No, High Suicide Rates Do Not Demonstrate That Transgender People Are Mentally Ill

Leelah Alcorn, a transgender teen who committed suicide in 2014 after experience family rejection. CREDIT: LEELAH ALCORN
Leelah Alcorn, a transgender teen who committed suicide in 2014 after experience family rejection. CREDIT: LEELAH ALCORN

To her credit, Caitlyn Jenner has escalated the public conversations on transgender identities, but as conservatives push back on the momentum for trans equality and safety, one myth keeps bubbling to the surface. Conservatives are constantly reminding their audiences that transgender people have a higher rate of suicide and suicide attempts than the general population. This, they imply, is evidence that transgender people are inherently mentally ill and their identities should not be affirmed.

Dr. Paul McHugh, one of the only medical professionals conservatives can ever find to support their anti-trans views, makes this point regularly. Walt Heyer, opponents’ “ex-transgender” poster child, makes this point regularly, as do his compatriots at The Federalist. A recent story in the New York Times about a transgender teen prompted the National Review and the Family Research Council to also reinforce the suicide rate meme. If transgender people are so susceptible to suicide, they all argue, then the best response is to reject transgender identities.

But none of the studies that demonstrate the high suicide rates among transgender people actually prove the point conservatives are trying to make. They actually all indicate that people who are transgender feel ostracized for their identity; their high suicide rates reflect rejection, discrimination, violence, harassment, and the negative life circumstances that result from such treatment.

For example, one study that has been cited frequently is a Swedish study from 2011. It found that people who had actually undergone sex reassignment surgery were 19 times more times likely to die by suicide. Opponents of trans equality have used this stat to suggest that no trans person should undergo such surgeries, fueling the myths about “transition regret.” But the study did not compare trans people who had gotten surgery to trans people who had not gotten surgery — it compared them to the general population of Sweden, people who are not transgender. Thus, none of its conclusions actually support the claim that there are consequences to transitioning. Furthermore, the mortality rate was only statistically significant for people who had surgery before 1989; for those who had their surgery between 1989 and 2003, the increased mortality for transgender people was not statistically significant.

It is true that the Swedish study found mental health concerns for transgender people, but it didn’t actually determine explanations as to why. One telling finding, however, is that suicide attempt rates were higher than the general population for transgender women (people who had been assigned “male” at birth), but not for transgender men (people who had been assigned “female” at birth), whose attempt rate remained consistent with the rates for presumably cisgender females in the general population. Given transgender women are more likely to be profiled and targeted for discrimination, this suggests that the suicide attempt rate is not connected to the transgender identity itself, but to how people are treated for being transgender — a conclusion born out by other studies.

One of the biggest studies on the experiences of transgender people was the 2011 National Transgender Discrimination Survey (NTDS). It found that in the U.S., 41 percent of transgender and gender non-conforming people had attempted suicide, compared to a national average of just 4.6 percent. When all of the data were analyzed, however, researchers found a number of factors that significantly influenced whether a person was more likely to attempt suicide: being a person of color, experiencing poverty, being unemployed, achieving less education, being out or more easily perceived as transgender, experiencing housing discrimination or especially homelessness, experiencing harassment or especially physical or sexual assault, being rejected by family, or facing discrimination in health care. In other words, the more forms of discrimination transgender people experienced, the more likely they were to attempt suicide.

A brand new study from Canada confirms this effect. There, the suicide attempt rate for transgender people was similar to what other studies have found: about 18 times higher than the general population. But the study found that some factors greatly reduced the attempt rate. For example, when transgender people had affirming parents, the rate dropped by 57 percent. Access to legal documentation consistent with their gender identity dropped rates by 44 percent. Trans people who experienced low levels of anti-trans hate were 66 percent less likely to attempt suicide. And perhaps most importantly, the further along individuals were in their transitions — i.e. the closer they were to having a body and outward identity that matched their internal gender identity — the less likely they were to attempt suicide.

There is significant evidence to suggest that transgender identities have a biological origin, and there is already consensus among medical professionals that the best way to support transgender people is to affirm their gender identities. Despite conservatives’ attempts to portray transgender people as mentally ill, it has already been several years since “gender dysphoria” was declassified as a mental disorder.

The NTDS will soon be conducted again. Now under the name of the U.S. Trans Survey (USTS), the study will be able to show what progress transgender people are making over time. As public understanding increases, it will likely show that the suicide and suicide attempt rates in the transgender community decline in turn.

But as the 2011 numbers show, the disparities are vast and the resistance to transgender equality is severe. Hopefully, opponents of equality who claim to be concerned about transgender suicide rates realize that they have the cart and the horse mixed up — that it’s actually their rejection of transgender identities that contributes to these negative outcomes.