Does gender-affirming care in children reduce the rate of suicide?

Gender-Affirming Care and Suicide Risk in Transgender and Nonbinary Youth

Gender-affirming care is associated with significantly lower rates of depression and suicidality in transgender and nonbinary youth, with recent research showing 60% lower odds of depression and 73% lower odds of suicidality among those receiving puberty blockers or gender-affirming hormones. 1

Evidence on Mental Health Outcomes

Impact on Suicide Risk

Gender-affirming medical interventions demonstrate clear benefits for transgender and nonbinary (TNB) youth mental health:

• A 2022 prospective observational study found that youth receiving puberty blockers (PBs) or gender-affirming hormones (GAHs) had 73% lower odds of suicidality compared to those who had not received these interventions over a 12-month period 1
• The 2020 Trevor Project study showed that gender-affirming hormone therapy (GAHT) was associated with lower odds of:
  • Recent depression (adjusted odds ratio = 0.73)
  • Seriously considering suicide (adjusted odds ratio = 0.74)
  • Past-year suicide attempts in youth under 18 (adjusted odds ratio = 0.62) 2

Depression and Anxiety Outcomes

Gender-affirming care also shows benefits for other mental health outcomes:

• Youth receiving gender-affirming medical interventions showed 60% lower odds of depression after adjustment for temporal trends and potential confounders 1
• Studies demonstrate "large improvements in body dissatisfaction" and "small to moderate improvements in depressive symptoms" following gender-affirming hormone therapy 3
• Baseline mental health metrics from the Trans Youth Care Network Study revealed concerning rates of depression (51.3%), anxiety (57.3%), and lifetime suicidal ideation (66.6%) among transgender youth seeking gender-affirming hormone therapy, highlighting the need for intervention 4

Timing of Intervention

The timing of gender-affirming care appears critical:

• Later presentation to gender-affirming medical care is associated with worse mental health outcomes
• Youth presenting at later pubertal stages (Tanner 4-5) showed significantly higher rates of:
  • Depressive disorders (odds ratio 5.49)
  • Anxiety disorders (odds ratio 4.18) 5
• Earlier access to gender-affirming treatment correlates with better psychosocial functioning, with youth receiving puberty blockers at younger ages showing better mental health metrics than those seeking hormonal treatment later 4

Risk Factors and Vulnerabilities

Transgender and nonbinary youth face multiple risk factors for suicidality:

• Members of the LGBTQIA2S+ community experience increased risk for mental health struggles due to discrimination, marginalization, bullying, and loneliness 6
• Unlike other minority groups, sexual and gender minorities are often stigmatized by their own families of origin, leading to additional stressors 6
• Parental support is crucial, with nearly 80% of youth receiving gender-affirming hormone therapy reporting at least one supportive parent 2

Clinical Implications

When working with transgender and nonbinary youth:

• Use affirming language that mirrors patients' language about their identities, relationships, pronouns, and bodies 6
• Take a curious stance with open-ended, clarifying questions rather than making assumptions 6
• Validate the unique strengths of LGBTQIA2S+ people and affirm healthy expressions of gender 6
• Address cognitions arising from minority stress, including beliefs of personal failure, inferiority, or expectations of rejection 6

Assessment of Suicide Risk

For all youth, including transgender and nonbinary individuals:

• Assess for depression, anxiety, substance use, and other risk factors for suicidality
• Pay particular attention to older adolescents (16-19 years) with mental disorders, especially when complicated by comorbid substance abuse, irritability, agitation, or psychosis 6
• Consider prior suicide attempts, methods used, and current desire to die as important risk factors 6

Conclusion

The evidence strongly supports that gender-affirming care reduces suicide risk and improves mental health outcomes in transgender and nonbinary youth. Early intervention appears particularly beneficial, with studies consistently showing lower rates of depression, anxiety, and suicidality among those receiving appropriate gender-affirming medical care.