Respect Equality

‘Absurd:’ LGBTQ+ advocates, medical professionals respond to conservative study linking gender-affirming care to greater risk of youth suicide

“This wouldn’t get a passing grade in a research methods class.”
Aviana Bachmann, of Pierre, SD, protests outside the state capitol in Pierre on Saturday, January 15, 2022. (Toby Brusseau/AP Images for Human Rights Campaign)

Story at a glance

  • A new study from the Heritage Foundation, a conservative think tank, asserts that expanded access to gender-affirming health care is associated with an increased rate of suicide among transgender youth.

  • LGBTQ+ advocates and doctors have claimed the study is flawed and misleading.

  • The study is representative of a larger conservative-led push to restrict access to gender-affirming care for minors.

LGBTQ+ advocates and health care professionals are responding with outrage to a new study from the Heritage Foundation, a conservative think tank, finding that easing access to gender-affirming hormone therapy has increased suicide rates among transgender youth.

In a study published Tuesday by senior Heritage Foundation research fellow Jay Greene, it is asserted that transgender minors are more likely to attempt suicide in places where gender-affirming medical interventions like hormone therapy and puberty blockers are available “without parental consent.”

Greene’s study uses data from states where minors under certain circumstances may receive general health care without parental consent. Notably, under guidelines set by the World Professional Association of Transgender Health (WPATH) and the Endocrine Society, parental consent is required for an individual under 18 years old to receive gender-affirming medical care.

“The methodology and conclusions are absurd, which is likely why they didn’t submit it for peer review,” Jack Turban, a child and adolescent psychiatry fellow at Stanford University School of Medicine, wrote Tuesday on Twitter.

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Greene in the study challenges the conclusions of two peer-reviewed studies led by Turban, one from earlier this year and another from 2020. Both found that access to gender-affirming hormones improved mental health outcomes among transgender youth.

“The prior research on this subject is not only weak because it contains no credibly causal studies and only a handful of correlational studies, but also because those correlational studies are poorly executed,” Greene wrote in the study.

The Heritage Foundation did not immediately answer questions from Changing America.

In an interview with Fox News’ Laura Ingraham this week, Greene said other studies, including Turban’s, that examine the link between gender-affirming hormone therapy and suicidality are not accurate because they do not control for the pre-existing mental health of transgender young people who had wanted to receive gender-affirming hormones but were unable to do so.

“So really, all they’re finding is that people are thinking about suicide more if they begin with more severe mental health problems,” he said. “They’re not finding that the drugs are protective.”

But others have pointed to flaws in Greene’s own research, claiming that the absence of any analysis on gender-affirming health care itself represents a major fault in the Heritage Foundation study.

“Instead, it looks at states that let youth to visit doctors without parental consent… and somehow leaps to ‘[gender-affirming care] causes suicide,’” Erin Reed, a prominent transgender advocate, tweeted Tuesday.

“To even give this ‘research’ the respect of saying ‘this would never pass peer review’ is too much,” she wrote. “This wouldn’t get a passing grade in a research methods class.”

The Heritage Foundation study is representative of a larger conservative-led push against expanding access to gender-affirming health care, particularly for transgender and nonbinary youth.

In April, Florida’s Health Department issued new guidance stating that children younger than 18 years old should not be permitted to receive any form of gender-affirming care, pushing back on a Department of Health and Human Services (HHS) finding that gender-affirming care “improves the mental health and overall well-being of gender diverse children and adolescents.”

In Texas, Gov. Greg Abbott (R) has equated gender-affirming health care for minors to child abuse and ordered state agencies in February to open investigations into the parents of transgender and nonbinary children. Lawmakers in Alabama in April enacted a felony ban on gender-affirming medical care for transgender and nonbinary youth, arguing that such interventions harm the mental and bodily health of children.

But most mainstream research says otherwise. A 2020 peer-reviewed study published in the Journal of the American Medical Association found that suicidality dipped in U.S. states where nondiscrimination laws protect access to gender-affirming health care services, including hormone therapy.

A 2021 peer-reviewed study published by researchers at The Trevor Project, a national LGBTQ+ youth suicide prevention and crisis intervention group, found that access to gender-affirming hormone therapy was associated with lower rates of depression, thoughts of suicide and attempted suicide among transgender and nonbinary young people ages 13-24.

Earlier this year, researchers at the University of Washington in a peer-reviewed study found that receiving gender-affirming medical care like puberty blockers or hormones was associated with 60 percent lower odds of depressive symptoms and 73 percent lower odds of self-harm or suicidal thoughts in the first year alone.

Access to gender-affirming care, including hormone therapy, is supported by most major medical associations, including the American Medical Association, the American Academy of Pediatrics, WPATH and the Endocrine Society.