Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

By Jay Greene with The Heritage Foundation

“Adolescents who are confused about their gender suffer from an abnormally high suicide rate.Though research demonstrates that gender confusion generally resolves itself without medical intervention, some educators and medical professionals encourage teens, and even pre-teens, to take puberty blockers or cross-sex hormones so that their secondary sex characteristics, such as body and facial hair, breast tissue, muscular build, and fat composition, align more closely with the gender with which they identify. While the World Professional Association for Transgender Health (WPATH) acknowledges that these interventions can have significant complications, it warns that delaying intervention also has serious risks:

“Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence (Nuttbrock et al., 2010), withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents.”

“Other advocates, members of the media, and even White House staff invoke scientific authority to assert that cross-sex medical interventions reduce the risk of suicide. Sarah Harte, director for the Washington, DC, branch of an organization that provides medical intervention and support for youth called The Dorm, stated with confidence that “[l]aws and systems barring gender-affirming healthcare will contribute to higher rates of significant mental health problems, including deaths by suicide.” The CEO of The Trevor Project, Amit Paley, said, “It’s clear that gender-affirming care has the potential to reduce rates of depression and suicide attempts.”

“In an opinion piece in The Washington Post, University of Virginia Law School professors Anne Coughlin and Naomi Cahn claimed that cross-sex medication “has been shown to reduce the risk of depression and suicide for transgender youth,” and that “banning it creates an excruciating conflict for parents, as the steps they take to preserve their children’s lives may lead the state to investigate and punish them.” Even former White House press secretary Jen Psaki referred to such medical interventions as “medically necessary, lifesaving healthcare for [kids].”

“The danger of adolescents committing suicide if they do not receive these medical interventions is thought to be so urgent that the Biden Administration recently issued a statement “confirming the positive impact of gender affirming care on youth mental health,” while referencing “the evidence behind the positive effects of gender affirming care.” A number of states have also considered or enacted legislation making it easier for minors to access cross-sex interventions without their parents’ knowledge or consent. For example, California recently enacted a new law, AB 1184, to prevent insurance companies from notifying parents if children on their policies receive “sensitive services,” which were defined to include “gender affirming care.”

“However, young people may also experience significant and irreversible harms from such medical interventions. This Backgrounder reviews existing research on the relationship between cross-sex interventions and suicide, and then presents a new empirical analysis that examines whether easing access by adolescents to these interventions is likely to result in fewer adolescent suicides. The new analysis presented here finds that the existing literature on this topic suffers from a series of weaknesses that prevent researchers from being able to draw credible causal conclusions about a relationship between medical interventions and suicide. Using a superior research design, the new analysis finds that increasing minors’ access to cross-sex interventions is associated with a significant increase in the adolescent suicide rate. Rather than facilitating access by minors to these medical interventions without parental consent, states should be pursuing policies that strengthen parental involvement in these important decisions with life-long implications for their children.”

The full 30 minute read crafted by Jay Greene dives deeper into the context, research, and sources. For access, click the link below.