An analysis of studies finds that contrary to the claims of the Biden administration and establishment media, lowering legal barriers to make it easier for minors to undergo cross-sex medical interventions without parental consent does not reduce suicide rates.
In fact, there are higher rates of suicide among young people in states that allow the “sex-reassignment” measures, contends Jay P. Greene, a senior research fellow in the Heritage Foundation’s Center for Education Policy.
He argues that studies finding that “gender-affirming” interventions prevent suicide fail to show a causal relationship and have been poorly executed, employing methods that prevent researchers from being able to draw credible causal conclusions about a relationship between medical interventions and suicide.
“Only a small number of studies make comparisons to a control group –and those studies employ correlational research designs that do not allow causal conclusions, nor have those correlational studies been conducted properly,” he argues.
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The effects of puberty blockers and cross-sex hormones “as a medical intervention for adolescents who identify as transgender,” he writes, “have never been subjected to a large-scale randomized controlled trial (RCT), like the kind that is typically required for approval of new medications.”
Former White House press secretary Jen Psaki has called medical interventions for youth identifying as transgender “medically necessary, life-saving health care for” children. And the Biden administration issued a statement “confirming the positive impact of gender affirming care on youth mental health,” citing “the evidence behind the positive effects of gender affirming care.”
But even the World Professional Association for Transgender Health acknowledges that puberty blockers and other interventions can have significant complications, Greene points out. WPATH, nevertheless, maintains that delaying intervention also has serious risks, including prolonging gender dysphoria and “contributing to an appearance that could provoke abuse and stigmatization.”
Greene’s analysis, in contrast to studies cited by advocates, “reviews existing research on the relationship between cross-sex interventions and suicide, and then presents a new empirical analysis that examines whether easing access by adolescents to these interventions is likely to result in fewer adolescent suicides.”
He urges states to adopt a parental bills of rights affirming they have primary responsibility for their children’s education and health.
School officials and health professionals, he says, should obtain permission from parents before administering health services. That includes medication and “gender-affirming” counseling to children under 18.
And states, he insists, should also tighten the criteria for receiving cross-sex treatments, including raising the minimum eligibility age.
He also argues that the treatments used for “sex reassignment” originally were developed for other purposes. Puberty blockers were designed to delay puberty among very young children who began puberty well before their peers. Sex hormones were to treat people unable to produce enough of the hormones of their biological sex.
“The fact that randomized experiments were not required for this use of puberty blockers and sex hormones, and that this novel use of these drugs is relatively recent, means that only a handful of studies examine their effects, and all these studies use inferior correlational research designs,” he writes.
Greene’s analysis “exploits this natural policy experiment to compare suicide rates over time among those ages 12 to 23 in states that have a provision allowing minors to access health care without parental consent relative to states that have no such provision.”
He obtained annual suicide rates by age and state between 1999 and 2020 from the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention.
Greene then used a statistical model to predict the suicide rate among those ages 12 to 23 in each state between 1999 and 2020.
To control for the possibility of the influence of cultural, religious or other state-specific factors, his model controls for average suicide rates in the targeted age group in each state at baseline. And his model includes an indicator variable for each year between 1999 and 2020 to control for any year-specific national changes in suicide rates. Further, because there may be correlations between the suicide rates within each state across the years examined, the model clusters the standard error estimates by state.
He found that in the past several years, “the suicide rate among those ages 12 to 23 has become significantly higher in states that have a provision that allows minors to receive routine health care without parental consent than in states without such a provision.”
“Before 2010, these two groups of states did not differ in their youth suicide rates. Starting in 2010, when puberty blockers and cross-sex hormones became widely available, elevated suicide rates in states where minors can more easily access those medical interventions became observable.”
The pattern, he concludes, “indicates that easier access by minors to cross-sex medical interventions without parental consent is associated with higher risk of suicide.”
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