[temp_account_32]

Have 40% transgender people attempted suicide primarily because they are being bullied by society or because they have a mental disorder where their body doesn't match their brain and they become depressed because it is physically impossible to reconcile those differences, so they spiral into despair?

Genuine question, I just don't know how to tiptoe around this in a 2023 acceptable way without asking it bluntly.

Sounds like we need better medical treatment if half of people with the condition want to commit suicide, and telling people on the internet to stop bullying and putting colorful flags in your twitter profile won't suffice. Not advocating for hate, just saying that it seems the medical community delegated this whole thing to society with a note of 'please be nice and everything will sort itself out'.

[mrguyorama]

>Sounds like we need better medical treatment if half of people with the condition want to commit suicide

We KNOW exactly what to do and how to help trans people be happy and successful and not want to kill themselves: Preferred gender supporting care, treating them like the human beings they are, hormones for those who are confident enough to not regret it.

Here's what half the country currently votes for instead: Banning trans people from bathrooms, banning books that acknowledge the existence and acceptableness of trans people, calling trans people pedophiles and groomers on large public news channels, generally just making """jokes""" that amount to "if you are trans then you are stupid and broken and don't deserve to live"

[roughly]

Research on youth suicide rates shows an extremely high correlation with the family and social environment, in that family support and at least some welcoming spaces dramatically lower suicide rates among trans youth.

The Trevor Project collects research on these lines: https://www.thetrevorproject.org/resources/article/facts-abo...

[notch898a]

Looked at the page.

Says:

  LGBTQ youth are not inherently prone to suicide risk because of their sexual orientation or gender identity but rather placed at higher risk because of how they are mistreated and stigmatized in society.

This is a remarkable claim that demands proof. This seems to be a well thought out, researched, website therefore it can't be some oversight that they just spout this without evidence.

[malcolmgreaves]

> how they are mistreated and stigmatized in society.

You want someone to academically prove this concept to you? It is basic, as in fundamental, to human psychological safety and thus physical survival. Not everything true exists in a report.

[notch898a]

>everything true exists in a report.

Whoops, looks like I cut off part of the beginning of your sentence. That didn't change our interpretation of it now did it?

[roughly]

There's a lot of proof linked from that page. I presume you've read it all and have some specific disagreement?

[notch898a]

I'm looking for the citation for this:

  LGBTQ youth are not inherently prone to suicide risk because of their sexual orientation or gender identity but rather placed at higher risk because of how they are mistreated and stigmatized in society.

The citations show these individuals are placed at higher risk in association with mistreatment. I couldn't find the citations for the rest of the statement, including the 'rather' bit.

[roughly]

I think it’s effectively impossible to remove societal influence from the equation - in other words, we can compare between different local environments and personal histories, but there’s no trans youth in the western world that hasn’t grown up in an at least moderately hostile and othering society.

I think you may be able to do some comparative analysis based on different rates of depression & suicidal ideation among homosexual youths both over time and across different states/local environments to get a sense of the magnitude of the social effect, but it’s basically impossible to fully disentangle social effects when evaluating the mental health of trans youth when you’ve got senators and governors proposing bills decrying them as ‘less-than’.

But, let’s try an experiment: let’s keep working on society until that’s _not_ the case, and if there’s still a substantially higher incidence of trans suicide in a world in which they’re supported and have care options available to them, I’ll owe you a coke.

[za3faran]

> let’s keep working on society until ...

You can't posit that for every issue that pops up, it's not scalable at all. We have limited time on this Earth and limited resources, this is not a computer program where you can apply hypotheses in isolation and get quick results.

[GaryNumanVevo]

I think it should be a given that psychological safety is linked to suicide risk: do your own research if this seems like a stretch

https://scholar.google.com/scholar?q=psychological+safety+an...

[crote]

The medical community didn't delegate it to society.

Transitioning is an effective and proven treatment, which has a far higher rate of success than basically any other psychiatry-related treatment. The medical part is pretty much solved, and those physical differences can be reconciled quite well.

But as it turns out, the hate from society still remains, and it still has an effect. Turns out being happy is a bit tricky when it is literally a coin flip whether the person you are talking to believes you should be murdered merely for existing.

[harvey9]

Here's a paper which suggests that the medical part might not be solved

https://journals.plos.org/plosone/article?id=10.1371/journal...

"Conclusions

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."

[crote]

That paper doesn't state what you think it does.

If you read the Discussion, you'd see that this study actually contrasts other similar studies, which saw no such outcome. It even explicitly states that the overall mortality rate was only significantly increased for the group operated before 1989, and mentions that

> However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.

This study is often used in an attempt to discredit transgender healthcare. In fact, it is used so often that there is even an interview[0] with the author about its misrepresentation. The interview links half a dozen other studies done since then which confirm that transgender healthcare does indeed work, and is in fact quite effective.

[0]: https://www.transadvocate.com/fact-check-study-shows-transit...

[mftrhu]

No. Here's a paper which is frequently misquoted by people failing to read its open-access text in its entirety, and relying on third-parties often creative interpretations of it. It has been discussed by its author - Cecilia Dhejne - multiple times over the last decade, notably during her Reddit AMA https://thewinnower.com/papers/7252-science-ama-series-i-m-c...

> Thank you for your question and I am happy I was invited to AMA.

> I am aware of some of the misinterpretation of the study in Plos One. Some are as you say difficult to keep track since they are not published in scientific journals. I am grateful to friends all over the world who notify me of publications outside the scientific world. I do answer some of them but I can’t answer all.

> I have no good recommendation what to do. I have said many times that the study is not design to evaluate the outcome of medical transition. It DOES NOT say that medical transition causes people to commit suicide. However it does say that people who have transition are more vulnerable and that we need to improve care. I am happy about that it has also been seen that way and in those cases help to secure more resources to transgender health care.

> On a personal level I can get both angry and sad of the misinterpretations and also sometimes astonished that some researcher don’t seem to understand some basics about research methology.

[roughly]

How do those rates compare to people who were not allowed the reassignment?

"Trans people have a higher rate of suicide than the general populace even after reassignment" isn't disproving either the 'innate' or the 'societally-driven' risk model here.

[notch898a]

It would be false equivalence for me to suggest this is a suitable analogue, but it is interesting to note certain amputees are able to perform more or less completely normally from a social perspective in daily life (and possible even excel in sports etc) yet they can still suffer from phantom limb syndrome and have increased risk of suicide, anxiety etc.

There is clearly a significant social aspect here but I'm not willing to toss out that the body may just really not enjoy not being naturally in the expected configuration. Going to the gender you want seems to be partially solved but, like the person with the lost limb, it's doubtful we have anything close to a full substitute. I really worry the medical community has been doing a dis-service to the development of treatment by underplaying the suicidal aspects that may be less socially related.

[crote]

One thing to keep in mind is that the opposite is happening here.

With transgender people, the "original" state is unnatural. Medical treatment fixes this mismatch by making the body match the brain. It is a voluntary treatment with an extremely high success rate and negligible regret rates.

As far as I can tell, there is zero evidence that any remaining issues are caused by the treatment itself. All evidence points that the remaining issues are primarily socially related.

[f154hfds]

What did transgender people do before the treatments and therapies? How did they live in their original state all their lives without our medical interventions? Do we know that the treatments help in the sense that treated people commit suicide less than untreated people before the treatments were available?

[mftrhu]

> What did transgender people do before the treatments and therapies? How did they live in their original state all their lives without our medical interventions?

What did diabetics do before treatment and therapies? People with asthma, myopia, or really any other health issue? What does it matter?

> Do we know that the treatments help in the sense that treated people commit suicide less than untreated people before the treatments were available?

Why do we need to know that? What's the point of it? We don't evaluate effectiveness of any treatment by comparing current data with likely non-existent, pre-treatment (read: more than a century old, in this case) data.

[f154hfds]

My statement above is asking how to test whether the treatments are contributing to a social contagion effect. If they are, we can't test treatment vs. no treatment at a snapshot in time because the very existence of the treatment adds to the contagion effect which in turn produces suicides in treated individuals! To make sure social contagion is not the bigger factor we want to look at how these disorders manifested prior to the existence of the treatment and compare that to the effect of the treatment now.

[somsak2]

The treatments I'm familiar with, especially those that are assisted by prescription drugs, are quite new and unsupported. it's hard to find any studies of this stuff at all. the amount we know about efficacy here is shockingly low.

if you have references, I'd welcome them.

[crote]

https://pubmed.ncbi.nlm.nih.gov/24344788/ https://link.springer.com/article/10.1007/s10508-009-9551-1 https://mayoclinic.pure.elsevier.com/en/publications/hormona... https://link.springer.com/article/10.1007/s10508-014-0453-5 https://www.researchgate.net/publication/23553588_Long-term_... http://europepmc.org/article/med/25690443 https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2265.... https://pubmed.ncbi.nlm.nih.gov/29463477/

If by "quite new and unsupported" you mean "pioneered in the 1920s, well-established for many decades, backed by dozends of studies, and successfully applied to hundreds of thousands of patients worldwide", then yes - it is indeed quite new and unsupported.

If you want to read just one study, why not start with the last one? The Amsterdam Cohort consists of 6,793 people since 1972. That should be plenty to start with.

If you want even more, I recommend reading the "Standards of Care for the Health of Transgender and Gender Diverse People". Currently in its eighth edition, it describes the entire process, with hundreds of additional studies cited.

[mftrhu]

> The treatments I'm familiar with, especially those that are assisted by prescription drugs, are quite new and unsupported

The treatments you are familiar with have been around since the thirties. Research on them started with the Institut fur Sexualwillenschaft, which has been since burned down, and hundreds of papers have been published on the topic since, dealing with thousands of patients all over the world, with their findings all being remarkably consistent.

How hard have you actually looked into it?

[mensetmanusman]

The horror stories from detransitioners prove that the medical part is not ‘pretty much solved’. Unclear why such disinformation spreads so much.

[lilacat]

Proper medical care has been shown to improve the mental health of trans people, but the social isolation is still a major factor. Trans people can undergo medical transition to better align their bodies to their sense of self, but they often end up losing friends and family in the process, and face discrimination when it comes to finding work or housing, or simply just existing in the world. Not to mention many places currently have laws, or are pushing new laws, to limit trans individuals' access to things like medical care and other necessities.

[freejazz]

>Have 40% transgender people attempted suicide primarily because they are being bullied by society or because they have a mental disorder where their body doesn't match their brain and they become depressed because it is physically impossible to reconcile those differences, so they spiral into despair?

What's the difference when so many US states are now prohibiting treatement for this?

[teaearlgraycold]

> because it is physically impossible to reconcile those differences

Impossible to reconcile when they’re blocked from effective treatment. In a decent society trans people would be given treatment when asked for.

[xcxs]

> Have 40% transgender people attempted suicide

They haven't. This is an invented statistic that just gets repeated and repeated until people accept it as if it's truth.

[harambae]

Yeah "Blocked and Reported" Episode 149 (Jan 28, 2023) debunks this stat over a good 10 or 15 minutes for anyone that cares.

The flaw was in how the survey was conducted. I won't try to repeat it here- it's a long explanation to do justice.

[superjan]

Edit: never mind this comment, but can’t delete anymore. Don’t remember where I heard this.

If your brain does not get exposed to the ‘right’ set of hormones at the right time while you’re in the womb, your brain can develop a different gender identity than the rest of your body. This can be the explanation for some trans people, but I don’t know how many.

[vehemenz]

What does it mean to suggest the brain has a "different gender identity?" Surely we are not reverting back to mind/body dualism?

[xcxs]

This is just a hypothesis, there's no evidence for this.

[etchalon]

People were making the "they're committing suicide because their brain is wrong so we need to fix their brain" argument about homosexuality back in the 90s.

Research has pretty firmly come down on the "nah, it's society." side of things.

[daveslash]

If I understood temp_account_32's point correctly, the comment about the mental health was not "they're trans, therefore their brains _must_ be wired wrong", so much as it was "before they transition, they're often so distraught over their identity and who they see in the mirror, that it often causes despair and depression".

I agree with you that research has pretty firmly come down on the side of "nah, it's society" for the former. I think the latter is a fair point. To pin it all on society I find to be disingenuous. Transitioning can be a healthy thing in that case. Disclaimer: am not trans, so I openly admit I may be totally ignorant and off base.

[etchalon]

It's not all society's fault, but research has shown that the distress and depression of being outside societal defaults is greatly lessened when support is available and acceptance wide spread.

[daveslash]

Yes. Completely agree. To suggest that it's all society's fault is disingenuous. To suggest that society is fault-free is reckless and cruel, and society's part is not a small piece of the pie either. Society needs to step up to address the societal aspect of the issue as part of a multi-pronged approach.

[mensetmanusman]

It’s also impossible to decouple mental health from your surroundings, i.e. society etc.

[mensetmanusman]

It’s mental disorder issue, but mental health is so stigmatized that it’s phobic to suggest someone needs mental health help. It’s analogous to helping someone walk off a bridge and feeling like a hero for helping someone.

[notch898a]

Transgender is no longer classified as a mental disorder. Any attempt to have a discussion on this, I've found, has to overcome this semantics. If there is no disorder in the individual, obviously society is fully to blame.

https://nicic.gov/being-transgender-no-longer-mental-disorde...