Laws and conversion therapy threaten trans youth

Chase Strangio, an attorney and transgender rights activist, delivers remarks during the "Trans Youth Prom" outside of the US Capitol building on May 22, 2023 in Washington, DC. Trans and non-binary youth gathered to hold a prom-like event that included music, dancing, and speeches. After the prom, the kids and their families marched to the US Supreme Court Building. (Credit: Anna Moneymaker/Getty Images)

More states are banning gender-affirming care for minors and conversion therapy is still legal in much of the country. New studies show why that’s a deadly combination.

The recent tidal wave of anti-trans state legislation, coupled with a harmful practice that’s still legal in much of the country, could have dire consequences for many of the nation’s 300,000 transgender adolescents.

Three new studies add to the mounting evidence that banning gender-affirming care for minors and allowing parents to force their children into conversion therapy could lead to more suicide attempts. In addition, the legislation causes ambient harm by emboldening transphobic people and causing many trans youth and young adults to become more anxious, depressed, and withdrawn.

The studies find:

  • Gender-affirming hormone therapy reduces the suicide risk for trans youth by 14%, yet many states are racing to make it illegal for minors.
  • Forcing trans youth into conversion therapy raises their suicide risk by 55% and raises their risk of running away by 128%.
  • In a survey, 22% of trans youth and young adults report they’ve experienced more discrimination since the anti-trans legislation began making news.

Access to hormones

Gender-affirming hormone therapy uses estrogen or testosterone to align a person’s physical appearance with their gender identity. It’s been shown to reduce gender dysphoria and improve mental and physical health.

The new study in American Economic Association Papers and Proceedings finds that it also lowers the risk of suicide in transgender youth.

“Parents who subject their children to conversion therapy are inflicting serious harm.”

Analyzing thousands of datapoints from the 2015 US Transgender Survey, the researchers discovered that gender-affirming hormone therapy is linked to a 14% reduction in the risk of trans youth attempting suicide. The effect is largest when therapy is started at ages 14 or 15.

Despite its benefits, hormone therapy is inaccessible to a growing number of transgender adolescents and teens. Twenty states have enacted bans on gender-affirming care for minors, nearly all of them this year, and similar legislation is pending in at least eight other states.

“State lawmakers and governors have enormous power to lower the suicide risk for some of their most vulnerable constituents,” says professor Yana Rodgers, a gender studies expert at Rutgers University. “Unfortunately, many states are raising the risk by choosing ideology over evidence.”

Conversion therapy dangers

Conversion therapy is a pseudoscientific practice that seeks to change a person’s sexual orientation or gender identity. Leading medical and mental health organizations have warned that it’s harmful and ineffective.

Travis Campbell of Southern Oregon University and Rodgers analyzed data from the 2015 US Transgender Survey to examine how conversion therapy affects trans youth. Their study in the Journal of Health Economics reveals that it increases the risk of attempting suicide by 55% and increases the risk of running away from home by 128%.

The effects are largest in people who began conversion therapy between ages 11 and 14. Strikingly, the danger progressively worsens in the five years after first exposure. This reflects intensifying gender dysphoria and the stress of living in a hostile environment.

“Parents who subject their children to conversion therapy are inflicting serious harm,” Rodgers says. “The detrimental effects appear immediately and they accumulate over time.”

Twenty-one states, the District of Columbia, and more than 100 municipalities have banned conversion therapy for minors, and five states have enacted partial bans, but it remains legal in the rest of the country.

Hostile climate

The bans on gender-affirming care and the continued legality of conversion therapy add to an already hostile climate for transgender people.

“I just hate seeing how much people hate me for existing.”

Assistant professor Lindsay Dhanani of Rutgers University and Rebecca Totton of Amherst College surveyed 113 transgender youth and young adults living in 27 states and the District of Columbia to ask what it’s like seeing anti-trans legislation on the news, and how it feels when family, friends, and others in their circle express their support for those new bills and laws.

Their study, published in Sexuality Research and Social Policy, reveals that many respondents are dealing with more negative thoughts and emotions, more discrimination, a reluctance to seek medical care, and heightened fears of disclosing their gender identity.

Importantly, they feel the sting of anti-trans legislation in other states, not just their own, including bills introduced but not yet enacted. This suggests that the mere existence of the bill, and the anti-trans rhetoric behind it, causes harm.

“The indirect harm of this legislation is insidious,” says Dhanani. “Seeing these stories on the news, seeing them pop up on social media, can have a chilling effect on someone who’s already struggling with gender dysphoria and other challenges. It’s an affront to their sense of self.”

The survey reveals:

  • 39% say losing access to gender-affirming care would harm their mental health. One survey respondent wrote, “If i didn’t have it I quite literally would be dead right now. I attempted suicide many many times before I got care. Not once since.” Another wrote, “I would kill myself without gender affirming care, it’s the only thing worth living for: the potential that some day I might be able to be myself.”
  • 31% feel anxious, depressed, and stressed-out after seeing news coverage of anti-trans legislation. One person wrote, “I have been feeling hopeless about my future as a result of this.” Another wrote, “I just hate seeing how much people hate me for existing.”
  • 22% say they’ve experienced more discrimination and harassment by family members, strangers, or both. One participant wrote, “Yes, they have been more hateful and more willing to use harmful language (insults, misgendering, slurs).” Another wrote, “People feel more comfortable being disrespectful towards me.”
  • 15% hesitate to seek medical treatment of any kind, not just gender-affirming care, for fear of discrimination by health care practitioners. This finding suggests the legislation could worsen existing health inequities.
  • 10% worry about losing their coverage. One participant began taking low-dose testosterone sooner than they would have liked for fear of eventually losing access.
  • 4.5% are actively avoiding other people or concealing their identity. One person wrote, “I hide underneath hoodies so people are less likely to know I am trans.”
  • Many survey respondents reported the anti-trans legislation does not affect them directly because they already face barriers to gender-affirming care, such as affordability and fear of telling their family. But the indirect harm still resonates.

Source: Rutgers University