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In a recent essay defending her controversial views on sex and gender issues, author J.K. Rowling writes:

The argument of many current trans activists is that if you don’t let a gender dysphoric teenager transition, they will kill themselves. In an article explaining why he resigned from the Tavistock (an NHS gender clinic in England) psychiatrist Marcus Evans stated that claims that children will kill themselves if not permitted to transition do not ‘align substantially with any robust data or studies in this area. Nor do they align with the cases I have encountered over decades as a psychotherapist.’

Are gender dysphoric teens more likely to kill themselves if they are not permitted to transition?

Note:

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    Related: skeptics.stackexchange.com/q/45904/37236 (though there are some limitations with the answer)
    – Laurel
    Jun 11, 2020 at 13:51
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    It seems like there could be other significant factors here even if the correlation were true. A home or cultural environment that isn't understanding in general could be what leads gender dysphoric teenagers to consider suicide, with the prevention of transitioning being a symptom of that environment.
    – PC Luddite
    Jun 11, 2020 at 16:31
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    I think the question is flawed in so far as the generic question "Are teenagers more likely to take their lives if they are not allowed <something they really want> ?" would almost certainly have a "yes". Studies only focusing on teenagers denied a gender treatment they want would need to compare against e.g. teenagers denied a relationship with someone of a "conventional" opposite gender they became involved with. This would be the only way to see if the "gender denial" issue had a specific difference compared to other "significant denial" issues in teenagers.
    – StephenG - Help Ukraine
    Jun 11, 2020 at 18:55
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    @Tim: I'm less interested in what Evans is said to have claimed (i.e. that there is or isn't robust evidence) and more interested in the claim that Rowling is making (i.e. that the argument that denial of permission leads to higher risk of suicide is false) To answer that on this site, it is implied that you need evidence, so it could well be that an answer cites Evans, if Evans has published a literature review showing there is no robust evidence. [I am genuinely ignorant about whether he has.] Hmmm... This seems a clumsy explanation to me. Is that clearer?
    – Oddthinking ♦
    Jun 11, 2020 at 20:07
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    @PCLUddite: Agreed, but some randomised-controlled experiments are clearly beyond-the-pale unethical, so correlation - perhaps with confounding variables eliminated through modelling - is the best we can hope for.
    – Oddthinking ♦
    Jun 11, 2020 at 20:13

1 Answer 1

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A recent study found a high rate of suicidal ideation & a decrease in gender dysphoria in children & teenagers when treated with hormones - Psychiatric Co-Morbidities, Sexual Orientation, and Impact of Therapeutic Interventions in a Gender Non-Conforming Pediatric Practice:

The prevalence of psychiatric co-morbidities, suicidal ideation, and self-injuring behavior is high among GNC youth, but in this population, significantly worse among affirmed males. Both groups had significant improvement in the degree of dysphoria after beginning hormonal treatment.

Referencing a 2015 study, the Williams Institute found a direct link between hormone therapy and lowered suicidal thoughts & attempts (in adults):

Those who wanted, and subsequently received, hormone therapy and/or surgical care had a substantially lower prevalence of past-year suicide thoughts and attempts than those who wanted hormone therapy and surgical care and did not receive them.

The study Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation found the same to be true for trans teenagers:

There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.

Other studies have shown a decrease in depression and increase in overall functioning outcomes with puberty-blockers.

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    @Colin "allowed to transition" is rather vague, but I'd certainly include puberty blockers among that. If it's only about social transition instead, I'm not sure what "allowed" would mean.
    – tim ♦
    Jun 11, 2020 at 9:38
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    These are a few studies that point in one direction, but how representative are these? Are there more or less studies that show the opposite?
    – Alex
    Jun 11, 2020 at 15:04
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    @Alex that's a question that's best answered by a meta-analysis or systematic review, and as far as I can tell, none has yet been done on this topic. The best I can find is ncbi.nlm.nih.gov/pmc/articles/PMC5010234, which looks at adults rather than teens, and concludes that: "Hormone therapy interventions to improve the mental health and quality of life in transgender people with gender dysphoria have not been evaluated in controlled trials. Low quality evidence suggests that hormone therapy may lead to improvements in psychological functioning."
    – James_pic
    Jun 11, 2020 at 15:19
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    I definitely see what they mean by low quality evidence in that meta-study. The first and the third study don't use control groups (so it's impossible to tell apart the influence of the hormone treatment vs the passing of time) and the second study only asked people who, in fact, are transsexual as grown-ups (which is, presumably, or at least potentially, very different from being gender-dysphoric as a teenager.)
    – sgf
    Jun 11, 2020 at 20:58
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    @GwynethLlewelyn That's a bit like saying that there's no valid reason to postulate that retirees experience heart attacks more frequently, since "retiree" is not a biological category. Teenhood is the time you construct most of your identity, and your identity is at a special sort of turmoil at that time. Sure it doesn't overlap precisely with the end of legal childhood, but that's only a reason to be more fine-grained with your age categories (< 13, 13-21, 21-40 or whatever you like) rather than to dismiss them altogether.
    – sgf
    Jun 12, 2020 at 9:39

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