The 41% trans suicide attempt rate: A tale of flawed data and lazy journalists

If there is one constant in reports about transgender people, it’s the prevalence of suicidal intent.  Nearly all media accounts cite an average 41% suicide attempt rate. A Google keyword search for “transgender 41% suicide” results in over 43,000 hits.

Often, the attempted suicide rate is presented in the context of a story about a young person desperately needing to medically “transition” to the opposite sex. Caitlyn Jenner mentioned the 41% when accepting the ESPY courage award last month, and gender specialists like Johanna Olson routinely bring up suicide as a rationale for hormone and surgical treatments.

In every one of the stories I’ve read, the unspoken or explicit assumption is that transition cures suicidality.

A parent reading one of these stories will be terrified. The very notion that a child might attempt suicide is the worst possible nightmare a mother or father could imagine. The message being hammered  over and over again is that we can only save our young people by supporting their transition to the opposite sex, no questions asked, if that’s what they say they want.  Period. End of discussion. (I have personally been accused of contributing to the risk of youth suicide, simply by raising the questions I do in my blogs.)

So where does this 41% figure come from?

Many media accounts don’t cite the source of the 41% number, but this one does: an analysis released in January 2014 by The Williams Institute, in collaboration with the American Foundation for Suicide Prevention. The report, Suicide Attempts Among Transgender and Gender Non-Conforming Adults, drew its data from a 2008 U.S. National Transgender Discrimination Survey of 6456 self-identified transgender and gender non-conforming adults (ages 18+). Of these, 2566 (40%) were biological females at birth. (As always, natal females will be the main focus of my post.)

A suicide attempt rate of 41% is an emergency. Surely the Williams Institute analysis is conclusive enough to warrant the burgeoning number of gender clinics hurrying to diagnose and start “transitioning” young people who identify as transgender? Does the data convincingly show that gender dysphoria is alleviated by “passing” as the opposite gender, and that medical transition lowers suicide rates?

It does no such thing.

The authors of the study were well aware of its limitations, as I’ll show in this post. But you don’t have to take my word for it: read the AFSP/Williams Institute analysis yourself. It’s written in accessible language and is only 18 pages long, much of which is summarized in easy-to-understand tables. This material could be absorbed by even an average journalist, who presumably is paid to be at least marginally interested in the actual findings of the survey. Even a part-time, unpaid, obscure blogger like me can digest it in under an hour.

But it seems the actual “reporters”—even the ones who cite the source of the 41% figure–don’t analyze the report beyond such generalities as: The results are staggering..disturbing…alarming…

Yes, they are. A 41% lifetime suicide attempt rate is horrific, especially when compared to a 4.7% suicide rate for the US population as a whole, and a 10-20% rate for lesbian, gay, bisexual people (these numbers are according to the authors of the survey). What, exactly, does the survey tell us about attempted suicide in the gender nonconforming (GNC) and trans community?  What is causing this high rate of suicidality?  As with most things, the devil is in the details.

I will not attempt to cover all aspects of the Williams Institute analysis in this post, but will highlight a few of the more interesting nuggets of information I gleaned;  in particular, weaknesses and findings that have not been addressed in other accounts I’ve read.

  • The authors note that the survey was flawed because only one binary, Yes/No question was asked: “Have you ever attempted suicide?” More careful and rigorous studies always follow up with in-person interviews, and when self-harming behaviors (not intended to end life) are controlled for, the actual suicide attempt rate is typically halved—meaning the suicide attempt rate could be as low as 20%.
  • The highest suicide attempt rate of all–60+%–was GNC and trans people who self-report a mental disability. No big surprise there; it’s well known that having certain mental conditions is a risk factor for suicidality. But by the authors’ own admission, the survey made no effort to ask for further details about these mental health issues. The status of having a mental condition was self reported, with no corroboration from medical records or a provider. Nor was there any attempt to discover whether the actual rate of mental illness was objectively higher (via diagnosis by a mental health provider) than reported by the subjects.
  • People who had either sought or received transition-related services had a higher suicide attempt rate than people who have not. And the survey did not ask whether suicide attempts occurred before or after services were sought or received.
  • The data suggest that natal females seem not to be helped at all, in terms of self harm, by being either “stealth” trans or passing as male.  (This is the opposite finding from that of natal males.)

Right from the get-go on page 3, under Methods and Limitations, the authors acknowledge the fundamental flaws in the survey. They urge caution in interpreting their findings:

First, the…questionnaire included only a single item about suicidal behavior that asked, “Have you ever attempted suicide?” with dichotomized responses of Yes/No. Researchers have found that using this question alone in surveys can inflate the percentage of affirmative responses, since some respondents may use it to communicate self-harm behavior that is not a “suicide attempt,” such as seriously considering suicide, planning for suicide, or engaging in self-harm behavior without the intent to die …The National Comorbity Survey, a nationally representative survey, found that probing for intent to die through in-person interviews reduced the prevalence of lifetime suicide attempts from 4.6 percent to 2.7 percent of the adult sample … Without such probes, we were unable to determine the extent to which the 41 percent of NTDS participants who reported ever attempting suicide may overestimate the actual prevalence of attempts … In addition, the analysis was limited due to a lack of follow-up questions asked of respondents who reported having attempted suicide about such things as age and transgender/gender non-conforming status at the time of the attempt.

We could stop right here and say the survey’s main data point–the 41%–is worthless. If, in general population studies, it has been shown that, without followup questions, the rate of actual suicide attempts could be artificially inflated to nearly double, the real rate for GNC/trans people could be closer to 20%. In addition, the authors point out that, without some sense of when the self harm took place, there is no way to determine whether identifying as gender nonconforming or transgender was the key factor in the self-harming behavior.

But let’s not stop there. Even if the rate is closer to 20%, that is still unacceptably high. And self harm is a huge problem, whether the actual intent to end one’s life is present or not.

Second, the survey did not directly explore mental health status and history, which have been identified as important risk factors for both attempted and completed suicide in the general population. Further, research has shown that the impact of adverse life events, such as being attacked or raped, is most severe among people with co-existing mood, anxiety and other mental disordersThe lack of systematic mental health information in the NTDS data significantly limited our ability to identify the pathways to suicidal behavior among the respondents.

In other words, the survey is seriously flawed because there is no reliable information about the actual mental health status of the participants; and, since mental health problems are a known self-harm risk, there is no way to accurately figure out whether the suicide attempt rate is as high as it is due to co-occurring mental illness–not necessarily because of  “gender dysphoria.” Further, another high risk factor for suicidality is being physically or sexually assaulted, especially for people with mental health disorders.

So the authors tell us two things: the 41% figure should be interpreted with great caution; and the causes of the elevated self harm/suicide attempt rate (whatever that rate actually is)–the “pathways”–cannot be reliably determined.

Williams Table 12

What about people who have contemplated or received medical transition services? The survey tabulated everything from transition-related counseling to bottom surgery:

Respondents who said they had received transition related health care or wanted to have it someday were more likely to report having attempted suicide than those who said they did not want it. This pattern was observed across all transition-related services and procedures that were explored in the NTDS.

Williams Inst suicide table 5

People who said they “did not want” these services had a lower self-harm rate. Does medical transition, or seeking transition services, decrease or increase suicide attempt rates? We don’t know, because the survey didn’t ask respondents if the self harm occurred before or after such services were soughtas the authors note:

The survey did not provide information about the timing of reported suicide attempts in relation to receiving transition-related health care, which precluded investigation of transition-related explanations for these patterns.

This is very important: I have most often seen the 41% rate mentioned, with no caveats or analysis, to justify young people receiving medical transition services. It’s clear from the authors’ own words that this survey cannot be responsibly used as a basis for the presumption that medical transition reduces self harming behaviors over the lifespan.

And now to one of the more interesting findings in the Williams Institute report:  natal females (in contrast to natal males) who say other people generally don’t recognize them as trans or GNC have the same or higher suicide attempt rate as females who are more often recognized by others.

Williams Table 7

Trans men (FTM) were found to have the same prevalence of lifetime suicide attempts (46%) regardless of whether they thought others can tell they are transgender. … for respondents in the last two gender identity categories – female-assigned cross-dressers and gender non-conforming/genderqueer people assigned female at birth – the prevalence of lifetime suicide attempts was found to be higher among those who said other people “occasionally” or “never” can tell they are transgender or gender non-conforming, compared to those who said that other people “always,” “most of the time,” or “sometimes” can tell. 

And later–buried  in the Executive Summary, we find this:

Importantly, our analyses suggest that the protective effect of non-recognition is especially significant for those on the trans feminine spectrum. For people on the trans masculine spectrum, however, our data suggest that this protective effect may not exist or, in some cases, may work in the opposite direction.

What does it mean to “not be recognized” as transgender or gender nonconforming? It could be one of two things: these natal females “pass” as male, or they are secretly gender nonconforming, perhaps cross dressing at home, in private. But in either case, being stealth or passing doesn’t seem to alleviate the urge to self harm.

I am going to guess that, for at least some of the natal females who answered this survey question, they did interpret  “people can’t tell”  to mean that they usually “pass” as male.  So for at least some of these females,  being perceived as male didn’t help them.  And FTMs, by all accounts, “pass” better than MTFs. Why wouldn’t passing relieve the distress for these female-born people? What is causing the misery in girls and women who are GNC or trans-identified?

If self harm risk remains elevated for many young women, whether they “pass” or not, wouldn’t a more compassionate and prudent approach be to help them–and their families–accept themselves as females who simply don’t fit societal gender norms? Many of these girls, prior to transition, live a lesbian lifestyle (even if they reject the label “lesbian”). How much kinder would it be to help them embrace the only bodies they will ever have, with the sexual preference they have, instead of endorsing extreme interventions that may never resolve their dysphoria?

Elsewhere in the survey, we learn that lack or loss of family support is a big factor in self-harm risk. This seems like a no-brainer. But support for what? Accepting a loved one’s gender expression or identity is not the same as getting on board with hormones and surgery. In fact, by encouraging the idea that they must medically transition (which entails lifelong and sometimes painful interventions) to be happy, might family and gender specialists even be increasing the risk of self harm?

It’s obvious that teens who are gender nonconforming are bullied and rejected because they don’t fit into the stereotypical boy or girl box–however they subjectively identify.  And like all kids, they just want to be accepted. Listen to Ash Haffner, the 16-year-old from Charlotte, North Carolina who died (as Joshua/Leelah Alcorn did) by bolting in front of a moving vehicle in February 2015, writing this days before her death:

if I die…I don’t want to be remembered as the faggot gay girl with all the scars on her arm. unfortunately thats who I am to alot of people. if those people would have just stayed silent and kept their ignorant thoughts in their heads then maybe i wouldn’t have those scars on my arm. maybe. it wasn’t always about what they had in their heads, it was what was inside of mine to. i just didn’t understand why i felt the way i did when i had a decent life. i may have come from a broken family but i always had a roof over my head and a loving mother who fully accepted me for who i was and never stopped trying. she was the only person who never gave up hope on me. but anyway, i don’t want to be remembered as the girl with problems, just remember me as someone who understood and stayed strong for as long as i could.”

Ash’s mother, who, according to media accounts, accepted her child as whatever gender Ash preferred, said:

“She was trying to figure out her identity,” Quick said. “She felt like a boy trapped in a girl’s body. She was caught somewhat in between. People weren’t really giving her the time to figure herself out. … All she wanted was for people to just accept her. Ash started enduring the most bullying when she cut her hair short.”

Ash’s “gender nonconformity”–her short hair, for crying out loud–is what caused the increase in bullying. Isn’t our challenge, as parents, as therapists, as a society, to  support our young people when they step outside stereotyped gender norms? To allow a girl to have a crew cut or wear boxer shorts? For a boy to wear a dress if he wants?

The Williams Institute analysis raises many more questions than it answers. It seems clear that being–or, more precisely, identifying as–some flavor of gender nonconforming or trans is correlated with a high rate of self harming behaviors. Mental health problems, coupled with a history of physical and/or sexual abuse or trauma, are associated with the highest risk of self harm. But judging by the evidence, gender specialists don’t seem to be taking those key risk factors into account when prescribing “transition” as an answer.

Whether the majority of these individuals who have self-harmed will ultimately benefit from medical transition is unknown (and for young people, this will not be known for years, if not decades), but there is absolutely nothing in the Williams survey analysis to indicate that medical transition will decrease suicidal intent or self harm.

In the words of the survey authors themselves:

Well-designed studies that specifically engage the transgender community will continue to be needed to identify and illuminate the health and mental health needs of transgender people, including access to appropriate health care services.

How about including the following things in “appropriate health services” for gender dysphoric young women?

  • family therapy aimed at helping parents and young women come to terms with being “gender nonconforming” women
  • evaluation and therapy for underlying mental health issues apart from gender dysphoria
  • strong female role models for girls and young women that don’t entail conforming to porn star chic
  • support for and acceptance of lesbian identity– especially for girls who don’t look like the gender-conforming, makeup-wearing “lesbians” on the “L” Word

Given the flawed data available to us, the leap in logic to assume the only viable choice is to medically transition or die ought to shame any provider, researcher, or journalist worth their salt. The Williams Institute data, if looked at honestly, should instead spur providers to offer effective psychological health evaluation and treatment for both young people and their families, and the least invasive intervention possible.



78 thoughts on “The 41% trans suicide attempt rate: A tale of flawed data and lazy journalists

      • You know, the same lazy journalists will be the same ones claiming that Trans Inc. should have known all along—once the lawsuits and investigations get rolling. They’ll point to exactly this sort of info and demand to know how this could have all happened. The fact that they themselves have mindlessly repeated the “41%” stat will conveniently disappear down the memory hole.

        What’s most offensive to me is that the study very clearly cannot connect ANY feelings of self-harm to “gender dysphoria” to the exclusion of any other reason. Yet, that is exactly what they do. My personal belief is that the compulsion to transition is not a mental illness in itself, but a symptom of an underlying condition which is still unidentified and poorly understood.

        Liked by 4 people

  1. Brilliant post, and so true. There is, as you point out, a cultural conformity about how to be a lesbian too – for example I look nothing like the L-Word stars (they’ve all got a hell of a lot more hair than me, for a start). The amount of men I used to know who watched that show far outnumbered the amount of lesbian women. There was an, er, obvious reason for this.

    When we stop, as a society, teaching small girls that their highest value should be being attractive to men, a lot of this fuckery will stop.

    Liked by 7 people

    • Yep. And the only “gender nonconforming” (I am getting SO sick of typing that word) lesbian on the “L” Word ended up transitioning! Some of the plot lines were believable, but you never, ever could suspend disbelief to buy that they were lesbians…just no.

      Liked by 4 people

      • Yes! And “Glee” was the same way, and was watched by so many teens and young adults. Despite having such diverse characters including many underdog-types one might find in high school, the only two lesbian characters on Glee were a couple of slutty, Playboy-hot, nymphomaniac cheerleaders. So frustrating.

        Liked by 4 people

      • I agree with you. I have begun saying and writing “sex-role non-compliant,“ instead.

        This term solves several problems. First, “sex-role“ makes it more clear what we’re talking about. Second, the phrase, “non-conforming“ implies that conforming to “gender,“ or sex roles, is something we *should* be doing or aspiring to. It exposes the genderist conviction that sex roles are biologically innate, rather than being the product of patriarchal socialization, and (contradictorily) a rightful imperative. (I say “contradictorily“ because if sex roles are innate, there would be no imperative for anyone to conform to them.)

        “Non-compliant“ implies a person exhibiting difference, or for some, critical thinking and independence from societal sex-role pressures. For feminists, sex-role non-compliance is a personal and political act of liberation: something we strive for in a variety of ways.

        Liked by 1 person

      • “Non-compliant“ implies a person exhibiting difference, or for some, critical thinking and independence from societal sex-role pressures. For feminists, sex-role non-compliance is a personal and political act of liberation: something we strive for in a variety of ways.

        According to the draft consultation document recently put out by Stonewall, the UK’s best-known LGBT pressure group, failure (from whatever reason) to conform to sex roles means you are ‘trans’, regardless of whether or not you ‘identify’ as such:

        ‘Within this document we use the term ‘Trans’ in its most all-encompassing form, to include any person whose gender identity *and/or gender expression* does not conform to conventional ideas of male or female gender, or the sex they were assigned at birth.’ [My emphasis]

        Liked by 1 person

    • The “L-Word” is a sell-out show full of “lesbians” who are more feminine than most heterosexual women I know and who are willing to have sex with a guy to get pregnant. (Hence why I use the quotes.) Willingly playing around with semen and getting pregnant is a heterosexual act and being willing to have sex with a man makes you not a lesbian. Of course these sell-out shows and movies (see the Kids Are Alright) promote that shit. If they can’t get rid of us, they will try to heterosexualize us.

      I only got half-way through the first season before I was too disgusted to watch anymore of it. You’re not alone in disliking this propaganda, trust me.

      I agree that shows like this do not help and do more harm than good. I haven’t seen Glee but I’m not interested if that’s the portrayal of lesbians they have.


      • Being willing to have sex with a man does not take away the lesbian card. Many lesbians have sex with men. Some of us weren’t out yet, but still well aware we were lesbians. And some just do it for the sex.

        Liked by 1 person

  2. I have long believed that this handy stat was not the definitive argument-crusher that the transactivists and their medical partners purport it to be. Turns out it’s not even a meaningful stat. Holy crap, are these doctors even READING this stuff? Doesn’t anybody out there other than Nate Silver know how to READ and evaluate stats? Kids’ bodies are being irrevocably altered based on crappy stats.

    Spack, I think, is just entranced with the scientific and reputation-bolstering possibilities of his transing magic. Enjoys playing God — or at least that’s the vibe I get from his public comments. Olson, on the other hand, is the true believer and evangelist, thinks she is doing good for these troubled kids and their families and that there’s really no other way due to the … 41%. Neither seems particularly torn/worried about what they’re doing. Olson’s latest released study looks to be intended as a retort to anyone hypothesizing that GID/dysphoria is some sort of hormonal imbalance that could be fixed with adding more of the hormones associated with the biological sex. (I haven’t actually seen anyone very seriously proposing that as a treatment) Garofalo, the voice of pediatric transing in Chicago, seems to be kind of a tortured soul in general. Many statements regarding his ambivalent feelings about what he’s doing. Not that it’s stopping him from doing it.

    Parents of nonconforming kids SO need to read this stuff before making decisions. 4thwave, I wonder if you could possibly make a ‘greatest hits’ page here somehow — this post, the Schwartz summary, the stuff you’ve done on brain sex, the stuff on the dearth of actual research, other items on health effects? What might be beneficial for the browsing parent would be a ‘must read’ list focused on the BAD SCIENCE — vs the feminist aspects, the social aspects. I know those are fundamental and they resonate with me, but there are parents for whom they are just going to be a scary turnoff if that’s what they see at the beginning of their explorations. (I’m good at suggesting extra work for people. sorry, chica….)

    Liked by 1 person

      • I love the idea of a Parent’s Guide. While I very much appreciate the opportunity to spout off how mad this all makes me, Trans Inc has claimed the label of “most oppressed evah” so Puzzled is right that a lot of the non-science criticism will likely be seen as a bunch of meanies ganging up on poor trans. I have friends who would do well to learn about the shoddy, wildly insufficient data underlying all of this. And thanks for all you do 🙂


  3. Here’s a thoughtful discussion of the effects that the threat of suicide has on parents and kids. It’s by Sahar Sadjahi and is available here:

    Click to access sadjadi-2013.pdf

    Some quotes:

    “Specters of violence and suicide among transgender youth and adults, as inevitable consequences of puberty, are frequently mobilized to achieve a compelling narrative about the necessity of medically treating children.

    The cruelties that a five-year-old boy in a dress endures from adults and other children alike are shocking and alarming. Parents face very difficult circumstances and decisions, sometimes even fearing for their children’s lives. However, these children are also brave, resilient, intelligent and creative. To pathologize their refusal of and discomfort with the social expectations of their natal sex and locate the source of the problem within the child ignores the conditions in which the suffering has developed. Simplifying and de-contextualizing their suffering might lead clinicians astray in recognizing what is vexing the child and make promises that the magic bullet of puberty suppression might fail to keep.

    The claim that violence, discrimination and self-harm are direct and inevitable consequences of puberty may constrict the decision-making of parents and children and the horizon of imagining other viable futures. Consent to a medical treatment that is preventive in nature and justified by future gains while entailing harms requires clinicians to allow the parents to imagine and explore various possible futures for these children, not the single future of suicide and murder.

    The absence of the discussion of sterilization of children as a major ethical challenge in this bioethics article, and many other clinical debates on puberty suppression, is striking. For any other group of children, such an intervention would be discussed extensively with ethics review boards.”

    Liked by 2 people

    • This article is excellent. Dr. Sadjadi is at Amherst College and, along with Dr. Margaret Moon, seems to be one of the few MDs who have publicly brought up the issue of ethics vis-a-vis transitioning kids. Would love to hear of others–are they out there?


      • I have emailed with Dr. S a few times. Recently sent her the Schwartz piece you blogged, 4thwave. All these people are terrified of the sociopolitical and professional blowback that is the likely result of going against the currently promoted narratives. But if they felt they could collect some critical mass it might move the discussion forward. Alice Dreger says this happened with treatment protocols for intersex kids when people within medicine started to make alliances with affected intersex people who were pissed about what had been done to them.


      • Critical mass is what is needed. Where will it start? The media is key. If more mainstream journalists would start paying attention to how flimsy the science is, especially around transitioning children, things might start turning around.


      • This link says she’s a medical doctor and studied medicine in Iran. She’s also an anthropologist. In any case, I’m sure she understands firsthand how many gay people in Iran are forced to transition.


  4. “Second, the survey did not directly explore mental health status and history, which have been identified as important risk factors for both attempted and completed suicide in the general population.”

    This. This admission right here. I’m flabbergasted that anyone could take these results seriously after reading the above. And it’s on page three! This is like conducting a survey on the causes of lung cancer and neglecting to ask the participants if they smoke.

    Liked by 3 people

  5. The idea that having short hair is what increased the bullying that drove Ash to her death is, frankly, mind-boggling and so, so sad.

    Have we moved completely backwards in time? These rigid gender roles are so bizarre to me. As a child I was very much the tomboy, and had a strong, loving relationship with my dad. My mom was an extremely ill, engulfing narcissist who sexually abused me from the time I was five until the time I was fourteen. I was lucky in that I had a great female role model in her mother, who was a tough as nails woman who doted on all her grandchildren while still managing to appear as grumpy as possible.

    When my cousin S came out as a lesbian, there was some nasty talk about it. Anyhow, there was a family dinner and it came up again, and my grandmother sat there, quietly listening. Then she said some things I’ll never forget. The first was “who are any of you to judge S, or who she loves, or how she finds her happiness?” The second was in language a lot more informed by the longshoremen of our family and was basically along the lines of “if I have to hear any of this bullshit about S again you’re never seeing *me* again, the subject is closed. Deal with it and move on.” Grandma was the matriarch to end all matriarchs, and done was done.

    As a teen I wore my hair incredibly short. It was as close to a crew cut as I could get. I loved wearing men’s suits and men’s cologne and men’s shoes. I liked wearing makeup, too. I never thought of any of this as being associated with my sexuality or gender at all. It was just what I liked. Then I began to enjoy dresses and heels and all the trappings that go along with looking feminine. No one ever questioned my sexuality, or asked me if I was maybe a boy, or anything like this. I don’t understand the focus on the younger generations today to define and label themselves. I was always just me, Livvie. I find it almost frightening, that people would be so interested in how I defined myself that I would be subject to question or asked to make some kind of statement about who I was. I was a teenaged girl living her life and trying to figure stuff out. Nothing more or less.

    I feel for young girls today, and I worry that they are being groomed and predated upon by men who want to make them suffer as they *think* they’re suffering. Made to hate their bodies because those men can’t have those bodies. Same for the boys whose mothers appear, to me, to be gravely ill with Munchausen’s by proxy and are being forced down a road that they don’t want. The whole thing is depressing and sad, but I have hope that in ten to twenty years these children who were basically experimented on will find their voices and speak for themselves, to tell their stories and their truths.

    Liked by 2 people

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  8. I agree with your pulling apart the numbers in order to point out the unreliability of the 41% but at the end of the day if a properly controlled analysis were to be done I’m fairly sure you would still find that the percentage is way above the national average.
    Please don’t dismiss being transgender as not having a very negative impact on people, because societal pressures to conform to the gender binary are intense and it is a very lonely place to be.
    Also I see a prevalence in the other comments towards “young people”, and the recognition of oneself as having issues with ones own gender can take a lifetime to come into focus, as in my case where it happened just short of my 60th birthday. There were no external pressures being brought to bear and nothing that would have given any indication of the sudden realisation as to why I had suffered problems throughout my whole life, but once I did recognise the truth everything became crystal clear.
    That said, I totally agree with your observation at the end of the Ash Haffner section. Society as a whole is too judgmental.

    Liked by 1 person

    • I totally agree (and state in the article) that the rate of suicidality and self harm amongst people who don’t conform to gender stereotypes is unacceptably high. My problem (and what I try to point out) is the conclusions that seem to be drawn from this data: that transition is a magic cure for negative, self harming behavior. I do believe there is a lot of suffering experienced by trans-identified and otherwise “gender nonconforming” people. But I don’t think it’s helpful that trans activists use data like this to emotionally blackmail parents, kids, and others with the “transition or die” meme. I appreciate the respectful tone of your comment. While I may have questions about the basis of someone believing they are born in the wrong body, as a mature adult, you certainly have the right to do what you think best for yourself.

      Liked by 1 person

      • I’m in my 40s and transitioned in 1999, and work with young adults who self identify as trans/GNC, and I too am concerned there doesn’t seem to be space in the collective cultural conversation for data driven discussions about how to minimize suffering by the *least* use of physical remedies (drugs, surgery, etc). Also, all the existing sexology theories out there are laughably over simplistic (e.g. brain-sex/wrong body, Blanchard, et al typology). Helping a child or young adult who is literally in the act of forming or crystallizing their identity vis-a-vis gender identity unpack the heteronormative and misogynistic messages culture burdens us with seems like not only a good idea, but an ethical imperative. How can anyone make a good decision without good information, after all? And by the way, I don’t think that is what SWJs might label “trans reparative therapy.”


      • Thanks for commenting here. I’m really heartened to hear from someone who works with trans-identified kids (as a therapist?) who seems to hold a more nuanced view. I’d like to hear more from you. You say you transitioned yourself. As an adult? Would you agree that medical “transition,” if it is to be undertaken at all, should wait until adulthood? If not, under what circumstances would you recommend “social transition,” blockers, and on from there for a young person? Please share more of your thoughts, if you are willing. If it interests you, I can publish as a guest post as well.


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  12. “How much kinder would it be to help them embrace the only bodies they will ever have, with the sexual preference they have, instead of endorsing extreme interventions that may never resolve their dysphoria?”

    What if the sexual preference for a natal female is for a female, but only if the natal female were male? That is, what if the natal female does not self-identify as lesbian, could not conceive of being a female having an intimate sexual relationship with a female, but desires an intimate sexual relationship with a female as a male? I’ve yet to see this addressed by critics of “transition,” and yet I have seen this expressed by those considering FtM transition. Perhaps this is generally dismissed as “oh this person is just a ‘closet lesbian/gay,’ and therefore it’s not actually examined. But if it is a real issue for someone who identifies in anyway as having difficulty with their birth assigned sex, and such a person does indeed express desire for intimate sexual relationship (not homosexual), then what is a compassionate and logically sound response to such a person?


  13. Pingback: Bogus, biased transgender “hypotheses” vs. scientific evidence | The truth about AUTOGYNEPHILIA

  14. Pingback: What’s at Stake? – Transcendence: Youth Trans Critical Professionals

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  17. I don’t consider it that flawed. There are some limitations but the suicide attempts itself show that these individuals clearly have other co-morbidities. You write:

    “In other words, the survey is seriously flawed because there is no reliable information about the actual mental health status of the participants; and, since mental health problems are a known self-harm risk, there is no way to accurately figure out whether the suicide attempt rate is as high as it is due to co-occurring mental illness–not necessarily because of “gender dysphoria.” Further, another high risk factor for suicidality is being physically or sexually assaulted, especially for people with mental health disorders.”

    There have been studies done that show transgendered or gender dysphoric people have other undiagnosed mental illnesses, which accounts for their high suicide attempts and completed suicides. You can contest the findings but whether it is 41%, 20%, or 60%, their rates are higher even than lesbians and homosexuals, and that the rates are not lowered even with societal tolerance.

    PS – why debate this statistic when you take ‘1 in 20 rapes aren’t punished’ stat, or the ‘women earn less than men’ stat seriously and say it’s good science? Why stop there? Why not apply the same criticism to all studies you come across?

    Right. 4th wave feminist. I appreciate the criticism of transgenderism, but honestly, repeating feminist myths about how gender is a social construct and that there is no brain sex is objectively wrong. Citing tumblr won’t make you any more right, or Cordelia Fine.


  18. Whether the 41% is accurate or not it is not what is important to me. I am the mother of a transgender child. 10%, 20%, 40% it just doesn’t matter when it’s your child and you are the one wrapped in fear. The reality is our transgender children and youth are dying! And society’s need to always put people into the binary isn’t helping. Our children need help, they need to feel valued, loved and supported. I know because my son was one of them. He attempted suicide as a young teen, thankfully he survived. Today, five years later he is a healthy, strong and very happy 18 year old – who has transitioned from female to male. We as parents did not push anything, did not make decisions lightly, swiftly or without professional guidance and care. In fact in our situations some have accused us of going to slowly but today I just have to look at my son to know for him transitioning was the right decision. I know how hard all this is to wrap our heads around but if we could all just show all our youth more love and support regardless of gender and put love first then suicide rates for everyone LGBTQ and non would come down – and that should be our end goal, not needing to prove or disprove percentages, because honestly, 1% is too high and it saddens me deeply when I know so much of it could be avoided with more understanding, compassionate and respect. It’s easy to support and show compassion towards those we understand but if we could all learn to show more compassion towards everyone, especially those we don’t understand this world would be a far better place than it is today. Cheryl B. Evans (Author of I Promised Not to Tell: Raising a transgender child).


    • This piece is no way makes light of suicidality. What it points out is that, regardless of the numbers, the issue of co-existing mental health issues is never addressed in these statistics. Even the authors of the Williams Institute study acknowledge this failing, as is pointed out in the blog post.

      Supporting and loving our gender-defiant/nonconforming children is critically important. The parents who gather here support gender defiance. We love our kids and support them in expressing themselves as strong and unique exemplars of how to expand possibilities for women and men. What’s truly sad is that activists try to bludgeon us into agreeing to turn our kids into lifelong medical patients with the unsubstantiated threat that otherwise, our kids will kill themselves. This deeply immoral weaponization of self harm is, in my view, one of the key reasons so many parents have agreed to “transition” their children. If you stick around here and read a bit more, you’ll see that many of us have built and maintained strong relationships with our kids, but protected them from a life revolving around drastic surgeries and hormone injections. Yes, we put love of our children first–not the demands and opinions of trans activists and “gender specialists” who stand to profit from this modern-day medicalization of the natural identity explorations of young people.

      Liked by 4 people

    • Anyone who argues that the truth and scientific proof doesn’t matter when it comes to using hormones and surgery ON CHILDREN AND TEENS has already lost the game. Sorry. That’s just propaganda, then. Lying. Enough.

      Liked by 3 people

      • I also find it significant how many “trans-parents” ultimately wind up seeking to publicize and monetize their children’s experience, regardless of the fact that doing so necessarily exposes that child’s deepest thoughts and feelings, and intimate family dynamics, to the public. Ms. Evans, I note that your book about your child is for sale on Amazon, in four editions no less. Whether it’s putting your kid on the cover of a national magazine, or having the child become the “poster-kid” for the “trans-kid-du-jour” article, or writing a book or blog post or article about it, it’s really striking how parents disregard the real psychological costs of the utter loss of privacy this will entail.

        Even folks who intentionally seek out fame and publicity, such as actors and singers, often wind up traumatized by being in the media’s glare. And for children and teens who certainly cannot consent to this wholesale invasion, it would seem doubly harmful.

        Forever after, a child or teen who is exposed like this will be searchable and identifiable as trans, and there are going to be costs to that. But just like the very real medical consequences, “trans-parents” just assume it away…

        Liked by 5 people

      • Also, no one talks about how difficult it would be for celebrity trans kids to change their mind in the future. The reputations of many people rest upon them continuing to believe they are transgender. Researchers in the Netherlands have pointed out that can be difficult for kids to desist who have been socially transitioned. How much more difficult for kids who have been thrust into the glare of public scrutiny since toddlerhood?

        Liked by 4 people

      • And how difficult it would be for a kid to desist and therefore stop that sweet trans-publicity income stream. Their family’s livelihood depends upon them being trans — so much unnecessary pressure put on a child whose situation is already fraught with difficulty.

        Liked by 1 person

  19. Pingback: Gender Struggling Children and Parent Fears of Suicide | Prepared To Answer

  20. Your comments make sense as an outsider. But as an individual with transgender tendencies, I wanted to say that transgender people would have picked doing nothing if they had been able to do so psychologically in the first place. To an extent, trans people go through their whole life struggling to accept even themselves for who they are to the society, to themselves, to God if they were still able to believe in one, and to those they know. On top of that, it is often related to social function and how you relate with other people, so telling them to accept it is on par with telling a normal person “by the way, you cannot fall in love with anyone or interact with other people” in the sense that they are being denied to pursue the way of how they want to relate with different people. “How much kinder is it to help them accept” mentality of a lot of normal non-transgender people is precisely the reason why suicidal rates are so high in my opinion – the implicit message in that approach is to say they are not normal and are rejected unless they accept correction. There is nothing wrong with the intelligence of trans people and thinking that the problem with trans people is because they are too immature to accept themselves is far from a realistic view of the situation. How many people who are dissatisfied with say, how tall they are, get to be suicidal? A lot of transgendered people who made transition was suicidal because they started too late and they can never lead the lifestyle gender that they are comfortable to. Hence the transgender community’s push for earlier intervention of a higher chance of successful transition. I think the data dive is beneficial to know, and I think it is a fair comment to say physical transition is not the only way to solve the problem, but your subtle message that we should try to change the person as a therapeutic method is quite biased and failed to address the same issue you indicated in the original study on fully exploring the reasons behind. I personally do not think it works, I tried changing how I feel about myself, using a variety of ways to numb my feelings and deny it, but it simply doesn’t work. I regretted that I did not take steps to transition sooner and eventually seeing myself walking farther and farther away from being able to do so.

    Liked by 1 person


  22. Pingback: La femme invisible, ou l’identité de genre à l’ère du libéralisme | Entre les lignes entre les mots

  23. Thank you for writing this. Parents are bombarded with terrifying and incorrect statistics to convince them to transition their kids or be responsible for their suicide. The trans lobby seems perfectly happy to let this continue instead of doing research, as you have, to objectively examine the area of transgenderism. As a movement, its focus is on increasing its influence instead of safeguarding the wellbeing of its most vulnerable members.

    Liked by 4 people

  24. Pingback: Transgenderism and the Neo-Fascism of the Regressive Left | Miranda Yardley

  25. Pingback: My first article- “A Mum’s Voyage Through Transtopia” | Lily Maynard

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  27. Oh no! Oh dear…

    tl;dr: You (the author) give valid reasons that the statistics in the Wiliams Institute paper are worthless. But then you draw conclusions based on the exact same statistics!

    I commend you for putting this effort into looking at the facts, but I also strongly recommend you take the post down, not only because of its potential to harm trans youth,* but also because your analysis is deeply flawed.

    I agree that the 41% rate is used too often and without important caveats (quote 1). I have definitely seen this figure irresponsibly, but it was in popular media. Your evidence of this is to a doctor quoted in a newspaper article, and the doctor doesn’t mention this statistic. (If you have more evidence of this, I’d be happy to see it.)

    Returning to the central problem with this post: you suggest that we ignore the statistics based on flaws in the survey (2, 3, 4). But you don’t! Instead, you draw numerous conclusions based on the “worthless” survey results (5, 6, etc.)!

    This is logically inconsistent.

    Please do consider whether this should be a public post. Or you might edit it to reflect your important analysis of the problems with the 41% statistic and the WI report, but without drawing your own conclusions from the data.

    If you think the data are worthless, don’t use them.

    — R., Ph.D., Princeton University (you don’t have to buy this credential, of course, but it’s true).

    * If we are going to draw conclusions from the report– which, as you also note, we shouldn’t!– you could have also noted that support from family is a strong protective factor against suicidality among trans people (Table 17, p. 12 of the Wiliams Institute report). It seems that the goal of this website is to warn parents not to take their trans kids gender expression/identities too seriously— i.e., to be rejecting rather than supportive. 😦

    Quotes from the original post:
    1. “I have most often seen the 41% rate mentioned, with no caveats or analysis, to justify young people receiving medical transition services.”
    2. “We could stop right here and say the survey’s main data point–the 41%–is worthless.”
    3. “People who said they “did not want” these services had a lower self-harm rate. Does medical transition, or seeking transition services, decrease or increase suicide attempt rates? We don’t know … ”
    4. “It’s clear from the authors’ own words that this survey cannot be responsibly used as a basis for the presumption that medical transition reduces self harming behaviors over the lifespan.”
    5. And now to one of the more interesting findings in the Williams Institute report: natal females (in contrast to natal males) who say other people generally don’t recognize them as trans or GNC have the same or higher suicide attempt rate as females who are more often recognized by others.
    6. “… being stealth or passing doesn’t seem to alleviate the urge to self harm.”


    • TL; DR means “too long didn’t read.” I guess you didn’t–because you managed to miss the main points.

      Right after the “worthless” paragraph which you go on about in your “critique,” comes this:
      “But let’s not stop there. Even if the rate is closer to 20%, that is still unacceptably high. And self harm is a huge problem, whether the actual intent to end one’s life is present or not.”

      This is the lead-in to the rest of the article, which lays out a number of points–including this about parental support:

      “Elsewhere in the survey, we learn that lack or loss of family support is a big factor in self-harm risk. This seems like a no-brainer. But support for what? Accepting a loved one’s gender expression or identity is not the same as getting on board with hormones and surgery. In fact, by encouraging the idea that they must medically transition (which entails lifelong and sometimes painful interventions) to be happy, might family and gender specialists even be increasing the risk of self harm?”

      Following this is discussion about the suicide of a (fully supported by her mother) trans teen, with the point made that she was bullied precisely for her gender nonconformity, and a plea for GNC kids to be supported:

      “Ash’s “gender nonconformity”–her short hair, for crying out loud–is what caused the increase in bullying. Isn’t our challenge, as parents, as therapists, as a society, to support our young people when they step outside stereotyped gender norms? To allow a girl to have a crew cut or wear boxer shorts? For a boy to wear a dress if he wants?”

      So your criticisms are spurious and were evidently conceived after skimming the piece and missing most of the key points–one of which is that there is no evidence that medical transition is curative for self harm, particularly in young people.


  28. Pingback: Gender X – Give me a break! – End This Insanity

  29. the suicide rate in trans kids drops as low as 4% in kids who have 100% support and grew up as there gender identity

    outside that its high yes and may stay high due to the pain of not being who they are and the feeling of never being able to but you do no kid any good by refusing them freedom of expression freedom to live and be who they are
    you can end the suicide rate only by entirely destroying gender lines that binds people
    also suicide rate used to be much higher back before hormones and surgery existed

    the pain of growing up a male when i was a girl you have no idea how much that hurt that pain sticks with me every single day as it does to any trans person it is not the transition that hurt its the not doing it sooner


      • just obtained a very valid reason to believe this suicide rate stat is not accurate due to the fact we have no research on the exact number of trans people we cant have a research on how many of an unknown number has committed suicide its not possible
        we can change that if gender identity would be included in the 2020 census
        the NTDS is the only source which points to an actual large scale survey conducted and in it it shows a suicide rate as low as 4% in trans kids
        tho the suicide rate may still most likely be at 40% your claim has only faulty data your statement goes against lead medical professionals such as the aap or the ama as well as lead research organizations such as the aclu ntds or the trc
        but i will add this its been proven by all i listed above kids do not grow out of gender dysproria thus meaning refusing them the ability to live by gi or trying to “change” them is harmful to any child and/or adult
        point is your statement is false
        id post all there statements but for some reason my internets messing up again there not hard to google tho

        Always a girl Always myself


      • The fact is we have zero data on longterm outcomes for the current generation of children who are being transitioned in greater and greater numbers. What we do know is that there is no historical record of minors who didn’t have access to hormones and surgery killing themselves. None. Yet trans activists, and people who make comments like yours, deceitfully terrorize parents with the false claim that trans-identified kids have one choice: transition or suicide. That’s what is known as spreading suicide contagion, and we don’t host it on this website. There are plenty of other places on the Internet that will be happy to have you spreading that untruth, but this isn’t one of them.

        Liked by 1 person

    • Actually the reverse is true. There is an even higher rate of suicide after transition

      Depression is not caused by being poor, or being an addict, or being overweight, or being alone, or gender dysphoria. It is a magnifying glass that distorts the perception of these very real problems as the total cause of unhappiness. How many times have we heard the the trope of being careful what we wish for because we just might get it?

      Clinical depression is completely separate from dysphoria and it should be treated as such. I may not have experienced gender dysphoria but major depression? I know very well getting everything you want is no cure.


  30. But the study never implied transition improved mental health?

    It just states that trans people have a higher risk of suicide. Whether they transitioned 20 years ago, yesterday, or not at all, the fact that trans people are clearly more suicidal than cis people becomes clear.

    Yes the study isn’t perfect, and nor is journalism on the topic, but my god your petty picking apart of this to feed into your own point that you don’t think trans people should be allowed to transition is some of the worst journalism I’ve seen.


  31. My girlfriend is Trans, male to female. She states that she has been unhappy with her masculine gender since she was very little, and wanted to change for a long time. She is aware some people regret it but she is sure that this is what she wants. My question, is simply, from your point of view, Forth Wave Now, what is the best way for me to support her? She’s had suicidal thoughts but much less since hormones. She does not commit crimes. She does have panic attacks about not having a female body and not being able to have kids. I would love her whether she transitioned or if tomorrow she told me she was staying like she was I would be thrilled either way cause I love her/him. I just don’t want her to do anything that would hurt her or that she would regret. That’s why I am asking you for your advice, cause I don’t want to cheer lead her on (I’ve been, as I said, completely supportive) and then know I cheer leaded her into doing something she regrets. I also don’t want to dissuade her and then her later feel regret about not going through with the procedure. She seems happier now that she is on hormones and the more she transitions, the happier she seems. That’s all I know. I just want her to be happy. That’s all I want.


    • Does your partner have a therapist or other trusted person to discuss these issues with–particularly the panic attacks/suicidality? We aren’t in a position to give advice on how to support your partner best, but it sounds like you have a lot of love and care between you. We at 4thWave are most concerned about the impact of gender ideology on minors; adults get to do what they want, despite any opinions we might have on it. If your partner decides to detransition at some point, there are several formerly trans-identified men who are active on social media and/or who write blogs which might be of help. Best of luck to you and your partner.

      Liked by 1 person

      • She has a therapist and she knows she can talk to me or our other mutual partner (we are a trio). I also told her about a hotline in case no one’s available at the moment. The only thing else I can do is be there for both of them, since my other partner is gay and Christian and hates himself for it, so he has dark thoughts too sometimes, and I also have dark thoughts sometimes for reasons I won’t get into deeply as I’m not sure they are relevant, but I am trans species so that comes into play sometimes as well.

        If you could give me the names of any of the blogs you are talking about that would help as I can share those with her if she changes her mind.

        As far as Gender Ideology’s affect on minors, I guess I would be more on the side of the kid than anything. I mean in my partner’s case, puberty blockers would have made this transition easier, and it could have taken place earlier, which also makes things easier from what I have read. At the same time, not doing that certainly (thank God) did not result in suicide. I think you are right that sometimes a person, especially a child, may not know what they want, since their personalities are still forming / coming out * . I don’t see a lot of studies out there, in fact I don’t see any studies comparing, one on one, suicide rates among people who never transition vs people who do transition, but there would be ethical problems here with withholding a potentially beneficial treatment from someone which is the same excuse used for not having a vaxxed vs unvaxxed study. And from what you have said in this post I think this may be a symptom of a larger sociological problem with the treatment of minors. There is a very good by by educator and researcher John Holt called “Escape from Childhood, On the Rights and Needs of Children.” It’s a free PDF online but was originally a published book. I’ve only read a little of it but I want to read more and I think it might help you all to take a look at it too, as I have read other work by Holt that I think indirectly addresses this topic.

        *I think previous lives can have an effect on personality which is why I also use coming out as well as forming.


  32. Just wanted to provide some sad information. Third Way Trans has ended his blog. It sounds as though he is extremely frustrated that his words have been misused (by both sides of the argument). I will really miss his very insightful articles on dysphoria and different approaches to coming to the best decisions for each individual. He will be sorely missed!

    Liked by 1 person

  33. Pingback: Tell The Guardian and The Observer To Stop Reporting False Statistics Regarding “Transgender” Suicide – Gender Critical Action Center

  34. Pingback: Attempted suicide by American LGBT adolescents | 4thWaveNow

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