A study on child and adolescent mental health carried out by researchers at Tampere University’s Faculty of Medicine and Health Technology, Finland says gender affirming treatments do not have a positive impact on levels of suicidality and suicidal ideation among patients with gender dysphoria.
The authors of the study, which was published in the British Medical Journal, note that it is their understanding that no previous study “has examined all-cause and suicide mortalities of gender-referred adolescents compared with matched controls nor while controlling for psychiatric morbidity.”
The findings of the study challenge the belief that it is better to start gender reassignment earlier in life – and the assertion that those who are unable to access gender reassignment treatments are more likely to take their own lives.
The study was conducted over three decades with subjects from across Finland between 1996-2019 where 2,083 gender referred patients under the age of 23 were studied against a group of 16,643 matched controls.
Cox regression models with HRs and 95% CIs were used to analyse all-cause and suicide mortalities.
Of the 55 deaths which occurred among the study population – 20 of which were suicides – the study says all-cause mortality “did not statistically significantly differ between gender-referred individuals and controls; however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%; p=0.004).”
The all-cause mortality of gender-referred adolescents “did not statistically significantly differ from that of matched population controls” the study said noting that suicide mortality “first appeared to be much higher among gender-referred participants; however, the association was fully explained by psychiatric treatment history.”
“All-cause and suicide mortalities did not differ between those gender referred who had and had not proceeded to GR [gender reassignment] when psychiatric treatment history was accounted for.” it said
“In the gender-referred group, 0.3% died by suicide a figure which the study says is “significantly lower” than the previously reported figures for suicidal ideation and self-harm among adolescents with gender dysphoria.
The study says suicide mortality among young people seeking gender reassignment is rare pointing to the youth of the study population when the median age was 18.5 years.
The authors noted that issues such as substance abuse which may contribute to mortality in gender dysphoric adolescents in other countries were “rare” in Finland.
“Most importantly, when psychiatric treatment needs, sex, birth year and differences in follow-up times were accounted for, the suicide mortality of both those who proceeded and did not proceed to GR did not statistically significantly differ from that of controls.”
The study says that these findings do not support the claims that gender reassignment is necessary in order to prevent suicide saying that gender reassignment “has also not been shown to reduce even suicidal ideation” noting that suicidal ideation is “not equal” to actual suicide risk.
The study says that while there is a belief that starting gender affirming treatments as early as possible will lead to better bodily outcomes than when initiated in adulthood, and with positive psychosocial outcomes such as reduced depression, self-harm and suicidality the evidence base for these benefits is “weak”.
In addition to this the study said that “participants diagnosed as transsexual in adulthood who had undergone both hormonal and surgical GR displayed increased suicide mortality compared with matched population controls”
However it said that when psychiatric treatment history is considered, gender dysphoria “significant enough to result in contact with specialised gender identity services during adolescence does not appear to be predictive of all-cause or suicide mortality.”
“Psychiatric morbidities are also common in this population. Therefore, the risk of suicide related to transgender identity and/or GD per se may have been overestimated.” it says.
The authors say that the first observed difference between the gender-referred group and matched controls in suicide mortality “levelled out when psychiatric treatment was considered.”
They continued that the novel contribution of the study “is showing that suicide mortality associates with increased psychiatric needs; this is an important finding if we consider the failure of previous studies on mortality among patients with GD to account for psychiatric morbidities.” it said.
The study says that in light of these findings, experiencing gender dysphoria “significant enough” to seek gender reassignment “appears to not be associated with increased suicide mortality, but suicides appear to be explained by psychiatric morbidities.”