Swedish study, meet the Dutch study: Suicide rates among trans people are elevated, but not by “20 times”

Zinnia JonesAsk anti-trans activists to provide sources for their assertions that trans people’s identities are inauthentic or that transition treatment is ineffective, and you’ll typically hear one of these four:

  • Johns Hopkins – A sloppily-done study of transition outcomes spearheaded by Paul McHugh, its glaring shortcomings were highlighted in the literature a year after it was published. McHugh later admitted that it was his intention from the outset to close the Johns Hopkins gender clinic, regardless of the study’s findings.
  • Rapid onset gender dysphoria – Later corrected to “Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria”, this proposed condition allegedly arises from the transmission of contagious gender dysphoria via websites such as this one. It only appears to exist due to a uniquely terrible choice of methodology in which a parent’s awareness of their child’s disclosure of a transgender identity was wrongly assumed to be contemporaneous with the child’s own private exploration or personal awareness of their transgender identity.
  • Pimozide – In a single case report, an antipsychotic drug was successfully used to treat a patient with a delusional disorder whose assertions of being transgender appeared to be a component of this delusion. The transphobosphere promptly spread this far and wide as evidence that all trans people could simply take pimozide to cure their gender dysphoria, and that a conspiracy must be at work to silence this case report (that’s been cited in dozens of publications on trans-affirming care).
  • And last but very much not least: the Swedish suicide study.

If there were a way to assess which published findings have been the most misused and misinterpreted, the Swedish study of 324 trans people would certainly rank highly. It’s essentially impossible to find an anti-trans group that doesn’t at some point cite Dhejne et al. (2011) while asserting that transitioning itself actually causes trans people to commit suicide. Ryan T. Anderson of the right-wing Heritage Foundation provides a representative example:

The most thorough follow-up of sex-reassigned people—extending over 30 years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest. Ten to 15 years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to 20 times that of comparable peers.

Never mind that the paper’s coauthors have pointed out that the study was not even designed to attribute causation or determine that transitioning had an effect of increasing the risk of suicide (or decreasing it from what would have otherwise been an even greater prevalence). Never mind that significantly higher odds of death from suicide were only observed in the cohort which transitioned from 1973 to 1988, and no significant difference in mortality was observed in the cohort which transitioned from 1989 to 2003. Never mind that lead author Cecilia Dhejne has spent years trying to correct these widespread misrepresentations. At this point, getting anti-trans activists to let go of the notorious Swedish study is like getting urine out of a pool – it’s passed beyond fact into something more akin to legend.

We may not be able to remove the terribly abused Swedish suicide study, but we can add to it: now, there’s a Dutch suicide study (Wiepjes et al., 2020).

This study, which included 8,263 trans women and trans men referred to Amsterdam’s VU University Medical Center from 1972 to 2017, does not show that rates of suicide among trans people “rose to 20 times that of comparable peers”, “ten to 15 years after surgical reassignment”. Over the entire time period, there was a rate of suicide deaths of 64 per 100,000 person-years among trans women and 29 per 100,000 person-years among trans men. Rates of suicide did not increase over this time for trans women or trans men, and trans women actually showed a decline in suicide rates over time. For 2013 through 2017, rates of suicide deaths were 43 per 100,000 person-years for trans women and 34 per 100,000 person-years for trans men, compared to suicide rates in the Dutch general population over the same period of 7 per 100,000 person-years for women and 15 per 100,000 person-years for men. The authors observe that Dutch trans people’s risk of death from suicide is “three to four times higher than the general Dutch population”.

What other demographics show similarly elevated rates of death by suicide? For context, a study of individuals in Denmark and Sweden who entered a same-sex marriage between 1989 and 2016 found that men had a rate of suicide deaths of 41.7 per 100,000 person-years, and women had a rate of 18.1 per 100,000 person-years; the overall rate of suicide was 2.3 times higher than that of individuals who were in opposite-sex marriages (Erlangsen et al., 2020). Any line of (il)logic arguing that transitioning is undesirable or harmful on the basis of suicide rates among its participants would likewise have to argue that gay marriage is something to be avoided due to similarly elevated suicide rates among its participants.

Suicidal ideation, suicide attempts, and completed suicides are indeed serious issues that disproportionately affect the trans community – but contrary to the arguments of anti-trans activists, social support and affirmation and medical transition have been shown to decrease these risks rather than increase them. And this recent study, encompassing a sample size far larger than that of the Swedish study, puts a substantial dent in the claim that trans people are “20 times” more likely to commit suicide following transition.

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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