Countering trans suicide figures

[Walkingtheplank]

DD asked I'd we could talk about trans issues/female rights yesterday. All very calm but ultimately we disagree on key points.

She raised the point that trans teens are more like to (try to) commit suicide.

Can anyone add a link here to a article explaining why this is not true so that I can share it with her?

Well let me help you. There are studies that measure regret relating to transition or active detransitioning. The figures range from about 1% to 3% who either regret transitioning or have detransitioned to some extent as a result of regretting their transition.

That is a regret level well below most serious medical interventions.

I think more women regret having children 😂

If you look at the limitations in those studies you will see that the 1% to 3% is only a very select sample. The majority of people who detransition are not yet caught in the research as they are not in the places and spaces where regret is being measured or tracked.

We probably need another 5 years before there are any meaningful stats on detransition. Especially since the number of young teens and youth transitioning has greatly increased in recent years and so we need to follow them for 5-10 years and see how they do over time.

We will also need to define detransition as it can refer to a social transition, a medical transition, or a surgical transition. For example it is likely that the number of youth 11-4 who socially transition and then later detransition in the next 5-10 years will be substantially higher than the number of 18+ adults who medically / surgically transition and then detransition in the following 5-10 years.

Detransition is also something right now that leads to shunning from the trans community and there can be a lot of guilt / stigma attached to it. It isn't yet something that people are all going mainstream with, although that is increasing. As the detransition community grows and there is more support for those with similar feelings and more acceptance, we will also see the stats rise as more will talk about it.

“Only 5 per cent of women and 7 per cent of men between the ages of 18 and 40 want a life without their own children, according to a survey done by the EU.” ( survey 2,455 parents in Poland) “The choice is irreversible, and has lifelong consequences,” Polish researcher Konrad Piotrowski at the University of Poznan points out in a new study
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254163

Where’s your evidence for an increase in detransition?

How high would the percentage of people detransitioning need to be, before you would think, 'the current treatment pathway needs to be reviewed, and more safeguards need to be instituted'?

Higher in a statistically meaningful way than other serious medical treatments which are not the subject of the same panic.

How about you?

So what's the number then?

What percentage will prompt you to support a review of the current pathway?

Incidentally your claim that the studies inherently exclude detransitioners isn’t true.

The US Transgender Survey includes anyone at any stage in transition, and the UK study concerned follow ups of people who had taken steps towards medical transition, and so detransitioners would have been captured (and indeed were captured at a rate of 0.47%*)

*That includes a combination of regret and active destransitioninh, and includes detransitioning due to post hoc conversion therapy, social pressure etc as well as gender identity changes.

Sorry, I am not sure what US and UK studies you are referring to. Can you link to the two studies so I can take a look at the methods.

One of the studies I looked at captured detransitioners who had sought out medical intervention to detransition - as in they wanted further medical or surigcal treatment to detransition over a fairly short time frame. Their limitations were that they were only capturing detransitioners who had attended their clinics to discuss medical / surgical options within x years of surgery. I have no idea if the 1-3% was a similar study or how they tracked people who had socially / medically transitioned and for how long to identify if they had detransitioned. And how many were lost to attrition over the course of the longitudinal study.

Thankfully Dr Cass is on the case, much more useful than people who don't fully understand them (and I'll include myself in that) trading studies online.

I will say there are a lot of factors that need to be carefully considered when looking at study design. Ones some of the most publicised studies of transgender patients have fallen foul of. I'm trying to remember which study it was, but I'm sure I remember one was published with much publicity saying transition made people happier, someone pointed out the methodological flaw, retraction was made but strangely not publicised. This one maybe: ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction

Where do the participants come from, is there bias in their selection? Are your controls really comparable to your treatment group? How long are you following up? Are patients who stay in the study and patients who are lost to follow up comparable or might that skew results? How are you measuring success? Are the cohort in the study representative of the cohort you are proposing to treat? Are you measuring objective things, or are the patients or participants' own biases likely to skew the results? Does the mere fact of conducting the study skew outcomes?

*medics or participants' biases

To quote a PP regarding the Netherlands study: 'Everyone is then matched to a person matching their sex and birth year in the Netherlands for a control.'

Is this a recognised method?

"Thankfully Dr Cass is on the case", Slightly off topic but an indication of the future of research in the UK on these experiments on children:

Cass has said "so far, nothing has changed my view that the infrastructure should be set up to prospectively enrol young people being considered for hormone treatment into a formal research programme with adequate follow up into adulthood".

There's also a programme of systematic reviews underway. She points out that "A high-quality systematic review is described as the most reliable source of evidence to guide clinical practice. The purpose of a systematic review is to deliver a meticulous summary of all the available primary research in response to specific questions"

So it looks as if finally the ability of Gendered Intelligence, Mermaids & other self interested adults to influence medical experimentation on children is coming to an end. It won't help this cohort who have been gaslit into giving up their future fertility, health, sex lives & relationships but it looks as if the needs of vulnerable children will finally become the priority.

https://cass.independent-review.uk/entry-9-learning-together/

@ChopperC110P

Thanks for linking the study again for me.

onlinelibrary.wiley.com/doi/10.1111/acps.13164

Ok. So this study

A total of 8263 adults, adolescents, and children were included, with a median age at first visit of 25 years (range 4 to 81 years) and a median follow-up time of 7.5 years (range 0.0 to 45.5 years).

“The selection of the study population is described previously “

This reference links to an article I have to pay to access so was a dead end but the abstract for that dated 2015 (The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets) tells us in 2015 there were 6,793 people (4,432 birth-assigned male, 2,361 birth-assigned female) 1972 through 2015.

So we have no idea how participants were selected for this study. We have no idea how many participants were removed from the study or why. I’ve found in other studies I’ve looked at some have 40-50% lost to follow up rates. So for example we have no idea if any of these people de transitioned and were therefore removed from the study.

The significant increase in sample size is indicative of the increase in numbers of trans people we are seeing. But it’s worth noting 1470 participants were added in the two years between studies.

This is 18% of participants of a study spanning 45 years were only added within the last two years.

Also:
“After surgery, all people were usually seen every 2 years for medical check-up.”
Looking at the end table they have recorded follow ups from 0.0-45.5 years. So anyone who commented suicide after surgery in the last 2 years are not included in these stats. Potentially 18% of this cohort have not been followed up as joined in the last two years.

“Results
Out of 5107 trans women (median age at first visit 28 years, median follow-up time 10.2 years) and 3156 trans men (median age at first visit 20 years, median follow-up time 4.8 years), 41 trans women and 8 trans men died by suicide. In trans women, suicide deaths decreased over time, while it did not change in trans men. “

Looking at the results table
“Data are shown as number or median (range).”
Median range was used for the follow up time as well.
Median is the mid point of the values looked at. So half of participant data for trans men comes from just the last 4.8 years. And half the data on trans women is from the last 10.2 years. And 18% of these people have had their follow up data taken at time of treatment because they haven’t yet been followed up.

Potentially a lot of suicide missed out of this data.

I would also argue for those with for want of a better phrase ’genuine’ lifelong disphoria ultimately surgical ‘treatment’ may be what is needed but for most socially contagious disphoria it is harmful as the scientific body of research shows most grow out of it. I would hypothesise those with gender disphoria as a result of social contagion may be more likely to commit suicide post transition. (I am aware these are people I’m talking about and it’s poor taste and I would like to stress I value them as people and don’t mean to dehumanise with these comments. I make these comments because I care about them deeply)

The median age for trans men at first visit was 20. This is incredibly young. And as this is a median age half of trans men were in fact younger than 20 when starting treatment. Median age for trans women was 28 which I would accept is old enough to make these decisions but half of them were younger. As young as 4 years old starting treatment for both genders. And I hope to god age 4 is not the start of a median range.

So to conclude. I accept the results uneasily. I’d like to see the actual data not medians. I would like to see how the suicides are spread in relation to the year a person started treatment and believe this should have been included in the results. I strongly suspect the results will change as more time passes as I believe tran people 45 years ago were very different to the cohort of trans people we have seen rise of in the last 10 years.

%But I'd say twisting facts to continue harming kids is worse than ghoulish its outright evil

So would I.

Teens include 18 and 19 years olds for which the data I linked

Yes they are teens, but also adults. How many 18/19 year old teens completed suicide in this cohort? It could have been anything from 1 upwards. You seem like you're approaching it as a semantic gotcha. Very typical.

So, if we can conclude that there is no trans child suicide epidemic, which it seems we can, the question "do you want a trans daughter or a dead son" can be recognised as the abusive, manipulative emotional blackmail as it is, I think. So no need to medicalise children when they are developing and changing and going through puberty.

Or more appropriately the line "a trans son or a dead daughter", given that girls are the largest group of "trans children".

This is such a confusing topic and also a difficult topic to research, partly, because there are so many different questions people want to have answers for.

The one the OP asks here seems to be if medical transitioning reduce suicides by transgender teens? (Is it near-future reduction we are talking about or lifetime reduction? Ideation versus completed suicides? As was pointed out on this thread earlier, women and girls have higher suicidal ideation and attempts, but men and boys complete more suicides, largely because they pick more irreversible methods)

But that, then is linked to a slightly different question, i.e., what percentage of children and teenagers who identify as transgender at some point stop identifying that way later. That group would not be helped by medical transitioning, so its size matters, and studies of measuring regret are extremely difficult to do.

Most we have are either from the era when gatekeeping was much more rigid against transitioning or use data from a source (such as gender clinics) which is likely to miss most detransitioners (who may not go back to where they transitioned). And the recent increase in teenagers transitioning may alter the rate of regret in the near future, too. Or not, but so far we don't have good studies on that, though some suggest higher regret percentages than one or two percent.

Then there are the large problems in how to find a good sampling frame (the places where individuals are contacted and asked to participate in a study, which should not be more likely to select some sub-group of people only), and good control (comparison) groups for the group we are interested in.

When a study is about the effect of medical transitioning on reducing suicides, the control group should ideally be people exactly like those who medically transition, except for that transitioning bit.

So comparing the medically transitioned to general people of the same age, sex, race etc. in the same country is not that good, given that those who transition differ in their identity, and probably in how they are treated and also often in how many mental health conditions they might have and the rates of neurodiversity and gay/Lesbian orientation.

All those other variables are linked to higher suicide rates so should be controlled for if we wish to study ONLY the effect of medical transitioning versus not.

But even trying to find people who considered transitioning and then did not would not guarantee a good control group, because the two groups differ in what they chose to do and that choice, in itself, may hide an additional unmeasured difference between them.

This is not to say that we can't get any useful information about this topic, but there will always be a debate about how to interpret it, at least until a couple of more decades have passed. Still, I would argue that we should focus on completed suicides more than on suicidal ideation in this context, given that suicidal ideation is high in many teens in general and, in particular in teen girls. (That is a separate and important problem to study, but it's separate from this one.)

Really good post, nepeta.

This originated with suzie green of mermaids. Kathleen stock calls it out as propaganda in her book. And tracks how the lie's around suicide have been used to push puberty blockers

Teaklaxon is being disingenuous (of course). We know that GIDS and other clinics have not been following up patients after surgery, so it's impossible to know how many de-transitioners there are. I don't know whether clinics in other countries such as the US are following up, but my guess would be no.

So we have to make the most of the evidence we have. One big clue is that the de-transitioners subreddit now has more than 47,000 members. If I were pushing gender medicine, I'd be pretty worried about that.

Yes, it is a standard method. Where you have a small study group, you can't sensibly subdivide it into groups by age/sex for analysis because they'd be too small, so instead people try to take into account of demographic differences by matching controls (from a large population/dataset where you have plenty to choose from) on age and sex to the study group.

As nepeta has explained, there are other factors in this case that they haven't been able to match on that may be very significant though.

It’s amazing isn’t it? TRAs want there to be lots of children trying to kill themselves. They want this to mean that they do complete suicide, even if there is no evidence of either.

They have to cling to this statistic because otherwise the real reason of “we want children to medically transition so they pass better as adults” is going to be seen as ghoulish as it actually is.