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February 19, 2024 - 7:00am
A new study challenges the common assertion that gender-dysphoric youth are at elevated risk of suicide if not treated with “gender affirming” medical interventions. If it’s true, it ought to have a seismic impact on the accepted medical approach to gender-confused youth.
Reported in the BMJ, the study examines data on a Finnish cohort of gender-referred adolescents between 1996 and 2019, and compares their rates of all-cause and suicide mortality against a control group. While suicide rates in the gender-referred group studied were higher than in the control group, the difference was not large: 0.3% versus 0.1%. And — importantly — this difference disappeared when the two groups were controlled for mental health issues severe enough to require specialist psychiatric help.
In other words: while transgender identity does seem to be associated with elevated suicide risk, the link is not very strong. What’s more, the causality may not work the way activists claim.
The association between gender dysphoria and mental illness is well-documented by both providers of “gender-affirming care” and trans advocacy groups and clinical psychology research. But one less well-evidenced claim, based on this association, is that these difficulties are caused not by being transgender, but by the political and social stigma associated with it. Gender dysphoria, we are to understand, is not in itself a mental health issue. What causes mental health issues in transgender youth — up to and including suicide — is the wider world’s rejection of their identity, and of the metaphysical frame of “gender identity” as such.
This is the root of the oft-repeated social media assertion that anyone who demurs about trans identity, however mildly, is complicit in “trans genocide”. The same assertion that invalidating trans youth makes them kill themselves is also behind the rhetorical question routinely used to browbeat parents into consenting to social and medical transition for their gender-confused offspring: “Would you rather have a live daughter or a dead son?”
It’s behind the prohibition on “trans conversion therapy” already in force in several countries, and promised by the Labour Party in England too. Such measures forbid therapists from exploring with their clients whether there is any link between their gender dysphoria and — for example — life trauma or other mental health issues. For logically, if the cause of distress and suicidality in trans people is not being accepted for who they are, any therapist who seeks to explore links between gender dysphoria and other biographic or psychiatric issues is complicit in just this kind of non-acceptance, and is thus not helping but harming their client.
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SubscribeIt doesn’t matter. Activists have their own truth, and isolated cases of suicide and murder, such as the tragic case of Brianna Ghey, can be weaponised for maximum emotive effect. Their feelings don’t care about your facts.
That’s true. I can’t help observing it is backed up on this page by the absence of the usual lunatic activist trolls that haunt every UnHerd article on the Trans debate. They were out in force last week when an un scientific online poll went in their favour. Where are they on this one?
Funny how those same activists are silent about the murder of Jorge Martin Carreno by a gender confused male calling himself Scarlet.
How long do you think before the study is retracted due to furious activism? Obviously the trans mob can’t let it stand, it threatens their entire schtick.
It will be interesting to see what happens. A while ago BMJ would not have published it in the first place. Do the little dutch boy activists have enough fingers to stop all the leaks that are appearing everywhere now?
I suspect they will adopt a new tactic of ignoring the specifics and pointing to a general up swell in transphobia that requires some very harsh “hate speech” laws to be enacted as a priority by a new Labour government. Unless something dramatic happens, that is what it is likely to happen and it will become impossible to have these conversations without risking a knock on the door from the police.
It was never about the science or lowering suicide rates. They’ll cherry pick whatever evidence they need to in order to keep the trans industrial complex gravy train going at full tilt. Potentially bllions of pounds of investment depend on the long term care needs of these misguided people. No cost is too great.
What about a bit of sex affirming care and an end to conversion therapy leading to potential infertility and mutilation. Perhaps if we paid sex affirming care workers more the incentive to convert would be lessened.
My prediction: TAs see figures 0.3% and 0.1%, and claim that trans-identifying youth is three times more likely to commit suicide.
Of course that will happen, and that claim will spread because the vast majority of people don’t understand ‘statistical significance’ or ‘confounding variables’
Is that not right?
The study included 2000 young people, of which there were 55 deaths including 20 suicides. They found for all-cause mortality there was no difference in deaths between trans-identifying kids and the control group that was statistically significant (meaning that you can’t definitively prove the cause was linked to how they identify), and for the suicides there was a slight diffference that was barely within statistical significance, but as the paper said, that gets nullified when you control for mental health intervention. So while it may not be ‘wrong’ to say that on these numbers the suicide rate is three times higher, it’s most certainly not correct to say it because of the wider context of how statistics work and what this study was looking at.
Therein lies the problem, though. The TRAs claim that the mental health problems are caused by gender dysphoria, and the child psychologists (well, the uncaptured ones) claim that the underlying mental health issues are what is significant.
Does that not call into question the other findings?
Actually the study included over 18,000 young people. just over 2000 had sought help for gender dysphoria, these were matched for age, sex and where they lived with 4 others as the control group. The figures 55 and 20 refer to the whole group, it is the bi-variate analysis which then determines whether there is any difference between GD and the controls.
20 suicides from 2000 would be 1%
It’s correct, but misleading out of context.
Given that the children mutilated at gender clinics were far more likely to be autistic (than the general population) then surely it is likely that existing mental health conditions lead many children to seek gender change as a solution.
Genuine (as opposed to Rapid Onset) Gender Dysphoria is a mental health condition in it’s own right. Why do you think the doctors at the front end of the treatment process are psychiatrists? It is one of a family of body dis-morphias
Up until recently, GD was universally recognised as a mental health condition, until activists got it reclassified as a sexual health condition in some places, including by WHO. There was no medical evidence to support the appropriateness of this reclassification and WHO itself admits that the purpose of the reclassification was to reduce the stigma and give easier access to “gender affirming care”.
Rapid Onset GD need further study, but from the studies already done on the large number of heterosexual girls in particular suddenly claiming to have GD, it appears to be a combination of social pressures and other mental health conditions which make them more susceptible. The “gender affirming care” mantra makes GD the perfect neurosis to develop, if you have low self esteem and want positive attention.
Its only about heterosexual male-bodies getting what they want.
Not entirely convinced that this:
Defeats this:
Also not entirely clear that any of this defeats the argument for gender affirming care.
All of it seems a lot to draw from 20 cases.
Which is why writers like Leor Sapir and Jesse Singal have been begging for more robust data and objective surveys in order to better understand what exactly is going on in order to improve health outcomes for all young people no matter what, rather than having activists driving “research” to prove a point but muddying the waters and making it harder for people to get the care they actually need.
What exactly is the rational argument for ‘gender affirming’ care, an oxymoron if there ever was such a thing.
It’s a huge ugly euphemism rather than an oxymoron.
The idea that mutilating a child’s sex organs can be considered care is an oxymoron. Yes it is used as a euphemism to cover the ugly truth, just as “top surgery” is used to obfuscate from the reality that you are giving a teenager a mastectomy of otherwise entirely healthy breasts.
The key issue for me is there is absolutely NO medical evidence to support this ghoulish practice. I believe there would be a lot more evidence against it had proper studies been done. But the ideologues who believe as an article of faith rather than of evidence in these treatments are themselves directly responsible for ensuring the evidence does not exist either way.
The best version of the argument for gender affirming care is that, done correctly, it can very much help a young person with dysphoria or other issues feel supported, while providing space for them to ask questions and ‘explore’ the idea of living as a trans person.
I did this once, as a teacher, before the issue was mainstream. We tried out a different name in conversations, talked about the issues, broke for summer break and when she came to see me in September, first thing she said was ‘I figured it out sir. I’m a lesbian!’
It worked, in other words, the one time I tried out gender-affirming care. I wanted her to feel safe to talk and ask questions, and she clearly ended up feeling safe enough to come out to me.
But it’s too often that people who do the affirming have no idea of the social science. Since the majority of young people who do experiment with another gender will ultimately decide / realize that they are gay or lesbian, you would hope the affirmers are aware of this commonplace stat. Or the existence of detransitioners, or the members of LGBTQ communities who do not support radical trans rights (such as entry to female change rooms / sports for trans women).
You would hope they were familiar with Tavistock and Keira Bell. You’d hope they had sources from ‘outside’ the DEI world – try sourcing the policy docs you see in public institutions. They all source themselves, as opposed to, say, the research.
I mean, I’m clearly a skeptical lapsed progressive social sciences guy, but even I was unaware of this latest study. This subject and these treatments are all very new – not historically, there have always been trans people across time and place – but in terms of a public health issue.
Those progressive European countries were behind the original ‘gold standard’ of affirming care and hormone blockers. There is an argument to be made for their use – you don’t want to get giant and hairy, for example, or you badly do – but when this ‘gold standard’ was being developed, the patients being treated were highly motivated, carefully screened – this was not a social trend. These patients needed gender affirming care, I would say.
The social sciences question is just that – how relevant are these early success stories with a small number of self-selected highly screened individuals, to our current climate where the default in some circles is ‘affirm affirm affirm trans dad bumper sticker’.
But while I don’t believe ‘rapid onset gender dysphoria’ is a real thing, currently, it is an idea that needs studying. There are so many confounding variables.
Eliminating the ‘you are killing trans kids’ argument targeting parents who think drag brunches are a waste of their kids time will only help further this conversation, so I’m thankful for this article.
Anyone interested in a 2013 TED Talk (so, historical artifact at this point)?
Norman Spack’s ‘how i help trans kids’ is kind of a best-case example of the argument for this model of care, in 2013. You can see he is a thoughtful, caring practitioner, and how this niche approach becomes mainstreamed at the same time.
(Alex, sorry, I started just answering your question but then kept going ….)
Little surprised at the number of down votes when the study lists exactly that as one of its disadvantages.
20 suicides relating to over 18,000 people of whom only 2,000 had GD so 14 suicides in the control group of 16,000 and 6 in the GD group. Yes very small numbers. But to have more suicides to go on would require a lot more GD children being mutilated. Controlling for things like the type of care they received and their treatment by society would require huge numbers to be mutilated in different ways under different conditions; the whole thing would be worse than what the Nazis did.
People like to read into things, things that are not there, but accord with what they would like to hear. The only point is that gender dysphoria is not a predictor of suicide when you take account of the other mental health issues a lot of these kids have. The claim that suicide is caused by social stigma is neither supported nor refuted by the study. More importantly though, the study provides some limited indirect evidence to refute the claim that “gender affirming care” is lifesaving (the it’s all social stigma anyway works against that claim anyway), which is the key justification for continuing with the lesser evil of mutilating children’s sex organs.
Research like this is welcome but let’s not get too distracted.
If a child is too young to consent to a tattoo, buy an alcoholic drink or watch a slasher film, then they are too young to consent to amputations and life-changing, often irreversible, hormone treatments.
We don’t treat anorexic children by affirming that they are indeed fat and should really give liposuction a go.
How do we treat anorexic children?
Depends on severity.
Low risk cases will be supported via CAMHS services who will assess, monitor and support them and their families with psychiatric intervention, behavioural strategies etc. Watchful, supportive care.
High risk cases will be hospitalised because severe eating disorders by their very nature have a massive impact on physical health – organs can shut down etc – and one of the highest mortality rates of all mental illnesses.
In extreme cases, subject to evaluations etc, they will be sectioned and force fed.
If we’re going to compare it to the trans example, the doctors would simply accept the patients diagnosis that they feel overweight and put them on the waiting list to get their stomach stapled
I agree with you, but I don’t know any countries that allow minors younger than 18 that allow for surgery. The hormone treatments are reversible, technically speaking, adolescence just resumes – but clearly, those are critical developmental years, and we have no idea what the cost of that delay is. It is clear that there is risk. That much is obvious to social scientists who take this seriously.
We now know that blockers are not simply reversible and cause irreparable damage. The US allows girls under 18 to undergo double mastectomy, a certain dsurgeon, Ms. Fallon, is making a career of mutilating young girls.
I like your arguments. And it is interesting that the public doesn’t make these comparisons.
When before have so many column inches and so many television minutes been dedicated to so few people, causing so much heartburn. We’re so far off the rails that castration and blocking the natural process of puberty is cast as “gender affirming” instead of the barbarism that it is. It makes one wonder how trans people managed to survive in a time before they were thrust in our faces at every turn by (mostly) mothers engaging in this peculiar form of Munchausen’s.
For the slow people in the back of the room: it is perfectly normal for boys and girls who differ from gender stereotypes to grow into men and women. That is the norm; it’s not an outlier result. Sometimes, the adults are straight and sometimes they are gay. I have seen this happen first hand. In virtually all of those cases, the boys and girls involved know that they’re boys and girls. Except now, they have adults in their ears telling them that maybe they’re not what biology says they are.
History will not be kind to our society. Nor should it.
They are reaching for the trans extremes because of existing problems with autism, ADHD and depression. If such conditions are sufficiently extreme, the medical professionals might find themselves in a double bind with this issue of emotional blackmail (threats of suicide if the new gender is not affirmed).
For self-harm and eating orders can be treated with existing therapeutic approaches, but what is to be done about belief in a gendered soul? There can be a diagnosis of body dysmorphia but where from there when all hinges on this complex of extreme beliefs determined by an accentuated level of narcissism itself arguably caused by depression and autism.
Pontus Pilate, the father of post-modernism (or is that too sexist?) put the question that refutes all the robust studies in the world.
Note the modal auxiliary verb: “If it’s true, it ought to have a seismic impact on the accepted medical approach…” [emphasis added] Mary knows her grammar, she knows that “ought” is not indicative, that it doesn’t imply that it “will” have a seismic impact.
It is worth reading the full article
https://mentalhealth.bmj.com/content/27/1/e300940.full
to see how easy it was for the Finns to gather the data in a robust way because the data is all kept centrally. Could a similar study be done as easily in UK? No because health data is a mess generally and GIDS lost track of the data on a lot of the kids they treated – one of the key Cass review findings.
It is a scandal that this has been allowed to go on without proper evidence gathering (normal evidence based medicine required in any other field where harmful drugs / procedures are employed). It is no coincidence that countries like Finland, who are now doing the proper studies, are banning the mutilation of their children.
I fully understand the calls for proper studies to be done in UK. However the opportunity to do them well before now has been wasted due to the opposition of trans activist to doing them in the first place and the lengths they go to to silence anything that is published. Therefore I am actually against studies which by necessity will allow even more children to be experimented upon. A ban on “gender affirming care” on anyone under 25 should be put in place and then the best studies possible done on available data. Once all data from around the world has been studied, if that provides positive evidence to remove or modify the ban then great let’s do it that way round.
The ‘it’s society that’s the problem ‘ argument has been a long-standing convenient cudgel for all revolutionary and/or special interest groups.
Like most statements, it may contain some truth but in this case I feel it is being trotted out disingenuously by its proponents to shut down discussion and divert attention from any number of red flags that are in plain sight regarding ‘gender affirming care’.
When the tide turns, the usual suspects will all be heading for the hills and refusing to take any responsibility for the ensuing mess.
Psychiatry has used the suicide card since I was a child in the ’60’s. Probably longer.
No one is trans.
Of course, sane and rational people have always known this.
I was impressed with Blaire White’s recent televised therapy session when he considers the very real possibility that his transgender expression may be a trauma response. His honesty may be a break through for many who follow him. One-by-one.
This data says – does it nor- that there is no material increase in suicides for Trans- but there are increased mental health issues.
“if true, it ought to have a seismic impact.” Truth doesn’t always have great impact, at least it isn’t always seen. Flat earthers are greatly impacted by the roundness of the earth, yet can live essentially normal lives despite their ignorance. However, the technical difference between being wrong about flat earth, and being wrong about trans-surgery side effects, is harder to dismiss. Sadly, not impossible. Fortunately for our species, the neat thing about Truth is that it kind of just sits there, doing what it does, waiting patiently for us to conform ourselves to it.
“Ultimately, though, the claims of gender ideology are less scientific than metaphysical. So don’t expect scientific evidence that contradicts its prescriptions to have much impact on trans advocates.” Just so, I’m afraid. Evidence has a hard time penetrating an ideology fueled by magical thinking. (See also Harrington’s excellent essay “Why the Centrists Changed Their Trans Tune.”)