Transgender youth have a much greater risk of suicide, according to the US Centers for Disease Control and Prevention. However, if they have access to a puberty blocker, their chances of suicide and mental health problems in the immediate term and down the road decline significantly, a new study finds.
The study, the first of its kind to examine access to pubertal suppression and suicidality, was published Thursday in the medical journal Pediatrics. The research comes as a handful of states are considering placing restrictions on transgender health care.
One state, South Dakota is considering a law that would make it a felony for health care providers to prescribe medication to stop puberty, among other gender affirming health care treatments. South Carolina and Missouri are also considering similar restrictions.
The legislation would contradict medical guidelines from several associations, including the Endocrine Society, which has guidelines that recommend doctors offer transgender teens pubertal suppression therapy, also known as puberty blocking. It became a treatment option in the United States in 1998.
With this therapy, doctors can inject a compound or use an implant that mimics the actions of a puberty-stimulating hormone that is released in the brain known as gonadotropin-releasing hormone. The compound makes the pituitary gland less sensitive to that hormone and, in doing so, it essentially pauses puberty. It’s a noninvasive process that can be reversed. Puberty starts again after the drugs are stopped.
The practice has become more common in the US recently, studies have found. The latest study, though, found that 16.9% of those who were part of a survey of the transgender community wanted pubertal suppression as a part of their gender-related care. Of those who were surveyed, only 2.5% got this treatment.
Those who underwent the puberty-blocking treatment had lower odds of lifetime suicidal ideation and past-month severe psychological distress, compared to those who wanted the treatment but did not receive it.
Researchers reached that conclusion by analyzing data from the 2015 US Transgender Survey, involving 20,619 people between the ages of 18 and 36 years old.
Some smaller studies in the past have shown that people who have undergone puberty-blocking treatments early in life, along with psychological support, have better mental health outcomes later in life.
“Historically we have known the puberty blockers are safe and effective and this is totally reversible, so the benefits far outweigh any risk. It is sort of a no-brainer to make these available in these circumstances,” said Dr. Michelle Forcier, a pediatrician who was not part of this study, but works with transgender patients. She is also an associate professor of pediatrics at Warren Alpert Medical School of Brown University.
Forcier said family support is key for children who are transgender. Using the name and the pronoun the child prefers is important to help reduce depressive symptoms and suicidal ideation, studies have shown, as are puberty blockers for those who want them.
Nobody would deny a child with asthma their inhaler, or refuse cancer treatment for a child with cancer, she said, yet some parents express reservations about puberty blockers. When they do, she reminds them that these drugs can be a “life-saving option.” Some estimates show suicide attempts among the trans community as high as 40%. Other estimates have shown it’s twice the rate of their peers.
“By not allowing their child to use these drugs, that is not a neutral option,” said Forcier. “This is why this paper is so important. This access is associative into adulthood and is important for safety. We know that access can offer protective effects. This is something that will help a parent keep their child safe.”
The drugs are expensive, Forcier said, and not all children have access to appropriate providers. She hopes access will get easier, as does Dr. Rachel Levine, secretary of health for the Commonwealth of Pennsylvania and a practicing pediatrician. Levine said this study is an important one, since it is the first to show a specific association between access to puberty blockers and a decrease in suicidiality.
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“It is very important for medical professionals to understand scientific studies like this,” Levine said. She pointed out several clinics in Pennsylvania that can provide this kind of care, althought most are located in large urban areas. Access would be much more difficult for children in rural Pennsylvania and in other areas of the country and she said she hopes that changes.
The study, she said, points to why access is so important, counter to some political movements to deny children such access.
“It is also critically important as far as policy,” Levine said, “that policy makers do not get in the way of medical standards of care.”