Study In The Journal Of Pediatrics Finds Trans Youth Care Lowers Suicidality, Few Detransition

The groundbreaking study found that suicidality dropped for transgender youth receiving hormone therapy by nearly 70%, with only 7 patients of 432 discontinuing treatment.

Ted Eytan // Creative commons

In the last year, many pseudoscientific organizations and anti-transgender activists have worked to prop up misleading claims to imply that gender-affirming care is ineffective or dangerous. These claims fly in the face of the dozens of important studies released over the last decade showing the powerful, measurable impact that gender-affirming care has on transgender youth who need it. Now, a recent study published in The Journal of Pediatrics adds yet another data point to the overwhelming body of evidence supporting this care, finding that suicidality scores dropped significantly an average of two years and up to five years after patients received gender-affirming treatment.

The study was conducted at an unnamed Midwestern clinic, though the authors note it was likely located in a state that banned gender-affirming care, as those bans prevented researchers from gathering additional data on the transgender youth in the study. It examined all transgender youth who initiated hormone therapy between 2017 and 2024 and completed a suicidality intake questionnaire at the start of treatment. Importantly, researchers did not limit follow-up to patients seen exclusively in the gender clinic—data was collected at any clinic within the hospital system that the transgender youth later visited, making the study far more resistant to the common challenge of losing patients to follow-up. Suicidality questionnaire data was then gathered from these young people for up to five years after treatment initiation, with the average follow-up occurring roughly two years later.

Of these patients, only eight refused to take the follow-up survey. Just seven discontinued hormone therapy, and the researchers note that of those who stopped HRT, only four did so because their gender identity had shifted. Even then, those four continued to identify as “gender diverse,” not reverting to a cisgender identity. These findings mirror a similar study at a pediatric clinic in Australia, which used comparable methods and sample size and found that only two of 552 patients discontinued hormone therapy after initiation. Together, these studies sharply contradict conservative narratives claiming that transgender youth are poorly screened for care or that regret and harm are widespread outcomes of treatment.

Importantly, the study found that gender-affirming care is likely lifesaving. While the authors do not present the result as a percentage, suicidality scores fell from 0.46 to 0.15—a roughly 68 percent decline—after patients were on gender-affirming hormones for an extended period of time when compared to their baseline. The effect was the same for both feminizing and masculinizing therapy. Researchers also note that the real impact may be even larger: 30 patients had already undergone puberty suppression before starting hormones and had likely experienced some benefits. As they write, “at baseline, participants who had received pubertal suppression prior to HT (n = 30) showed lower suicidality scores (M = 0.23, SD = 0.77) compared with the overall sample (M = 0.44, SD = 0.95).” Many others began with a suicidality score of 0, possibly because the knowledge they would receive treatment was itself protective. Even with these factors, the study still shows a significant reduction in suicidality.

The study did not pull punches against pseudoscientific critiques often levied against the evidence base for gender affirming care. For instance, they note that a demand for “randomized controlled trials” would likely be unethical, given that there is growing consensus among scientific, peer-reviewed studies on the efficacy of gender affirming care, stating “Although randomized controlled trials (RCTs) are considered among the most rigorous methods for evaluating treatment efficacy, they are ethically and practically challenging in the context of adolescent HT for GD. Masking is not feasible, control group retention is poor when treatment is accessible elsewhere, and equipoise is contested (ie, there is no longer genuine uncertainty among clinicians about whether treatment is beneficial), given the growing consensus around the benefits of HT for GD. Many thus view it as unethical to withhold a medically indicated intervention from youth experiencing high distress.”

They also noted that “In the absence of RCTs, observational studies provide important insights by examining outcomes in real-world clinical settings without assigning participants to treatment or control groups. In medicine, observational designs are commonly used when randomization is infeasible and are often sufficient to inform clinical guidelines, especially when findings are consistent.”

Given the findings, the researchers conclude there is “a stable and clinically meaningful association between HT and reduced suicidality.” They attribute the improvement to multiple factors: the well-documented effects of hormones on mood, the relief that comes with physical changes in body shape, hair growth, and voice, the emotional stability that follows being affirmed in one’s gender, the ability to navigate social spaces with less fear of misgendering, and the broader sense of possibility that comes with finally receiving care. And they stress that none of this stands alone—these results mirror a growing body of research released over many years, all pointing to the same conclusion. Gender-affirming care saves lives. It remains one of the most effective interventions available for transgender youth who need it.

You can view the journal article in The Journal of Pediatrics here.