Do puberty blockers or other forms of gender-affirming care reduce suicide risk in transgender youth?

Findings that support a protective effect

A frequently-cited U.S. study of 20,619 transgender adults in the 2015 U.S. Transgender Survey compared respondents who wanted pubertal suppression in adolescence with those who both wanted and received it. • Receipt of puberty blockers was associated with significantly lower odds of lifetime suicidal ideation (aOR 0.3) and of ever attempting suicide (aOR 0.3) when compared with those who wanted the treatment but did not get it [1].

Critiques and alternative interpretations

Journalist Jesse Singal reviewed the same paper and later correspondence among the authors and critics. He notes:

The dataset is retrospective and relies on adult recollection of childhood medical history and suicidality; therefore causality cannot be inferred [2]. Confounders such as family support, socioeconomic status, or co-occurring mental-health conditions may explain part of the difference; these variables were either imperfectly controlled or not available [2].

According to Singal, an earlier, preregistered analysis showed no statistically significant reduction in suicide attempts; this version was reportedly removed during peer review [2].

Where the debate stands

Supporters of the original study argue that, despite limitations, it provides the strongest empirical evidence available to date that timely access to puberty suppression may confer mental-health benefits. Critics counter that methodological weaknesses, post-hoc analytic changes, and the reliance on self-report attenuate confidence in the reported effect and leave open the possibility that other factors drive the association.

Summary

The best-known quantitative study reports a strong association between puberty blockers and reduced lifetime suicidality [1]. However, that finding has been questioned on methodological grounds [2]. Therefore, while evidence suggests a potential protective effect, the magnitude—and even the existence—of that effect remains contested in the literature and in public discourse.

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Sources

Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation – Pediatrics (2020 peer-reviewed research article)
Researchers Found Puberty Blockers and Hormones Didn’t Improve Trans Kids’ Mental Health at Their Clinic—Then They Published a Study Claiming the Opposite – Singal-Minded (Substack) (2022 investigative commentary)

Question

Does gender affirming care lower youth suicide risk?