There was widespread media coverage in January of claims in a new report that prescribing puberty blockers to transgender teens prevents suicides – literally.
While any suicidal ideation is of huge concern, it’s important to use sound data – not least because of the danger, according to guidelines from the Samaritans, of adding to the distress – and suicidal thoughts – of vulnerable people by over-stating prevalence of suicides. So what does sound data tell us?
It is often quoted that 48% of young trans people have attempted suicide – but this comes from a study with of only 27 young trans people – too small a sample to be reliable.
Another oft-quoted analysis is of 35 studies with data from 113,468 ‘sexual minority youth’, which concluded that transgender youth were six times more vulnerable to suicidal thoughts than others. But look a little closer and only one of the 35 studies (published by Clark et al in 2014) included data on transgender youth. Of the 8,000 young people surveyed in that study, 1.2% were transgender, so the data on suicidal thoughts is drawn from 114 individuals – also not a large sample to give robust data.
If we accept, albeit without robust data, that transgender youth may be prone to suicidal thoughts, what is the evidence to support prescribing puberty blockers as part of a Gender Affirming Model of Care for young people suffering distress around the sex of their body? Science journalist and film maker Malcolm Clark has delved deeper.
January’s study published in US Journal Pediatrics by Turban et al was based on a statistical analysis of a survey of 28,000 transgender people carried out online in 2015 by transgender lobby group, the National Centre for Transgender Equality.
The survey reports that 3,494 of the respondents had wanted puberty blockers but only 89 of those actually ever got them.
Clark says: “The media quoted Turban’s conclusion that getting blockers had massively improved mental health outcomes. But drilling down into the statistics tells a more complex and troubling story.”
Over a lifetime, 90% of those who didn’t get puberty blockers had THOUGHT about suicide whereas only 75% with puberty blockers had.
But while 51% of those without puberty blockers had ATTEMPTED suicide SO did 41% of those who took them. That’s over the course of a lifetime. Events in the last year are more easily recalled.
While 58% of those who’d not received puberty blockers PLANNED suicide in the last year so did a full 55% of those who had taken puberty blockers as kids. The difference of 3% is insignificant when talking about just 89 people.
“Then comes the shocking fact,” says Clark.
The numbers actually ATTEMPTING suicide in the last year were HIGHER in those who’d taken puberty blockers. As for the percentage who ended up hospitalised after an attempt in the last year, it was almost DOUBLE among those who’d taken blockers (45% to 22%).
Of interest in the study, but not mentioned in the headlines, is the fact that The Endocrine Society recommends puberty blockers should only be given to children whose other mental health problems are “under control”.
The report states: “It is plausible that those without suicidal ideation had better mental health when seeking care”.
In other words those who took puberty blockers were less mentally troubled to begin with – yet end up with some suicide ideation statistics (such as attempting in the last year) that are worse than those who didn’t get them.
“Puberty Blockers don’t appear to save lives,” Clark concludes, “LITERALLY or otherwise.”
Jack Turban and others authors of the report heavily promoted the idea through Twitter and a press release that their work had proved puberty blockers reduced suicide thoughts – despite their their own paper’s conclusion that you cannot say there is causation. And despite their own report concluding an alternative explanation for lower suicide thoughts over a life-time might be that puberty blockers are only given to those screened for mental health. And despite their own research uncovering deeply concerning statistics that suggest puberty blockers may have increased suicide planning and attempts.
This misrepresentation of the conclusions of their own report is, at best, baffling.
Read more on this story
Suicide by trans-identified children in England and Wales
Transgender Trend
Investigation by Michael Biggs, Associate Professor of Sociology at the University of Oxford, September 2018
I have never in my life been witness to a group of people who have gone out of their way to distort science for their benefit and logic by damned!
Here’s is another example, and this was found in the Scientific American no less!
https://blogs.scientificamerican.com/voices/stop-using-phony-science-to-justify-transphobia/
Wow! That is shocking, actually.
The following letter to the editor of Pediatrics was published online:
RE: Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation
Avi Ring, Prof. emeritus neuropysiology, Univ.. Oslo, Norway (guest prof)
Turban et al. present an analysis of subjects from the database of the 2015 U.S. Trans Survey of more than 20,000 respondents. The authors extracted responses of 89 adult transgender subjects who experienced gender dysphoria (GD) in childhood and demonstrated that those who received puberty blockers (PB) fared better in measures of adult suicidality than those who did not.
This result is intuitive; adults more readily “pass” in society when development of secondary sex characteristics of the non-preferred biological birth sex was inhibited. The authors’ result supports this hypothesis.
Nevertheless, a word of caution is in order. The authors conclude that all who wish should be given PB. Presently, however, there is no method to predict persistence in GD. Estimates vary [1], but on average only about 15% persist; in contrast, when given PB, virtually 100% persist [2]. Thus, an indiscriminate prescription of puberty blockers will significantly increase the number of adolescents who continue to full transition, which may worsen long-term outcomes in attempted suicides.
The differences in expected outcomes if PB is or is not prescribed can be estimated. Of 1000 children with GD, if all receive puberty suppression then we expect all 1000 to go on to full transition whereas without the pubertal inhibition only 150 (15% of 1000) will transition. As the authors correctly state in the paper, 40% of transpersons attempt suicide in a lifetime, which means that with PB administration to all, we expect 40% of 1000 = 400 persons to attempt suicide. The authors show, however, that because of the benefits of PB, this may perhaps be adjusted downward by a factor of 0.6; the expected outcome is then 240 attempted suicides. In contrast, if none of the 1000 subjects receive puberty suppression then only 60 persons (40% of 150) are expected to attempt suicide.
The estimate here excludes a number of details such as the baseline of suicide attempts in a control population, lifetime suicide attempts of desisters, and differences in suicide risk for different subgroups of transgender subjects (e.g. FtM, MtF), but these omissions are consistent with the assumptions in the analysis by Turban et al. and unlikely to affect the conclusion.
Thus, pending reliable prediction of who will desist or persist, prescription of PB is not warranted. Giving PB to all who wish it is expected to significantly increase the total number of suicide attempts, up to 240 per 1000, compared with the outcome when not giving puberty suppression to anyone, 60 per 1000.
1. Ristori, J., Steensma, T.D. (2016) “Gender dysphoria in childhood” International Review of Psychiatry, DOI: 10.3109/09540261.2015.1115754
2. Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). “Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study” Journal of the American Academy of Child and Adolescent Psychiatry, 52: 582–590
I’d like to thank Jeff White for sharing these findings about puberty blockers in his comment. The statistics are in keeping with what I was able to ascertain about this contentious form of treatment. I also understand that the drug, Lupron or Leuprorelin, when it was used for so-called “on label” purposes e.g. mainly to treat end stage prostate cancers, precocious puberty or for the “chemical castration” of sex offenders led to a number of Class Action suits in addition to calls for it to recalled from the marketplace. It would also seem that the manufacturers have quite the stockpile to shift, though I concede that this is just my impression.
I have read and been informed personally that this substance, if given long-term to children in the dosage suggested to block puberty actually seems linked to a lowering of IQ by approximately 11% or points in those on it for over 2 years, although that’s a preliminary finding. The use of it to block puberty is literally an experiment – although women who have been on it long-term have apparently been found to suffer from memory loss.¹ Long term Lupron use is also associated with an increase in self-harm and suicidal ideation in those already suffering anxiety &/or depression.
It seems to me that the chief “benefit” of the use of PB in treating gender dysphoria is likely to be a greater number of children being stuck on the path to gender transition, not a considerable lowering of their distress and suicide rates as is claimed by TRAs. I’d rather that far fewer adolescents wished to kill themselves. I’d also rather that adolescents chose not to permanently alter their bodies with surgery and irreversible hormone treatments in a quest to alleviate a distressing set of psychological symptoms.
I feel that a path of providing psychological support which seeks to get at the root of the distress caused by gender dysphoria, rather than the endless “affirmation” of a maladaptive coping strategy² teamed with untested pharmaceutical intervention is far more likely to be help vulnerable young people.
¹https://thefederalist.com/2018/12/14/puberty-blockers-clear-danger-childrens-health/
²The notion that “changing sex/gender” by transitioning will somehow solve most or all of the individual’s problems