Thread by @benryanwriter

No, Youth Gender-Transition Treatment Is Not 'Life Saving', Study Finds
The first ever study to test the widely made claim that youth medical gender-transition treatment prevents suicide deaths found no such evidence, I report for @NYPost. 🧵⬇️ nypost.com/2024/02/24/opi…

The movement backing gender-transition treatment for kids is built on the claim that it's “life saving.” Groups that claim this: @ACLU @GLAAD @HRC @WPATH @AmerAcadPeds @AmerMedicalAssn. But no one's tried to figure out whether this claim is true. Until now

A major new Finnish study found: Cross-sex hormones and gender-transition surgeries for adolescents and young adults had no significant independent link to suicide deaths, nor did gender distress severe enough to send young people to a gender clinic. mentalhealth.bmj.com/content/27/1/e…

What was independently tied to a greater chance of suicide in adolescents and young adults with gender-related distress? A high number of appointments with mental-health specialists--meaning, severe mental health challenges. nypost.com/2024/02/24/opi…

The Finnish researchers concluded:
▶️Suicide deaths were about 4 times higher, but still rare, in gender-distressed young people.
▶️Their higher suicide rate was tied to their much higher rate of severe psychiatric problems, not to their gender distress. nypost.com/2024/02/24/opi…

What gender-distressed young people need most urgently, the Finnish study authors concluded, is comprehensive mental health care – and not necessarily controversial medical interventions. nypost.com/2024/02/24/opi…

This study gets to the heart of a fierce debate: Whether trans-identified youths’ high rate of mental health problems is mostly caused by stigma against trans people. Or whether, as many skeptics argue, at least some young people might identify as trans as a way of dealing with mental health issues that aren’t driven by gender identity. nypost.com/2024/02/24/opi…

Erica Anderson, former head of @USPATH1, a @WPATH division, frowned upon a reportedly common question gender clinics ask of on-the-fence parents: “Would you rather have a living son or dead daughter?” “It is most unethical to say that kind of thing to parents,” said Dr. Riittakerttu Kaltiala, leader of the new study, and top adolescent psychiatrist at Finland’s Tampere University Hospital. “It’s not based on facts.” @eanderh @kaltial nypost.com/2024/02/24/opi…

@PaulGarciaRyan, president of @TherapyFirstOrg, which calls for counseling as the priority treatment for youth gender distress, pointed to guidelines that say journalists and doctors shouldn’t oversimplify suicide or say it’s an expected response to any one factor. Doing so, he said, might actually cause “or worsen suicidal thoughts in vulnerable young people.” Garcia-Ryan, who is himself a detransitioner, having previously identified and lived as a trans woman, was a major part of Pamela Paul’s recent @NYTimes @NYTOpinion article on gender transition treatment:
nytimes.com/2024/02/02/opi…
nypost.com/2024/02/24/opi…

How the researchers conducted their analysis:
They relied on Finland’s comprehensive health database, which has lifetime health records, and death records, on everyone in the nation (population 5.5M) and thus no loss to follow-up unless people left the country.

The researchers examined records on all 2,083 people who had their first visit to either of the nation’s two gender clinics at age 22 or younger—at 18 on average and as young as eight—from 1996 to 2019.

These researchers put together a comparison group of nearly 17,000 Finns. This included eight people (4 males and 4 females) for each gender-distressed person, matched to their age and birthplace.

There was an average of nearly 7 years of health information on each person, through June 2022.

38% (796 people) of the gender-distressed youths went on cross-sex hormones or received gender-transition surgeries. Many started this treatment before age 18, Dr. Kaltiala told me for my reporting for @NYPost. (That detail is not in the paper.)

There were 55 deaths. 20 were suicides, including 7, or 0.3 percent, of the gender-distressed youths and 0.1 percent of the comparison group.

This translated to a suicide death rate of 51 per 100,000 cumulative years of follow-up in the gender-distressed group and 12 per 100,000 in the controls. This meant that before the data were adjusted for confounding variables, the gender-distressed youths had about a 4.25-fold higher suicide rate than the comparison group. This difference is similar to the 5.5-fold higher suicide rate among gender-distressed youths found in a recent analysis of attendees of England’s youth gender clinic. (See: )

Both these studies concluded that suicide deaths, while higher in gender-distressed young people, are nevertheless rare in this population. This stands in contrast to widespread alarming claims that such young people have an extremely high suicide rate. These claims appear unfounded. However, this population does have a high rate of suicidal thoughts and behaviors, which are genuinely miserable and harrowing experiences, as my sources were eager to emphasize.

After adjusting for age, biological sex, and the number of specialist psychiatric appointments, the study authors found no statistically significant independent difference in the suicide death rate between the gender-distressed youths and the matched controls based on: 1) Whether they received gender-transition treatment; or 2) The fact that they had gender distress severe enough to send them to a gender clinic. ncbi.nlm.nih.gov/pmc/articles/P…
nypost.com/2024/02/24/opi…

It remains possible that if the Finnish overall follow-up time had been longer and/or the study population had been larger, the study authors could have detected an independent, statistically significant difference in the suicide death rate based on whether adolescents and young adults received gender-transition treatment. But the fact that the authors could not do so even with the quite large data set at hand speaks to how rare suicide deaths were.

It also speaks to what Dr. Marci Bowers, president of WPATH told me: That suicide deaths are not a good metric of success for prescribing cross-sex hormones to young people who identify as transgender. Dr. Bowers said the evidence is, nevertheless, overwhelming that this treatment improves kids’ mental health. nypost.com/2024/02/24/opi…

The rarity of suicides in this Finnish study stands in direct conflict with the oft-repeated question that gender clinics pose of on-the-fence parents: “Would you rather have a live son or a dead daughter?” According to this study, this mantra falsely suggests that suicide is extremely likely, and imminently so, absent gender-transition treatment for young people with gender dysphoria.

Many people I interviewed characterized this question as egregiously coercive and deeply unfair to say to worried parents. Some version of it was allegedly posed of the parents of the person who is suing the @AmerAcadPeds and the author of the AAP’s 2018 policy statement on pediatric gender-transition treatment. I covered that case for the @NewYorkSun:
nysun.com/article/lawsui…

Of all the orgs that have claimed gender-transition treatment is “life saving” and that I contacted for comment for this @NYPost article, @WPATH was the only respondent. No response from: @ACLU @GLAAD @HRC @WPATH@AmerAcadPeds @AmerMedicalAssn. nypost.com/2024/02/24/opi…

In recent years, multiple teams of researchers have systematically reviewed the available studies about gender-transition medicine for kids. They all found the science to be of low quality and uncertain. Accordingly, multiple European nations have moved to restrict minors’ access to gender-transition treatment, including Finland in 2020. By the late 2010s, Finland had already started sharply dialing back access to puberty blockers and cross-sex hormones for minors after Dr. Kaltiala’s analyses strongly suggested such treatment was not helping the young people’s often severe mental health problems. nypost.com/2024/02/24/opi…

Dr. Kaltiala recently came out against pediatric gender-transition treatment in @bariweiss’ @thepf:
‘Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It.’
thefp.com/p/gender-affir…

A 2023 Finnish study by the same team found that providing gender transition treatment was not associated with a subsequent reduction in the rate of psychatric specialist appointments, suggesting that the treatment did not improve mental health. cambridge.org/core/journals/…

Other major figures in the pediatric gender care field who have called gender-transition treatment for youths “life saving” and who did not respond to my requests for comment for my @NYPost article finding that this claim is not supported by evidence include: @Stanford’s Diana Tordoff and @UCSF, psychiatrist @Jack_Turban, the leaders of 2 papers oftenpointed to as evidence that this treatment lowers suicidality, but which have been denounced by skeptics as flawed.
Sources:

Tordoff et al:

Turban et al:

@JesseSingal’s criticism of Tordoff:

@NYPost article on new Finnish study: jamanetwork.com/journals/jaman…
publications.aap.org/pediatrics/art…
jessesingal.substack.com/p/researchers-…
nypost.com/2024/02/24/opi…

Also not responding to my requests for comment was Diane Chen, a Lurie Children’s Hospital in Chicago psychologist, who led a two-year study that gave hormone treatment to 315 youths and saw two suicides—a very high suicide rate among people *on* gender-transition treatment. nejm.org/doi/full/10.10…

Here is the new Finnish study:
All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study
mentalhealth.bmj.com/content/27/1/e…

nypost.com/2024/02/24/opi…

@GLAAD, for one, has claimed that the “science is settled” regarding the benefits of gender-transition treatment for minors. But the science is complex and ever-evolving. The Finnish study contradicts GLAAD's claims that such treatment is "life saving."

https://twitter.com/benryanwriter/status/1758196058348257338?s=20

The Finnish study was first presented at the @SEGM_EBM conference in New York City in October. I wrote about it then: benryan.substack.com/p/youth-gender…