Gender-Affirming Care Improves Mental Health—and May Save Lives

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In the middle of a large number of anti-trans laws proposed earlier this year, Spencer Cox, the Republican governor of Utah, made a passionate petition to his state legislature while trying to veto a bill that would prevent young trans compete in women’s sports. “I want them to live,” he wrote about trans athletes in his state, referring to the astronomical rates of suicide attempts among the trans community. Several surveys have estimated that about 40 percent of trans people may attempt suicide throughout their lives; among the general public, this figure stands at about 5 percent.

But despite the governor’s veto attempt, the Utah bill was passed, as have some people across the country banning gender-based health care for children and teens. Many other such invoices are currently in process. These treatments, mainly drugs that delay the onset of puberty and hormonal treatments such as testosterone and estrogen, help trans people achieve the body and appearance they feel is right. Experts fear the bans will have catastrophic effects. “Young people will die,” says Dallas Ducar, CEO of Transhealth Northampton, a medical center in western Massachusetts that offers gender-based health care services.

Because these treatments for teens are relatively new and access to them is limited, the set of studies on their effects on mental health is small and recent. But WIRED spoke to half a dozen academics who have published transition and suicide studies in peer-reviewed journals, and they all agree: gender-based medical care seems to reduce that risk among trans young people. There is no single study that proves it once and for all, no argument that can end all arguments. Researchers say they cannot ethically conduct the type of randomized controlled trial that is the gold standard for most medical research: this would involve giving a placebo to a person in a potentially dangerous situation. Yet, as a whole, these studies tell a coherent story, solid enough to convince its authors of the vital importance of these medical treatments. “All the data we have right now suggests that they decrease suicide,” 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 complicated because it deals with a small number: trans people are a minority of the population, and those who receive gender affirmation treatment as minors are an even smaller subset. Some of these minors may receive puberty blockers, others only receive hormones and some receive both. Gathering enough participants to achieve statistically significant results requires a lot of time and money.

Studies limited to people who have attempted suicide would be even smaller. Thus, researchers often focus on suicide, a term that encompasses a wide range of behaviors, including thinking about ending life. Critics have argued that this research shows no evidence of a crisis; after all, thoughts are not actions. But the ideation is a strong predictor of suicide attempt and a “marker of very serious psychological distress,” Turban says. And because it’s more common, it’s easier to study.

To do this, researchers have two main tools at their disposal. The first is the longitudinal study, which tracks individuals over a period of time to evaluate the effectiveness of a medical intervention. In the context of trans health care, these studies usually begin in the clinic: patients who want to perform a specific intervention will be recruited for the study and then researchers will follow them throughout their treatment.

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