Author’s note: If you are thinking about hurting yourself or ending your life, please reach out and get help. We want you to stay alive. National Suicide Hotline: 1 (800) 273-8255; National Crisis Textline: Text “GO” to 741-741; Trans Lifeline: 877-565-8860; Trevor Helpline for LGBT Youth: 1-866-7386.

I have seen a growing number of people citing statistics about increased suicide risk as evidence that therapists/psychologists/counselors/society should not support trans people’s identities and transitions. Gina Loudon told Fox News that those who supported trans people’s right to transition were “science deniers,” claiming that research has found that trans people’s suicide risk increases 20-fold when they transition (spoiler: that statistic is inaccurate). Michael Cook recently penned a blog post titled “What do the statistics say about transgender mental health?”, in which he concluded that the idea that trans people’s psychological stress will be relieved through transitioning is pure deception that runs counter to the evidence. Heath Lambert, professor of biblical counseling who counsels trans people to avoid transition, defends his position by stating that trans people who have transitioned still have higher rates than the general population.

I’ll be clear: Trans people do have increased suicide risk. Across all demographics, if a person is transgender they are more likely to seriously consider and attempt suicide.1 The research, however, just flat out does not support the above views that this increased risk is due to some instability associated with undergoing a gender transition. I propose we take a thorough look at the statistics and the science on trans suicide, so we can get a grasp on what we do know about trans people’s suicide risk. Below are 8 consistent findings from the literature on trans suicide.

1. Rejection and lack of support increase risk of suicidality.

Researchers who conducted the National Transgender Discrimination Survey found that trans people who were rejected by their families were twice as likely to have attempted suicide as trans people who were not rejected.1 Studies have also found that the less social support a transgender person experiences and the more lonely they feel, the more likely they are to seriously consider suicide.2 Family and peer acceptance and support, on the other hand, have been found to be associated with decreases in suicidality, depression and anxiety.3,6 This fits with Dr. Thomas Joiner’s evidence-based Interpersonal Theory of Suicide, which suggests that suicidality emerges when people simultaneously feel that they are a burden to others and lack a sense of belonging.

2. Suicide risk increases when trans people experience discrimination.

Discrimination greatly contributes to suicide risk.4 For example, in one study, trans people who had lost a job for being trans were more than 50% more likely to have attempted suicide than trans people who had not experienced employment discrimination.1 This actually extends to the policy level and general political climate, too. A study published this year in Behavioral Medicine found that trans people have increased suicide risk if they live in states that lack legal protections for LGBT people.5

3. Trans people who experience shame about being trans or about their bodies are more likely to be suicidal.

Trans people may internalize the negative messages about trans people that are perpetuated by media, society, and bigots. They are internalized as negative beliefs about transgender people or negative gender-related beliefs about themselves, and are often experienced as shame about being transgender. This is called internalized transphobia. A piece of this can also be the shame that some trans people feel about the way their body looks and/or is perceived by others. Research has found that both of these experiences (internalized transphobia and body shame) are associated with increased suicide risk.5,6,7

4. Trans people who are easily identifiable as trans are at greater risk of attempting suicide.

Research shows that suicide risk increases as a trans person’s visibility increases. That is, when a trans person is consistently open about being trans or is regularly perceived as trans by others, they are more likely to seriously consider or attempt suicide. This increase is due in part to increased experiences of gender-related discrimination, harassment, and violence.1,8 This likely also explains the mixed findings about medical transitions and suicide risk.

5. Undergoing an affirming medical transition does not make trans people more suicidal. In fact, it reduces suicide risk.

This is a big one. A lot of people who argue against supporting/affirming a person’s transition try to make the case that transitioning makes trans people more suicidal. They often cite a thoroughly debunked study from the 1970s or a gross misrepresentation of recent research. This argument might also come from a misunderstanding of a more recent study, which found that transgender people who have had some form of gender affirmation surgery were slightly more likely to have attempted suicide in their lives than those who who had not (43% vs. 39%). This difference was more pronounced when looking at people who had taken any medical transition steps (e.g., hormone replacement therapy).1 This doesn’t mean trans people who have transitioned are more likely to attempt suicide than trans people who don’t transition - it means they are more likely to have attempted at one point in their life. These are very different statements, and the former is not supported by other research. The only published longitudinal studies which have reliably measured mental health of transgender people before transitioning and again after beginning that transition found that medical transitions significantly reduce psychological distress.9 A recent study out of Canada further clarified these findings by evaluating differences in current suicidal thinking and past-year suicide attempts at various stages of transition. Trans people who were on hormones were half as likely to have seriously considered suicide in the past year. Trans people who reported that their medical transition was complete were 62% less likely to have seriously considered suicide. They were also significantly less likely to have recently attempted suicide. Of trans people who had seriously considered suicide in the past year, those who said they were in the process of transitioning were more likely to have attempted suicide than those who had completed a transition and those who wanted to transition but hadn’t started.6 The finding that trans people who are seriously considering suicide may experience an increased risk of attempting when they are “in the process of” a medical transition is not surprising. It is a safe assumption that this increase in risk is due to initial increases in visibility (e.g., coming out, being more visibly non-conforming) that, in the beginning, offset the reduction of psychological distress transition has been found to have. So in sum, existing evidence overwhelmingly shows that medical transitions, when desired, are linked to improved mental health and suicide risk reduction, though the difficulties of beginning a transition may increase suicidality of those already considering suicide. It is important to also note that despite the reduction in risk, trans people who have transitioned are still at greater risk of attempting suicide than non-transgender people.10 The rest of this post should help explain why the risk persists.

6. Trans people who survive trans-related violence and abuse are substantially more likely to attempt suicide.

Transgender people who have experienced verbal, physical, or sexual abuse/assault due to their transgender identity or gender expression are substantially more likely to have attempted suicide. The more frequent/regular this abuse was, the more likely a transgender person was to have attempted suicide. Additionally, higher rates of transgender-related abuse/violence were linked with a greater number of suicide attempts, suggesting what researchers call a “dose-redose” effect: the more a person experiences transgender-related abuse/violence, the more chronic and severe their suicidality appears to be.4,7,11,12 An unfortunately, these studies and others also show that it is not uncommon for trans people to experience harassment, physical assault, and/or sexual assault due to bias. For example, 35% of trans people reported being physically assaulted in school for being trans or gender non-conforming. That percentage was higher for trans people of color and trans people who were visibly identifiable as trans or gender non-conforming.8

7. Trans people are more likely to experience general risk factors for suicide.

The experiences and characteristics that make anyone more likely to be suicidal also make trans people more likely to have seriously considered or attempted suicide. These include, but are not limited to: youth, alcohol and substance abuse, trauma, homelessness, lower education levels, depression, and severe mental health issues.3,4,5,13 Unfortunately, research suggests that (besides age), trans people are more likely than the general population to experience these risk factors.1

8. Intersecting identities matter.

Belonging to other minority and/or sitgmatized groups increases trans people’s risk of seriously considering and attempting suicide. For example, studies consistently show that trans people of color have higher rates of suicide attempts than white trans people. Trans people with HIV and/or disabilitites are also at increased risk, as are low-income and homeless trans people.5,8

Edited on 11/2/2015 to include suicide prevention / crisis resources.

References

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force. http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf
Yadegarfard, M., Meinhold-Bergmann, M. E., & Ho, R. (2014). Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among Thai male-to-female transgender adolescents. Journal of LGBT Youth, 11, 347-363. doi: 10.1080/19361653.2014.910483
Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Counseling and Clinical Psychology, 81, 545-567.
Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons. Journal of Homosexuality, 51, 53-69. doi: 10.1300/J082v51n03_04
Perez-Brumer, A., Hatzenbuehler, M. L., Oldenburg, C. E., & Bockting, W. (2015). Individual- and structural-level risk factors for suicide attempts among transgender adults. Behavioral Medicine, 41, 164-171. doi: 10.1080/08964289.2015.1028322
Bauer, G. R., Scheim. A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15. doi: 10.1186/s12889-015-1867-2
Grossman, A. H., & D'Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behaviors, 37, 527-537. doi: 10.1521/suli.2007.37.5.527
Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide attempts among transgender and gender non-conforming adults: Findings of the National Transgender Discrimination Survey. Report published by American Foundation for Suicide Prevention and The Williams Insititute.
Keo-Meier, C. L., Herman, L. I., Reisner, S. L., Pardo, S. T., Sharp, C., & Babcock, J. C. (2015). Testosterone treatment and MMPI-2 improvement in transgender men: A prospective controlled study. Journal of Consulting and Clinical Psychology, 83, 143-156. doi: 10.1037/a0037599
Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Langstrom, N., & Landen, M. (2011). Long-term follow-up for transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLOS One. doi: 10.1371/journal.pone.0016885
Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., & Beck, J. (2010). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. The Journal of Sex Research, 47, 12-23. doi: 10.1080/00224490903062258
Goldblum, P., Testa, R. J., Hendricks, M. L., Bradford, J., & Bongar, B. (2012). The relationship between gender-based victimization and suicide attempts in transgender people. Professional Psychology: Research and Practice, 43, 468-475, doi: 10.1037/a0029605
Testa, R. J., Sciacca, L. M., Wang, F., Hendricks, M. L., Goldblum, P., Bradford, J., & Bongar, B. (2012). Effects of violence on transgender people. Professional Psychology: Research and Practice, 43, 452-459. doi: 10.1037/a0029604