Transgender Youth and Suicidal Behavior: How Can We Mitigate Risk?
Ana Rabasco, B.A., and Peggy Andover, Ph.D., Fordham University
(originally published 7/16/2019)
In 2015, major news outlets were awash with the story of Leelah Alcorn, a transgender teenager who died by suicide at age 17. Before killing herself, Leelah wrote a compelling and public note, noting the pain caused by her parents’ and society’s rejection, and prompting national discussion on the specific risk factors for suicidal behaviors that transgender people face.
Leelah’s story is not unique. Transgender adolescents are at very high risk for suicidal ideation and behavior. Research has shown that approximately 65-75% of transgender adolescents think about suicide, and 15-30% make a suicide attempt. One large-scale survey of transgender adults from the United States found that, among those who had attempted suicide, 34% had done so by the time they were 13 years old. In contrast, the rate of suicidal ideation and behavior in the general population is far lower, with 17.2% of adolescents reporting thinking about suicide and 7.4% reporting a suicide attempt in the last year.
Transgender youth experience high rates of victimization, verbal harassment, and cyberbullying. For example, one study found that 58% of a sample of transgender adolescents reported experiencing victimization in school. We know that victimization and lack of acceptance are associated with suicidal behavior among both transgender adolescents and adults, and with suicidal ideation and suicide attempts among transgender youth. However, research has shown that even minor acts of acceptance, such as using a transgender adolescent’s chosen name and pronouns, are linked to positive outcomes, including reduced depressive symptoms, suicidal thoughts, and suicidal behavior.
Other important aspects of transgender people’s mental health, such as depression, can be improved by access to gender affirmative psychotherapy or medical interventions, although research in this area is limited. One study found that when transgender adolescents were given hormone blocker medications to suppress puberty and then provided with gender confirming medical interventions in later adolescence, their body satisfaction increased and their rates of depression decreased. Future research should explore whether hormone blocker medications that suppress puberty specifically reduce risk for suicidal ideation and behavior among transgender youth, including the effects of the intervention on gender identity and adolescent development, weighing the ethical considerations inherent in providing treatment. The Endocrine Society and the World Professional Association for Transgender Health support puberty suppression, in conjunction with comprehensive mental health care, as a safe and effective treatment for transgender adolescents.
Consensus among professional organizations, such as the American Psychological Association (APA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Association of Social Workers (NASW), has been reached that therapies aimed at changing gender identity or sexual orientation are inappropriate and, given the risk of harm, must not be used. In fact, conversion therapy has been banned in 18 US states. Although the link between conversion therapy and suicide in children has not been reported, gender identity conversion therapy has been associated with increased risk for suicidal ideation and behaviors among transgender adults.
Transgender adolescents’ mental health is damaged by victimization and non-affirmation. Conversely, when transgender adolescents are treated with respect and provided with gender-affirming interventions, their mental health improves. While the link between certain medical interventions, such as puberty suppression, and reduction of suicidal behavior requires further investigation, victimization has clearly been identified as a risk factor for suicidal thoughts and behaviors among transgender youth. Transgender and cisgender adolescents share some of the same risk factors for suicidal thoughts and behaviors, including depression and hopelessness. However, gender-based discrimination and victimization and gender dysphoria further add to transgender adolescents’ risk for suicidal thoughts and behaviors.
Reducing suicide risk among transgender youth should be a priority. This can take the form of supporting evidence-based treatment for transgender adolescents, endorsing policies that protect transgender people, and practicing transgender affirming clinical care. As research in this area grows, these are the first steps in helping to reduce the high rate of suicidal thoughts and behaviors among transgender adolescents.