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Does gender affirming care lower youth suicide risk?

The question of whether gender-affirming care lowers suicide risk for youth is a subject of significant debate, with different studies and reviews reaching varied conclusions. While some observational studies report a positive correlation between receiving care and improved mental health outcomes, major systematic reviews and critiques point to a lack of high-quality evidence and methodological weaknesses in the existing research.

Evidence Suggesting a Reduced Risk

Several studies suggest an association between gender-affirming care and a lower risk of suicide or suicidal ideation.

A 2020 study in Pediatrics surveyed transgender adults and found that those who had access to puberty blockers during adolescence when they desired them had lower odds of lifetime suicidal ideation compared to those who wanted them but could not access them [1].
A 2022 study in JAMA Network Open followed a cohort of 104 transgender and nonbinary youths aged 13-20. The study reported that after 12 months, the receipt of puberty blockers and gender-affirming hormones was associated with a 60% decrease in depression and a 73% decrease in suicidality [6].
A 2023 study in the New England Journal of Medicine followed 315 transgender youth in the Netherlands. It found that after two years of receiving hormones, participants’ mental health and psychosocial functioning improved, with a decrease in suicidal thoughts. Life satisfaction and body image also improved, while depression and anxiety remained stable [7].

Criticisms and Calls for Caution

Conversely, other analyses and systematic reviews highlight significant weaknesses in the evidence base, arguing that the link between gender-affirming care and reduced suicide risk is not well-established.

The Cass Review, an independent review commissioned by NHS England, concluded in its interim report that the evidence for medical interventions in youth is of “very low” quality. The review noted that existing studies are often small, lack control groups, and have high rates of patients dropping out, making it difficult to draw firm conclusions about the long-term benefits or harms of treatments like puberty blockers and hormones [3]. The final Cass Review, published in 2024, reinforced these findings, calling for a more cautious approach and emphasizing the need for higher-quality research.
The U.S. Department of Health and Human Services (HHS) was associated with an internal review, posted online by an anonymous author, that analyzed the evidence base for pediatric gender-affirming care [4, 8]. This review concluded that the available studies are of low quality and that a “causal link between hormonal interventions and improved mental health outcomes cannot be established” from the existing data. It pointed to issues like confounding variables and a lack of long-term follow-up [4].
Journalist Jesse Singal, in a detailed critique of the 2022 JAMA Network Open study, argued that the study’s authors misrepresented their own findings. Singal noted that while the study’s abstract claimed significant mental health improvements, the data within the study showed no statistically significant change on its two primary outcome measures for depression and anxiety. The reported improvements in suicidality were from a secondary, single-question measure [2].
A 2024 study in The Journal of Sexual Medicine examined mental health outcomes after gender-affirming surgery in a large national database (not exclusively youth). It found that while overall suicide risk was not higher than in the general population after an adjustment period, there was an increased risk of suicide attempts for certain subgroups, particularly those with pre-existing psychiatric conditions [5]. This suggests that outcomes are not uniformly positive and depend on individual patient factors.

In summary, while some studies show a correlation between gender-affirming care and reduced suicide risk in youth, this finding is contested. Major systematic reviews from health bodies like the NHS and critical analyses of the research highlight a lack of robust, high-quality evidence, preventing a definitive conclusion. The field largely agrees on the need for more rigorous, long-term studies to better understand the effects of these interventions.

Sources

Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation - Pediatrics. This study surveyed transgender adults and argues that there is an association between accessing pubertal suppression during adolescence and lower odds of lifetime suicidal ideation. (https://publications.aap.org/pediatrics/article-abstract/145/2/e20191725/68259/Pubertal-Suppression-for-Transgender-Youth-and?redirectedFrom=fulltext)
Researchers Found Puberty Blockers and Hormones Didn’t Improve Trans Kids’ Mental Health at Their Clinic — Then They Published a Study Claiming the Opposite - Singal-Minded. This article provides a critical analysis of the 2022 JAMA study, arguing that its conclusions are not supported by its own data and that the researchers misrepresented their findings regarding mental health improvements. (https://jessesingal.substack.com/p/researchers-found-puberty-blockers)
Independent Review of Gender Identity Services for Children and Young People: Interim Report - Cass Review (NHS England). This interim report expresses significant caution, concluding that the evidence base for medical interventions for gender-diverse youth is of very low quality, preventing firm conclusions about the benefits and risks of treatment. (https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143846mp_/https://cass.independent-review.uk/wp-content/uploads/2022/03/Cass-Review-Interim-Report-Final-Web-Accessible.pdf)
Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices - U.S. Department of Health and Human Services (Anonymous Review). This document, purportedly an internal HHS review, systematically analyzes the literature and argues that the evidence is of low quality and insufficient to conclude that medical interventions for youth improve mental health outcomes. (https://archive.jwest.org/Research/DHHS2025-GenderDysphoria.pdf)
Examining Gender-Specific Mental Health Risks After Gender-Affirming Surgery: A National Database Study - The Journal of Sexual Medicine. This study found mixed post-operative outcomes, noting that while overall suicide risk was not elevated, certain subgroups (e.g., those with pre-existing psychiatric conditions) had an increased risk of suicide attempts after surgery. (https://academic.oup.com/jsm/article-abstract/22/4/645/8042063)
Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care - JAMA Network Open. This observational study reports that receiving puberty blockers and hormones was associated with lower rates of depression and suicidality among transgender and nonbinary youth over a 12-month period. (https://pubmed.ncbi.nlm.nih.gov/35212746/)
Psychosocial Functioning in Transgender Youth after 2 Years of Hormones - New England Journal of Medicine. This prospective study from the Netherlands reports that after two years of hormone treatment, transgender adolescents showed improved psychosocial functioning, including a decrease in suicidal thoughts. (https://pubmed.ncbi.nlm.nih.gov/36652355/)
An HHS review opposed gender-affirming care for minors. Its author is anonymous. - The Washington Post. This opinion piece discusses the controversy and origins of the anonymous HHS review, providing context on its unofficial nature and the debate surrounding its conclusions. (https://www.washingtonpost.com/opinions/2025/06/26/hhs-review-anonymous-author/)