On Tuesday, the ACLU tweeted an article written by one of its staff members and published by CNN. The author, Henry Seaton, a 24-year-old transgender man, is the “trans justice advocate” at the ACLU of Tennessee, one of the states currently passing restrictions on minor access to “gender-affirming” drugs and surgeries. The ACLU’s tweet said: “When Henry was 17, gender-affirming care saved his life.” It also quoted from Seaton’s CNN article: “To enact a sweeping ban on this age-appropriate, medically necessary care is akin to telling kids like me that their lives aren’t worth living if they decide to be true to themselves.”
This is one of countless examples in recent months of transgender activists and advocacy groups—of which the ACLU is arguably the most powerful—declaring that loss of access to hormones and surgeries will prompt transgender-identified kids to kill themselves. This politically potent “affirm or suicide” narrative has been marshalled at nearly every opportunity in public debates over pediatric gender medicine. It enjoys the endorsement of top-ranking officials in the Biden administration. Last year, the Department of Health and Human Services called “gender-affirming care” a “potentially lifesaving” intervention.
On Thursday, in a debate in the Georgia House of Representatives over a bill that would impose liability on doctors who perform child sex-change procedures, state Rep. Karla Drenner, a Democrat, tearfully said: “To all the children in our state who are going to be negatively impacted, please don’t lose hope. Please don’t give up. Please don’t kill yourself.”
In February, in response to legislative efforts to ban “gender-affirming care,” transgender activist Erin Reed declared on Twitter: “I have had multiple calls—4 to be exact—of kids who have attempted or completed suicide because of anti-trans legislation. . . . These bills are killing our kids.”
By invoking the suicide trope, individual activists, organizations like the ACLU, and Democratic politicians are violating well-recognized, research-based guidelines on how to talk responsibly about suicide. That they do so with such consistency and despite evidence of the danger suggests two possibilities: they are either ignorant about suicide and its prevention, or they are invested in the suicide narrative and its political advantages more than in reducing the likelihood of suicide in vulnerable youth.
Decades of research suggest that suicide is a socially contagious behavior, especially in youth. In 1994, the Centers for Disease Control and Prevention published a document titled “Suicide Contagion and the Reporting of Suicide: Recommendations from a National Workshop.” In a section titled “Aspects of News Coverage That Can Promote Suicide Contagion,” the CDC cautioned against “[p]resenting simplistic explanations for suicide.” Suicide, it explained, “is never the result of a single factor or event, but rather results from a complex interaction of many factors and usually involves a history of psychosocial problems.”
Transgender advocacy groups acknowledged the dangers of speaking irresponsibly about suicide and agreed with the CDC’s guidelines—that is, until Republican-majority states started pushing back against medical associations and the Biden administration on the issue of pediatric gender medicine.
In 2017, the Movement Advancement Project (an LGBT advocacy group), the Johnson Family Foundation, and the American Foundation for Suicide Prevention coauthored a document titled “Talking About Suicide & LGBT Populations.” The nation’s leading LGBT advocacy groups officially endorsed it. These included the Human Rights Campaign, GLSEN, the Trevor Project (which focuses on suicide prevention), GLAAD, PFLAG, the Transgender Law Center, SAGE, the Center for American Progress, and the National LGBTQ Task Force. In a section titled “Guidelines for Talking About Suicide in Safe and Accurate Ways,” the document contains this recommendation:
DON’T attribute a suicide death to a single factor (such as bullying or discrimination) or say that a specific anti-LGBT law or policy will “cause” suicide. Suicide deaths are almost always the result of multiple overlapping causes, including mental health issues that might not have been recognized or treated. Linking suicide directly to external factors like bullying, discrimination or anti-LGBT laws can normalize suicide by suggesting that it is a natural reaction to such experiences or laws. It can also increase suicide risk by leading at-risk individuals to identify with the experiences of those who have died by suicide.
This recommendation couldn’t be clearer. Insisting, as the ACLU, CNN, and countless journalists, activists, and Democrats have, that a law restricting access to drugs and surgeries will cause kids to kill themselves is a perfect example of the kind of messaging that “Talking About Suicide & LGBT Populations” considers dangerous.
The document also recommends: “DON’T use social media or e-blasts to announce news of suicide deaths, speculate about reasons for a suicide death, focus on personal details about the person who died, or describe the means of death. Research shows that detailed descriptions of a person’s suicide death can be a factor in leading vulnerable individuals to imitate the act. Also, avoid re-posting news, headlines or social media content with this kind of information.” It adds: “DON’T idealize those who have died by suicide or create an aura of celebrity around them. Idealizing people who have died by suicide may encourage others to identify with or seek to emulate them.”
Pediatrician and “gender-affirming care” activist Morissa Ladinsky apparently did not get the memo about avoiding the description of “means of death” and not “creat[ing] an aura of celebrity” around those who kill themselves. At the annual conference of the American Academy of Pediatrics in Anaheim, California, last October, Ladinsky told an audience of fellow AAP members about Leelah Alcorn, a trans-identified 17-year-old who committed suicide in 2014. To the horror of some of her colleagues, Ladinsky said that Acorn died by “stepping boldly in front of a tractor trailer.”
Ladinsky later gave what some would regard as an apology. “I regret my choice of words that has been interpreted to glorify self-harm.” But no LGBT advocacy group criticized her comments or expressed concern that they might contribute to self-harm among vulnerable youth. The ends of Ladinsky’s rhetoric—maintaining the legality of child sex-change procedures—were apparently enough to justify the means.
To be clear, evidence exists that youth who identify as transgender and feel acute distress over their bodies, especially around puberty, have higher rates of both suicide and suicidality (the latter referring to thoughts of suicide as well as nonlethal self-harm without an intent to die) than population-matched controls. Thankfully, however, actual suicide in this population remains extremely rare. A U.K. study found that the suicide rate among clinic-referred transgender-identified youth was 0.03 percent, or four deaths out of 15,000 gender-distressed minors.
In the United States, where between 2.1 percent and 9.1 percent of youth now identify as transgender; and where rates of diagnoses of gender dysphoria have skyrocketed in recent years; and where, so we are told, these numbers of “trans kids” have always existed, albeit “in the closet,” we would expect to have seen an epidemic of suicides among gender-distressed teenagers before “gender affirming” drugs and surgeries first became available 15 years ago. Yet no evidence of such an epidemic exists. Indeed, rates of suicidal behavior among youth have increased since 2011.
Claims about trans identification being a proxy for suicidality typically rely on apples-to-oranges comparisons. They compare rates of suicidality among youth with trans identification or gender dysphoria with rates among youth in the general population. An apples-to-apples study would compare suicidality rates in the first group with suicidality among non-gender-distressed youth with similar mental health comorbidities (e.g., depression). A recent study did exactly that and found that the disparities in suicidality between gender-distressed and non-gender-distressed youth all but disappeared. For example, in Canada, referred trans-identified natal males had almost 49 times more suicidal behavior than non-referred males but only 1.8 times more than referred (non-trans) males. Among females, the rates were 17:1 (referred to non-referred) versus 1:1 (referred to referred). Youth with gender-related distress are more or less in the same category of risk as youth without gender issues but with similar psychiatric problems.
Studies from multiple countries that offer “gender-affirming care” have shown that the majority of minors referred to pediatric gender clinics are teenage girls with no history of gender-related distress before puberty and with at least one psychiatric diagnosis. Typically, these diagnoses precede the advent of gender issues. Researchers in Finland found evidence of “severe psychopathology preceding onset of gender dysphoria” in 75 percent of patients seen in the country’s gender clinics. In the U.K., the review by physician Hilary Cass of the Gender Identity Development Service found that up to a third of the minors referred for services had autism or other neuroatypical conditions. In the U.S., one study found, 70 percent of pediatric patients are diagnosed with autism, ADHD, or some other mental-health problem prior to receiving a diagnosis of gender dysphoria.
By now it is well-known that members of Generation Z—and young liberal females, in particular—are experiencing one of the worst mental-health crises on record. The crisis is strongly linked with smartphone and social media use, and the social isolation and lack of psychological resilience they breed. The extraordinarily high rate of comorbid mental-health conditions among teenagers who reject their bodies and their sex must be understood against this background. More importantly for this debate, the common comorbid conditions in this population—anxiety, depression, eating disorders, ADHD, autism, and history of sexual trauma—are independently associated with suicidal thoughts and behaviors.
Given the high rates of preexisting psychiatric comorbidities among referred adolescents and the fact that these comorbid conditions are independently linked to suicidality, the transition-or-suicide narrative is very likely a confusion of correlation and causation. It is more likely that teenagers with suicidal tendencies are gravitating toward a trans identity—perhaps believing that the fresh start promised by gender transition will solve their problems—than that some kids are born transgender and are suicidal as a result of being an embattled minority (the “minority stress” theory).
Worse, 20 states and the District of Columbia have enacted bans on so-called conversion therapy, a term misleadingly borrowed from research on homosexuality to mean any form of counselling intended to help youth come to terms with their bodies (or as activist-physician Jack Turban has put it, forcing kids to be “cisgender”). By promising a “quick fix” for a much more complicated and intractable problem, social and medical gender transition obscure the true nature of the current mental health crisis and put viable solutions even further out of reach.
When it comes to suicide, the ACLU and its de facto client, the American gender industry, are woefully out of step with a growing international consensus. In January, Riittakerttu Kaltiala, chief psychiatrist of the pediatric gender clinic at Finland’s Tampere University and the country’s top expert in the field, told Finland’s liberal newspaper of record that it is “purposeful disinformation” to say that denial of gender “affirmation” will result in suicides. Presumably recognizing the risk of inadvertently fueling suicidal behaviors among vulnerable youth, Kaltiala said that such messaging was “irresponsible.”
There is a reason why systematic reviews of evidence in Europe and Florida examined the link between suicidality and “gender affirming” hormones and found that the certainty of evidence for benefits was “very low.” Studies that purport to demonstrate benefits suffer from severe methodological weaknesses. One study from Sweden found that adult transsexuals who had undergone full medical transition had a suicide rate 19 times higher than population-matched controls, though the study’s design makes it impossible to say whether the high suicide rate was because of their transition.
Medical authorities in Sweden, Finland, the U.K., and (most recently) Norway are not indifferent to teen suicides; they have simply been able to put the problem in its proper context, avoiding moral panic or activist manipulations.
The ACLU’s irresponsible suicide rhetoric must be understood against the collapse of its historic mission as defender of civil liberties, a collapse precipitated by the infusion into the organization of a younger generation of activists schooled in academic “critical social justice.” The ACLU has become one of the most powerful forces driving the expansion of the “civil rights” state, often at the expense of civil liberties. In 2020, one of its star attorneys currently working on LGBT issues and representing the organization in the media, Chase Strangio, publicly declared that “stopping the circulation of this book [Abigail Shrier’s Irreversible Damage] and these ideas is 100% a hill I will die on.” And this, to emphasize, comes from a lawyer at an organization that has defended the constitutional right of neo-Nazis to march through a predominantly Jewish neighborhood, where many Holocaust survivors lived.
The ACLU has gone all-in on illiberal trans activism, allowing young attorneys like Strangio to disseminate falsehoods about medical science and compromise an organizational reputation earned, lawsuit by lawsuit, over more than a century. It is time for ACLU leadership to hold its staff accountable—if not for defending medical practices other countries have recognized as harmful, then at least for talking about suicide in irresponsible ways.
Photo by Jason Kempin/Getty Images for TBS