study that proves it once and for all, no clincher that can summarily end every argument. Researchers say they can’t ethically pursue the kind of randomized control trial that’s the gold standard for most medical research: That would involve giving a placebo to a person in a potentially dangerous situation. Still, as a whole these studies tell a consistent story, one robust enough to convince their authors of the vital importance of these medical treatments. “All the data that we have at this point suggests that they decrease 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 tricky 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 tinier subset. Some of those minors may receive puberty blockers, others only receive hormones, and some receive both. Gathering enough participants to obtain statistically significant results takes a lot of time and money.
Studies limited to people who have attempted suicide would be smaller still. So researchers often focus on suicidality, a term that captures a wide range of behaviors, including thinking about ending one’s life. Critics have contended that this research does not show evidence of a crisis—after all, thoughts are not actions. But ideation is a strong predictor of attempted suicide, and a “marker of really severe psychological distress,” Turban says. And, because it’s more common, it’s easier to study.
To do that, researchers have two primary tools at their disposal. The first is the longitudinal study, which tracks individuals over a period of time to evaluate the efficacy of a medical intervention. In the trans health care context, these studies typically start in the clinic: Patients who want to pursue a particular intervention will get recruited for the study, and then researchers will follow them over the course of their treatment.