Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria
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LETTER TO THE EDITOR
Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria Michael Biggs1 Received: 11 February 2020 / Revised: 12 May 2020 / Accepted: 14 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
According to Turban, King, Carswell, and Keuroghlian (2020), suicidal ideation is lower in transgender adults who as adolescents had been prescribed “puberty blockers”—gonadotropinreleasing hormone analogs (GnRHa). This finding was derived from a large nonrepresentative survey of transgender adults in the U.S., which included 89 respondents who reported taking puberty blockers. Turban et al. (2020) tested six measures of suicidality and three other measures of mental health and substance abuse. With multivariate analysis, only one of these nine measures yielded a statistically significant association: the respondents who reported taking puberty blockers were less likely to have thought about killing themselves than were the respondents who reported wanting blockers but not obtaining them. This finding was widely reported in the media; the lead author published a column on its implications for health policy in the New York Times (Turban, 2020). Unfortunately, the finding came from a low-quality survey which is known to have elicited unreliable answers on puberty blockers. The analysis assumed that puberty blockers were available in the U.S. several years before they actually were. Most seriously, Turban et al. (2020) barely acknowledged the fact that adolescents with severe psychological problems would have been less eligible for drug treatment, which confounds the association between treatment and suicidal ideation. The article therefore provided no evidence to support the recommendation “for this treatment to be made available for transgender adolescents who want it” (Turban et al., 2020, p. 7).1 Turban et al. (2020) analyzed data from the United States Transgender Survey of 2015 (James et al., 2016). Respondents were not sampled from any defined population, but were recruited online. This convenience sample excluded those Editor’s note. This Letter was peer reviewed by three members of the Editorial Board and myself. * Michael Biggs [email protected] 1
Department of Sociology, St Cross College, University of Oxford, 42 Park End Street, Oxford OX1 1JD, UK
who underwent medical intervention and then subsequently stopped identifying as transgender. Obviously, those who actually committed suicide are omitted. Aside from these general problems with the survey, the key questions on puberty blockers evidently confused many respondents. Puberty blockers are given below the age of 16 years, when adolescents become eligible for cross-sex hormones (Hembree et al., 2009). Yet, 73% of respondents who reported having taken puberty blockers (question 12.9) said they started on them after the age of 18 years. As the survey report acknowledged, “the question may have been misinterpreted by some respondents who confused puberty blockers with the hormone
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