When I have questioned the allegedly urgent need for thousands of teenagers to permanently alter their bodies through surgery and to become lifelong sterile hormone-injecting patients, I have heard this response: “They need to be affirmed or else they will commit suicide.” It has always struck me as a bizarre argument, in that this simplistic approach urges that therapists cease acting as real-life therapists (by ignoring alternate potential causes for the “transgender” issues) and that these therapists serve merely as rubber stamps. Equally strange, many of those who dare to question the trans narrative have been shut down and fired. See here and here and here. Trans Right Activists (TRA’s) proudly violate the sage advice of John Stuart Mill and Karl Popper, who urge us to vigorously question all claims. They also violate Jonathan Rauch’s critically important advice from his excellent book, The Constitution of Knowledge (these excerpts at pp 88-89):
[L]iberal science’s distinctive qualities derive from two core rules, and that any public conversation which obeys those two rules will display the distinguishing characteristics of liberal science. The rules are
- The fallibilist rule: Ho one gets the final say. You may claim that a statement is established as knowledge only if it can be debunked, in principle, and only insofar as it withstands attempts to debunk it. That is, you are entitled to claim that a statement is objectively true only insofar as it is both checkable and has stood up to checking, and not otherwise. In practice, of course, determining whether a particular statement stands up to checking is sometimes hard, and we have to argue about it. But what counts is the way the rule directs us to behave: you must assume your own and everyone else’s fallibility and you must hunt for your own and others’ errors, even if you are confident you are right. Otherwise, you are not reality-based, [and]
- The empirical rule: No one has personal authority. You may claim that a statement has been established as knowledge only insofar as the method used to check it gives the same result regardless of the identity of the checker, and regardless of the source of the statement. Whatever you do to check a proposition must be something that anyone can do, at least in principle, and get the same result. Also, no one proposing a hypothesis gets a free pass simply because of who she is or what group she belongs to. Who you are does not count; the rules apply to everybody and persons are interchangeable. If your method is valid only for you or your affinity group or people who believe as you do, then you are not reality-based.
Leor Sapir has examined this alleged connection between denial of affirmative care and suicide. Here is an excerpt from his article, “Pediatric Gender Medicine and the Moral Panic Over Suicide Hyperbolic rhetoric about suicide rates may do more to increase suicide than prevent it“:
The affirm-or-suicide mantra has become the central strategy of contemporary transgender activism, and at times it would seem that activists have little else in their rhetorical arsenal. Federal courts have used it to impose new policies on schools under Title IX. When Florida passed the Parental Rights in Education Act—a law that limits classroom discussion of gender identity and sexual orientation to “age appropriate” circumstances and that requires schools to notify parents when their children are being “socially transitioned” to the opposite gender—Secretary of Transportation Pete Buttigieg agreed with his husband Chasten that it would “kill kids.” Florida’s law was in response to, among other things, books like Gender Queer: A Memoir, which contains graphic depictions of oral sex, appearing on school library shelves. The book’s “non-binary” author, Maia Kobabe, countered that her book’s presence in libraries was “life-saving.”
A few weeks later, transgender Assistant Secretary for Health and Human Services Rachel Levine used the same word to justify the federal government’s support for “gender affirming” interventions. Neither Levine nor President Biden, who has given his own imprimatur to the controversial practice, seemed to care much that Europe’s most progressive welfare states have been moving in the opposite direction, placing strict limitations on the use of puberty blockers to treat adolescents in distress presumably because of their “gender.” Scandinavians are not indifferent to teen suicide. Rather, they have examined the evidence behind the affirm-or-suicide claim and have found it wanting.
Despite the unwaveringly confident manner in which these claims are often asserted, there is no good evidence that failing to “affirm” minors in their “gender identity” will increase the likelihood of them committing suicide. As I discuss below, that claim is based on a small handful of deeply flawed studies that, at most, find loose correlations between “affirming” interventions and improved mental health. Some find no reduction of suicide at all, and a new study claims to find that puberty blockers actually increase the risk of suicide.
Not only is the empirical basis for the affirm-or-suicide mantra shoddy at best, but its dissemination is also profoundly irresponsible. Such extreme rhetoric limits our ability to better understand and respond to mental health problems in vulnerable youth, and may itself contribute to the real and documented phenomenon of “suicide contagion.”
What is wrong with the studies upon which activists rely to claim that failing to affirm will cause suicide?
Firstly, surveys of TIY suicidality rely on self-report and do very little to vet respondents when they say they “attempted” suicide. Secondly, studies purporting to show that TIY are at elevated risk of suicide tend to compare suicide rates in TIY with rates in non-TIY—a deeply misleading comparison. This is because TYI, especially among the new clinical cohort of “rapid onset gender dysphoria” (ROGD) teenagers, exhibit extraordinarily high rates of mental health problems (psychological co-morbidities) quite apart from their gender-related distress.
