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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:

Oddthinking
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    Related: https://skeptics.stackexchange.com/q/45904/37236 (though there are some limitations with the answer) – Laurel Jun 11 '20 at 13:51
  • I’ll note that the question title doesn’t match the claim. Evans isn’t claiming that teens are more (or less) likely to take their own lives after transitioning: he’s claiming “there are no robust data” to back it up either way. I don’t think your question of “are dysphoric teens more likely to kill themselves” is an accurate portrayal of the claim in question. – Tim Jun 11 '20 at 15:55
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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 '20 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 ?" 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 '20 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 '20 at 20:07
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    @StephenG: Seems a red herring to me. That would allow us to rank on a rather macabre scale the "importance" in a teen's mind of transitioning versus cis relationship versus getting an XBox, but that's not the question. – Oddthinking Jun 11 '20 at 20:11
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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 '20 at 20:13
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    @Oddthinking a little clearer yes. I think my comment wasn’t especially clear anyway! – Tim Jun 11 '20 at 21:23

1 Answers1

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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.

tim
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    Pubertal suppression is not a way of transitioning, though. – Colin Jun 11 '20 at 08:08
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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 '20 at 09:38
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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 '20 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 https://www.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 '20 at 15:19
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    @James_pic the meta analysis essentially agrees with the main claim: there’s no evidence – Tim Jun 11 '20 at 15:51
  • @Tim the meta analysis I linked is specific to adults. I couldn't find anything tackling teenagers. – James_pic Jun 11 '20 at 16:05
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    @James_pic and unfortunately absence of evidence is not evidence of absence. Hmm – Tim Jun 11 '20 at 16:06
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    @Tim if you've got evidence that furthers the discussion, you should post it as an answer. This answer does include some evidence, it would just be easier to evaluate if there had been a systematic review of all available evidence. – James_pic Jun 11 '20 at 16:14
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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 '20 at 20:58
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    While from the perspective of the parents and the legal system there might be a need to separate statistics between 'teens' and 'adults', generally speaking, there is no valid reason to postulate that they experience gender dysphoria differently. After all, the _distinction_ between a 'teen' and an 'adult' is established in an arbitrary way (i.e. at a set age, 18, 21, etc.): one day before a certain date you're a 'teen', afterwards an 'adult'. Why should gender dysphoria be different at different ages...? 'Being an adult' is just a legal issue, not a biological one. – Gwyneth Llewelyn Jun 11 '20 at 22:16
  • (cont. from previous comment) While arguments can be made that a 'teen' is a pre-adult still under the influence of hormones and a physical change of their bodies, the truth is that we're talking about _averages_ here. Some societies (past and present) consider, say, a woman who has menstruation to be 'of marrying age', which can be merely at the age 13 years or so; while some physical and mental characteristics can be developed only around 25-27 years of age. Every individual is different, even if _on average_ they might have similarities with others at the same age... – Gwyneth Llewelyn Jun 11 '20 at 22:23
  • (and...) Therefore, the issue is, for me, _not_ if gender dysphoric teens are more or less likely to take their lives than adults; but just that gender dysphoric _people_ (of any age) are, indeed, more likely to take their lives when compared with non-gender dysphoric people. 'Being a teen', which legally means having limited freedom to do what one wants/needs, and assigning such responsibility to parents, _might_ just slightly increase the suicide ratio (when compared to adults — who _also_ have limitations upon their freedom!), but is it really statistically significant? – Gwyneth Llewelyn Jun 11 '20 at 22:26
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    @tim pubertal suppression delays puberty. It doesn't transition someone from male to female sex characteristics or vice versa. Dr. Evans's claim appears to be about the latter form of therapy. – Colin Jun 11 '20 at 23:27
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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 '20 at 09:39
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    @GwynethLlewelyn Re: _Why should gender dysphoria be different at different ages...?_ Because almost everything is different at different ages. _'Being a teen', (...) might just slightly increase the suicide ratio, but is it really statistically significant?_ In fact, it doesn't. [According to the NIMH](https://www.nimh.nih.gov/health/statistics/suicide.shtml), suicide rate is highest from about 45 years of age onward. (Even though you might point out that there's no valid reason to postulate that it should -- we only get to dismiss influences of age _after_ we checked for them empirically.) – sgf Jun 12 '20 at 09:43
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    @Colin Whilst it doesn't give a male<->female transition, puberty suppression certainly does prevent the person developing characteristics of their birth gender which will exacerbate their dysphoria. It also makes full transition easier, further down the line, because the body has not gone through changes which might need to be altered surgically. Speech is a particular issue for the male-to-female transition, because a boy's voice breaking in puberty is not a process which can be reversed except with surgery to the vocal cords. – Graham Jun 12 '20 at 10:29