I didn’t mean internally risky, but it would be damaging to the relationship with the United States, especially if there was a change of administration in 2024. While the US isn’t at the point where asylum makes sense, it certainly could be in 3 years and so preparing for that makes sense.
I’ve been trying to track down some statistics to quantify what we are dealing with here. Near as I can tell, there are 50,000-100,000 clinical diagnoses of gender dysphoria among Americans under 18. Of those, 5-10k are on HRT or hormone blockers, with HRT being about 3-4 times more common than hormone blockers (which surprised me, I was expecting it to be the other way). As to the piece that gets the bulk of the media attention, there are on the order of 250 top surgeries and 10-15 bottom surgeries done on teenagers each year. I can’t find a distribution of what states those occur in.
The suicide statistics, while unpleasant to think about, are what I was more interested in. I’ve often seen estimates of suicide ideation ranging from 40-60%, but had the impression that those relied on self reported surveys making me wonder if the numbers are high. And while I still think they are, the size of the surveys are large enough to make me think that they aren’t as skewed as I might have thought. E.g., there was a paper published last year by some people associated with the Trevor project that was based on a survey with 35,000 respondents, so they captured a pretty large chunk of the adolescent trans population (the survey age range was 13-24, so also includes some young adults).
The Trevor project survey had suicide ideation rate of 57% among people who wanted HRT but couldn’t get it, with suicide attempt rate of 23% for that group. Among people who were on HRT, the ideation rate fell to 44%, and attempt rate to 14.6%. If you figure 7,500 teens are on HRT (the midpoint of the range I mentioned earlier), and assume that treatment removes 8% * 7,500 attempts, that is 600 fewer suicide attempts per year as a result of HRT.
There is also a paper just published this year in the New England Journal of Medicine that tracked every patient receiving HRT from the top children’s hospitals in LA, SF, Chicago, and Boston. Their study had suicide ideation rates of 4%, with 2 deaths in a sample size of 315. That is much lower than the Trevor project outcomes. They avoided sample selection issues, which should make the numbers more accurate, but also used relied on reports during study visits rather than relatively anonymized surveys, which could reduce responses about suicidal thoughts. But what strikes me is that they also are drawing from people who live in areas that are much more trans friendly than the nation as a whole, and getting markedly better numbers.
So the bottom line is I don’t think anyone has a complete sense of the impact of HRT on mental health, but it does seem that giving teenagers the medically appropriate treatments eliminates hundreds of suicide attempts each year, and having a society that is more trans friendly would likely do at least the same.
Florida has introduced a bill that would legalize the kidnapping of trans children by anti-LGBTQ parents, even if they cross state lines and regardless of any custody orders.
Sounds like the Fugitive Slave Act
I’d be a bit of surprised if any group of teens had a suicide ideation rate of less than 10%. Kids love thinking about killing themselves, don’t they?
I think there’s 2 problems with this conclusion.
1 is that demographics-- age, race, gender, sexuality, etc. have wildly different rates. So anything you look at might have sampling issues (which you note).
2 is that receiving vs not receiving HRT could just be a proxy for acceptance (which I guess you also note).
That said, it might be enough to conclude that it’s not causing suicide.
(Also would like stats on successful suicide! since they differ vasty from attempted).
(Also this isn’t meant to dump on your interest in suicide statistics. I do think it’s a very useful way to approach mental health care. I just wish we did it more, and more thoroughly. I find it kind uh, depressing, how we have every possible advantage and technology and resource to devote to happiness and still kill ourselves at a record pace.)
I have to think that feeling loved and supported, and being able to talk to your friends about your feelings and trials, names a huge difference.
If you look at old statistics, there was an enormous incidence of suicide ideation, attempt, and success among gays. That’s one of the reasons psychologists confidently labeled it a mental health disorder. Today, my understanding is that gay adults have comparable suicide stats to straight adults. With no “treatment” at all, except the ability to live uncloseted and to enjoy normal relationships with family and friends, gay mental health has become normal. The psychologists had it exactly backwards.
I’m sure that gender affirming medical treatments are helpful to many trans people. But at least one reason they are helpful is that they increase the likelihood that others will look at the person and recognize them as the gender they identify with. I suspect that widespread acceptance, and the ability to enjoy normal relationships with family and friends AS THE CORRECT GENDER is more important than any particular medical treatment.