Does Transition Reduce The Risk Of Suicide For 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 treatment option 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. Both of these hormones are naturally produced in the bodies of biological men and women.

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 for trans people can be comparatively safe and effective. 

One powerful argument in favor of transition for trans people 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.)

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, SpeakingofSuicide.com.) 

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.

READ Myths About Transgender Identities

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 among trans people, 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. 

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.

Does Transition "Work" For Trans People?

Does transition improve quality of life for transgender people?

There’s a pretty big body of research that indicates that transition reduces anxious and depressive thoughts and feelings among transgender people.

A typical study on the subject found that: “Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation.” (Source: Archives of Sexual Behavior.)

Does transition cause regret among trans people?

There are two issues here. First, do a high percentage of transgender people regret their transition, and second, what does such regret mean?

Let’s address the incidence of regret. Trans people do sometimes regret gender reassignment surgery or other aspects of medical transition. That happens in less than four percent of patients — by comparison, elective plastic surgery in the general population has a regret rate of 65 percent. By those standards, either elective plastic surgery should be banned or GCS (Gender Confirmation Surgery) should be elective.

However, GCS isn’t elective (in the West) and is carried out as part of a supervised medical transition. The current rate of regret among male to female transgender gender confirmation surgery patients is between one percent and two percent, among the lowest for any surgical procedure. (Source: Psychological Medicine.)

Why do people regret transition? If the majority of those who regret transition do so because they feel they were mistaken to seek it in the first place (because they were not transgender after all), that would be a strong indictment of the current system at least and possibly of the very idea of transition as a solution to trans problems.

In fact, though, the evidence shows that trans people tend to regret transition for the following reasons that are unrelated to their gender identity:

• Lack of support from the patient’s family
• Poor social support
• Late-life transitions (which frequently show a reduced response to hormone therapy)
• Severe psychopathology
• Unfavorable physical appearance
• Poor surgical result

(Sources: Acta Psychiatrica Scandinavica, Archives of Sexual Behavior.) 

One of the biggest trends in the last fifteen years has been the fall in dissatisfaction rates in post-transition transgender individuals — in spite of the increase in their number — as surgical techniques improve, leading to more functional and esthetic outcomes. This is the opposite of what you’d expect if transition was ineffective as a therapy for the issues trans people face.

READ Is Binary Transgender Acceptance Another Trap For Non-Binary Trans People?

Does transition reduce suicidal thoughts or suicide?

The Wall Street Journal’s Paul McHugh ran a story in which he observed that post-transition trans people had a suicide rate that was higher than the background population. This is true — but it’s a non sequiteur for our purposes. 

While the numbers shouldn’t be trusted absolutely because several social and medical factors conspire to muddy them, they do point toward a sharp reduction in suicide risk after transition. Among those trans people who had undergone a medical transition in the Ottowa study, for instance, suicidal ideation was halved — a dramatic improvement.

If I've left out something important or you feel I've misrepresented the facts, or you have something to add to the discussion, get in touch in the comments section below.