Does Medical Transitioning Lower the Risk of Suicide? 

“Would you rather have a live son or a dead daughter?” 

This is the choice that gender ideology advocates often give to parents with a gender dysphoric child. It’s a bit ironic that they reject the gender binary but phrase this as a stark binary choice. They claim that because children and adolescents who identify as transgender are far more likely to contemplate, attempt, and commit suicide, the only way to save them from suicide is medical transition and full acceptance by everyone as the opposite sex. 

That’s the claim. But what’s the evidence? 

Almost every study indicates that kids who identify as transgender are more likely to contemplate, attempt, and commit suicide. Bauer et al. document that 22-43% of people who identity as transgender in Canada, Europe, and the United States have attempted suicide; 35% of Ontarians who identify as transgender had seriously considered suicide and 11% had actually attempted suicide in the past year alone.¹ Considering that only 3.7% of all Canadians had ever seriously considered suicide and only 0.6% had attempted suicide in the past year, Ontarians who identify as transgender were 9.5 times more likely to seriously consider suicide and 18 times more likely to attempt suicide than the average Canadian in the past year.  

Would you rather have a live son or a dead daughter? 

Few studies examining the outcomes of medical transition take a longitudinal approach, which would mean collecting information over a long period of time rather than just shortly after transition. Dhejne et al. is the best study in this regard, studying 324 people who underwent a surgical transition between 1973-2003 and following their outcomes for up to 30 years.² Overall mortality (e.g. the risk of dying from any cause) was statistically the same for the first 10 years after transition for people who underwent a surgical transition compared to a control group from the transgender population. But the mortality rate among those who had surgically transitioned significantly increased after 10 years. Those who had surgically transitioned were 2.9 times more likely to die from any cause, 19 times more likely to die by suicide, and 7.6 times more likely to consider suicide compared to the general population. 

Many advocates and scholars explain this risk of suicidality through minority stress theory. This theory posits that stigma, prejudice, and discrimination against people experiencing gender dysphoria create a hostile and stressful social environment that causes them to consider suicide. However, Bränström et al. conclude that minority stress is a relatively minor factor behind these poor outcomes, finding that only 13-15% of suicidal ideation and attempts are attributable to minority stress.³  

Little attention has been paid to the possibility that gender dysphoria itself (and any comorbid conditions) directly contributes to suicidality. If our gender is determined by our biology rather than by our feelings, then it would be unsurprising that these correlations or even causations exist. Medical and surgical transitioning won’t fix these problems. If anything, they are likely to make them worse in the long-term. 

Medical and surgical transitioning won’t fix these problems. If anything, they are likely to make them worse in the long-term. 

And that’s what some studies show. 

Even though people who identify as transgender are at a much higher risk of suicide than the general population, medical transitioning does not lower this risk. Dallas et al. analyzed the outcomes of Californians who underwent a surgical transition (a vaginoplasty for males attempting to become females and a phalloplasty for females attempting to become males) from 2012-2018.⁴ Among those who had a phalloplasty, the rate of suicide attempts did not change after the procedure, even though the phalloplasty was supposed to affirm their new gender identity and decrease their risk of suicide. For those who had a vaginoplasty, the suicide rate doubled after surgery. 

Many studies claim that medical transitioning reduces suicidality, suicide attempts, and suicide death. But virtually all of these studies suffer from the same methodological weaknesses: observational analyses (rather than randomized trials), short-term time frames, small sample sizes, high non-response or drop-out rates, and the presence of confounding variables (rather than clear causal links), all of which make them low-quality studies. 

This conclusion was affirmed in a recent systematic review, The Impact of Gender-affirming Surgeries on Suicide-Related Outcomes, by Marques et al. in 2023.⁵ Systematic reviews are some of the most valuable academic sources because they find and assess all of the academic studies on a topic. Marques et al. found 11 studies on the impact of medical transitioning on suicidality. They found “a wide scope of results” and concluded that “GAS’ [gender-affirming surgeries] influence on suicide deaths cannot be drawn due to the low quantity and quality of evidence.” 

Furthermore, a Finnish study published this year by Ruuska et al. corrected many problems with earlier studies (e.g. had matched controls, long-term data, a large sample size, a full response rate, and analyzed confounding variables) found that the increased risk of suicide among young people referred to a gender identity clinic disappeared once psychiatric treatment was accounted for.⁶ In other words, the high rate of suicide among young people with gender dysphoria was due to other psychiatric conditions, not gender dysphoria. 

The claim that medical transitioning is necessary to prevent suicide is not supported by high quality evidence.

In summary, the claim that medical transitioning is necessary to prevent suicide is not supported by high quality evidence. While people suffering from gender dysphoria may be at a higher risk of suicide than the average person, it is likely that other mental health conditions, not the gender dysphoria per se, are causing this suicidality. 

Instead of medical transitioning, kids need mental health supports. In other words, children identifying as transgender need the help of loving parents and patient counsellors to live healthy and happy lives in the bodies they were born with.  

1. Greta R. Bauer et al., “Intervenable Factors Associated with Suicide Risk in Transgender Persons: A Respondent Driven Sampling Study in Ontario, Canada,” BMC Public Health 15, no. 1 (June 2, 2015): 525, https://doi.org/10.1186/s12889-015-1867-2. ↩︎
2. Cecilia Dhejne et al., “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLOS ONE 6, no. 2 (February 22, 2011): e16885, https://doi.org/10.1371/journal.pone.0016885. ↩︎
3. Richard Bränström et al., “Transgender-Based Disparities in Suicidality: A Population-Based Study of Key Predictions from Four Theoretical Models,” Suicide and Life-Threatening Behavior 52, no. 3 (2022): 401–12, https://doi.org/10.1111/sltb.12830.5. ↩︎
4. Kai Dallas et al., “Mp04-20 Rates of Psychiatric Emergencies before and after Gender Affirming Surgery,” Journal of Urology 206, no. Supplement 3 (September 2021): e74–75, https://doi.org/10.1097/JU.0000000000001971.20.  ↩︎
5. Inês Rafael Marques et al., “The Impact of Gender-Affirming Surgeries on Suicide-Related Outcomes: A Systematic Review,” Journal of Psychosexual Health 5, no. 3 (July 1, 2023): 134–44, https://doi.org/10.1177/26318318231189836. ↩︎
6. Sami-Matti Ruuska et al., “All-Cause and Suicide Mortalities among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study,” BMJ Ment Health 27, no. 1 (January 1, 2024), https://doi.org/10.1136/bmjment-2023-300940. ↩︎