Quick Conservative

Gender Care & Suicide Risk: What Science Doesn't Know

July 24, 2023 Jessica Walters Season 1 Episode 7
Gender Care & Suicide Risk: What Science Doesn't Know
Quick Conservative
More Info
Quick Conservative
Gender Care & Suicide Risk: What Science Doesn't Know
Jul 24, 2023 Season 1 Episode 7
Jessica Walters

A new review reveals major flaws in research linking gender care (including hormone therapy, puberty blockers, and sex reassignment surgery) to reduced suicide risk.

Sources for every claim are always linked on QuickConservative.com.


Facebook: @QuickConservative
Instagram: @QuickConservative
YouTube: @QuickConservative
Twitter: @QuickConserv

Show Notes Transcript

A new review reveals major flaws in research linking gender care (including hormone therapy, puberty blockers, and sex reassignment surgery) to reduced suicide risk.

Sources for every claim are always linked on QuickConservative.com.


Facebook: @QuickConservative
Instagram: @QuickConservative
YouTube: @QuickConservative
Twitter: @QuickConserv

A lot of people claim that gender treatment (including puberty blockers, hormones, and surgery) is “life-saving care,” in that it reduces suicide. But a review of scientific research suggests that this relationship might be best compared to intoxication, in that alcohol also produces a desired, measurable effect – it reduces anxiety – and yet its medical consequence clearly argues against its use as a front-line anxiety medication.

This is the dilemma surrounding the gender treatment debate. Scientists can’t isolate what’s causing suicidal behavior within the transgender community to begin with – which means, even in cases where suicidal behavior is shown to decrease after gender treatment, they can’t explain why. All they know is that a high-risk variable, with life-altering side effects, is correlated with a desired, measurable result.

But if you wouldn’t prescribe alcohol to treat anxiety – even though one appears to help the other – why would you accept that chemical or surgical castration is the best way to prevent transgender suicide, when scientists can’t even pinpoint the connection? 

My name is Jessica, and you’re listening to Quick Conservative.

Transgender individuals do have an increased risk of suicide. So if you care about fixing that problem, you need to be willing to step back and look at the whole board. No matter how much you support “gender care,” promoting a treatment should never become more important than protecting a patient. And right now PR campaigns are misleading patients into thinking we know way more than we do and misdirecting them from getting help for other serious risk factors.    

Ok, so let’s tackle our  first problem:

Suicide is a super complex issue, with a ton of influencing factors – or, in science-speak: confounding variables – including psychiatric disorders, psychiatric treatment, trauma, and substance abuse. So you’d assume that studies on gender treatment and suicide would control for those variables, right?


In a review of 23 of the best studies out there – meaning they’re quantitative, peer-reviewed, and frequently cited by The Washington Post (kidding on that last one) – researchers found that only three even considered whether the participants had psychiatric diagnoses or mood disturbances. Which is crazy, since 1) mental illness is one of the most commonly cited risk factors for suicidal behavior, and 2) transgender patients have a significantly higher rate of mental illness than the general population.

Same thing with psychiatric treatment. Only three studies made any attempt to factor it in and only one considered psychotropic medication. Which again, seems like a pretty big omission, since in a meta-analysis of 23 placebo-controlled clinical trials and one multicenter trial, spanning nearly 4,600 patients, the FDA found that antidepressant use in pediatric patients is associated with an increased risk of suicide

Oh, and that one study? In a review of 3,753 transgender youth, researchers found that over 75% were on psychotropic medication (including antidepressants, anti-psychotics, and lithium). They were also six times more likely to have a mood disorder, and over five times more likely to have a psychotic disorder, than their siblings. Researchers also reported that mental healthcare visits were not significantly changed and psychotropic medication use actually rose following gender treatment.

And, despite a meta-analysis confirming that transgender individuals have a higher prevalence of substance use than the general population, only two of the studies accounted for that variable. Again, a major problem since, as the Journal of Public Health explains, “there is a strong association between substance use disorder and suicide outcomes.”

So, no. Scientific studies do not prove that restricting access to gender treatment promotes suicidal behavior – because they can’t. There’s way too many variables clouding the water.You can’t claim a specific treatment saves lives by fixing X, when you don’t even know if X is the main problem. And you certainly can’t claim a cause-and-effect relationship between two events – like gender treatment and reduced suicide risk – simply because they’re associated. What’s that saying?

Correlation does not imply causation.

Consider some of these other data points:

  • One recent study found a quarter of transgender participants experienced childhood sexual abuse. 
  • Another study of over 25,000 transgender patients found the presence of personality disorders and psychosis – so we’re not just talking depression or anxiety – was over 20 times and 3 times higher, respectively, than cisgender patients. 
  • Research also shows transgender individuals are more likely to experience chronic health conditions.

These are all well documented suicide-risk-enhancing factors. So why aren’t they part of the mainstream dialogue? If the goal is to genuinely reduce harm, we should be addressing every single variable – not pretending that one course of action (gender treatment) is a cure-all, simply because it’s politically en vogue. 

But back to our studies. What about the papers that actually controlled for psychiatric diagnosis/treatment and substance use?

In one study that factored in mental health therapy and substance abuse, researchers found that puberty blockers and hormones were associated with lower odds of suicidality over twelve months. However, buried down in the last paragraph of the paper, the authors acknowledge:

“There may also be residual confounding because we were unable to include a variable reflecting receipt of psychotropic medications that could be associated with depression, anxiety, self-harm and suicidal thought outcomes.”

In a second study of transgender and gender diverse people, those who had a history of gender surgery had lower last-year suicidal ideation than those who didn't. However, as the study authors note: 

“Much of the literature on mental health benefits of gender-affirming surgery has been complicated by inability to adjust for a key confounder: baseline mental health status.”

The present study is no exception. And, it also didn’t address psychotropic medication.

Then there's the Psychological Medicine study that found reduced suicidal ideation in Veterans who received gender treatment. However, an indirect-effects analysis revealed that depression scores predicted over half of the variance in suicidal ideation over the past two weeks. And, once again, psychotropic medication and substance use weren’t included.

Still, as you can see: Literature is starting to accumulate linking gender treatment to reduced suicidal thoughts and/or behavior. But is it actually gender treatment itself that’s mitigating suicide risk or another related variable? What is causing these suicidal tendencies to begin with? And is there a safer, more effective treatment alternative with a lower side-effect profile? These are answers we 100% do not have at this time.

And we may never have them!

The American Psychiatric Association is quick to point out that even for at-risk populations, suicide attempts and parasuicidal behaviors are statistically rare enough to make it “impossible to predict on the basis of risk factors either alone or in combination” one’s risk of suicide. 

It’s also worth noting that plenty of studies have found gender treatment doesn’t improve mental health, with a 2022 report published by the British Medical Journal writing:

“Puberty blockers used to treat children aged 12 to 15 who have severe and persistent gender dysphoria had no significant effect on their psychological function, thoughts of self-harm, or body image.”

There’s also multiple studies that suggest gender treatment increases suicide risk (although they, too, suffer from methodological errors). 

So when doctors or organizations like the ACLU claim that “gender-affirming care is life-saving care,” their statements need to be taken for what they are: promotional slogans – not sound scientific fact. Based on currently available data, at best gender treatment is associated with reduced suicide risk. At worst, it’s a band-aid correlation with life-altering consequences that, yes: produces a desired, measurable effect – but, much like anxiety calmed by a few drinks of liquor, hides beneath its surface a deeper problem that, shielded by the mask of gender reassignment, may never receive the attention, care, or treatment it deserves.

Today’s post isn’t about winning a political debate. It’s about the very real human beings at the center of this conversation who are considering taking their lives. If preventing suicide was the real goal, we’d be pouring over ever single variable with equal zeal. But we’re not. 

Multiple studies show transgender individuals experience increased physical, psychological, and sexual abuse as children. One study of transgender individuals requesting treatment at a gender care clinic revealed nearly half had a personality disorder. Another study of transgender patients found the frequency of personality disorders was 81.4%. And let’s not forget the earlier study of over 3,700 transgender patients that found 75% were on mind- and/or mood-altering medication. Doesn’t it seem like maybe we should look into those variables just as passionately as we look into gender dysphoria? 

As bioethicists and doctors point out in a recent letter published by the Journal of the American College of Clinical Pharmacy:

“Uncertainties about long-term risks of medical transition are often overshadowed by the most potent argument provided by advocates of the affirmative model: failure to affirm a young person's transgender identity may result in suicide. However, the relevant question is whether affirmative care [itself] reduces suicide risk.”

The authors go on to posit the same arguments made by today’s post, highlighting quality concerns with current research and warning:

“The widespread methodological weaknesses in the research coupled with the lack of certainty that benefits outweigh harms, should raise questions about [gender] affirmation being positioned as the ‘standard of care’ in the United States and Canada.”

Unfortunately, Americans don’t seem to be listening.

Promoting the treatment has become more important than protecting the patient. It’s ethically reckless and, in my opinion, to ensure truly informed consent on behalf of transgender patients, those involved need to be a lot more honest about how very little we know about this new and highly complex area of medical research.

Thank you for listening to Quick Conservative. Looking for sources for today's podcast? Visit Quick Conservative.com. You can also find us on Facebook, Instagram, YouTube, and Twitter.