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For transgender people medical transition is held up as the solution. Without it a high proportion of trans people will tragically eventually commit suicide. But how effective is it really at improving the quality of life of trans people?

Once doctors and the person in question are certain beyond reasonable doubt that a person is transgender, there are two treatment options. One involves trying to change the person — to make them not be transgender anymore. This option is widely discredited, is about as effective as it sounds and should be avoided with the same scrupulousness as the “ex-gay” movement. The other is usually medical transition.

Medical transition for a transgender person involves the use of hormone therapy to establish an endocrine environment appropriate to the target gender. Trans women will take a drug, usually spirolactone, to reduce the efficacy of the testosterone their testes are still producing. Other than that, hormone therapy for trans women is basically the pill; hormone therapy for trans men is basically steroids. That’s not intended to be belittling: testosterone is an anabolic steroid, and the birth control pill is a form of hormone treatment. 

If you’re a trans teen reading this and you’re thinking of self-medicating, be aware that the majority of adult trans people would warn you against this option, which can be dangerous or even fatal. By comparison, properly supervised medical transition can be comparatively safe and effective

The final step of medical transition involves surgical genital reconstruction to create genitals appropriate to the target gender.

One powerful argument in favor of transition is the risk of suicide among transgender people. This is enormously high. Among trans people who can be easily “read” or “clocked” but haven’t transitioned, 42 percent will attempt suicide. Among trans people who suffer violence or mockery at school — and that’s most trans people of school age — 78 percent will attempt suicide. (Source: The Williams Institute/AFSP.) That’s more than three quarters. An Ottowa study found that 11 percent of transgender people in the Ottowa area attempted suicide in the single year of the study. (Source: Globe and Mail.)

Deaths by suicide among trans people are equally shocking. In the USA, they occur at 800 per 100, 000 per year — 0.8 percent, compared to the whole-population level of 13 per hundred thousand.

Suicide attempts in the trans population occur at a rate almost 20 times the level for the whole population. Deaths by suicide occur at a rate 61 times the general population. (Sources: Globe and Mail, 

With a problem that serious, it’s no wonder that transition is held up as a solution and referred to by trans writers as a lifesaver.

But does it live up to its reputation?

Ideally to answer that question we’d have a wealth of medical data. But unfortunately, that’s not the case. For one thing, getting hold of a properly designed study on the effects of transition isn’t easy because you can’t construct a double-blind controlled trial of transition the same way you can’t construct one for parachutes. It’s ethically impossible.

What evidence we do have appears ambivalent at first glance and appears to depend heavily on where the statement is coming from. Trans activists tend to say transition is effective, sharply reduces suicide risks and saves lives. Anti-trans voices from the radical feminist and conservative camps will say that transition isn’t effective, causes more problems that it solves and so on. Are these two camps arguing because there’s no real evidence?

Not really. In terms of the efficacy of transition in reducing depression, anxiety and the risk of suicide, the conservatives are basically distorting the evidence for ideological reasons. It shouldn’t be any surprise to learn that trans people who transition still have higher anxiety and depression rates — and greater risk of suicide — than the general population. 

Even after transition not all trans people “pass” as their target gender and many are carrying the legacy of years of stigma, shame, low incomes and dysmorphia. Unsurprisingly these pay off in more anxiety and depression.  

What we do see across the board is that transition is associated with reduced feelings of anxiety and depression, less suicidal ideation and better mental and physical health.

Continue reading after recommendations

  • The Williams Institute/American Foundation for Suicide Prevention: "Suicide Attempts Among Transgender and Gender Non-Conforming Adults." Globe and Mail: "Suicide Risk for Trans People Can Be Reduced, New Study Shows." "Transgender People and Suicide: The Tragedy, and The Hope." Archives of Sexual Behavior: "Long-Term Follow-Up Of Adults With Gender Identity Disorder." Psychological Medicine: "Sex Reassignment: Outcomes And Predictors of Treatment In Adolescent and Adult Transsexuals." Acta Psychiatrica Scandinavica: "Factors Predictive of Regret in Sex Reassignment." Archives of Sexual Behavior: "Factors Associated With Satisfaction or regret Following male-To-Female Sex Reassignment Surgery."
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