Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review

Abstract

Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender-affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. There is a need for continued research in suicidality outcomes following gender-affirming treatment that adequately controls for the presence of psychiatric comorbidity and treatment, substance use, and other suicide risk-enhancing and reducing factors. There is also a need for future systematic reviews given the inherent limitations of a narrative review. There may be implications on the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed.

Creating a supportive environment for patients who are transitioning

“…5 The healthcare team must also address psychological factors, such as abuse, neglect, anxiousness, depression, and sometimes suicide. 6 Recommendations from the Options for psychological and medical treatment of GD World Professional Association for Transgender Health include seeking a GD diagnosis and psychotherapy treatment before starting medical treatment such as the administration of masculinizing or feminizing hormone therapy. Healthcare providers should require a GD diagnosis.…”

“…5 Being in various stages of treatment spanning over several years can create problems such as depression, anxiety, and thoughts of suicide, leading to increased emotional and mental health concerns. 6 The medical team, including nurses, specialists, and mental health professionals can assist in making decisions and discussing different treatment options for addressing GD. They can guide the patient and the family in the timing of social transitioning, prescribing, and overseeing medical management and support systems within the community.…”

“…These disparities can lead to suicidal thoughts, anxiety, substance and physical abuse, and sexually transmitted infections, as transgender people face stigma and discrimination when seeking help for testing and medical or mental health care. 6,9 Many transgender patients have inpatient and outpatient psychiatric treatments, and nurses can aid their patients through these visits.…”

“…13 Maintaining a good quality of life during the transition for a transgender patient can be critical to the parent or loved one's support system, which helps them with struggles from stigma, prejudice, and violence leading to mental health challenges such as depression, suicide, and homelessness. 6,12 Unfortunately, this is a newer field, and Patients often feel that knowledge of their transgender status may negatively impact their care.…”

Dermatological considerations for transgender and gender diverse patients: An Australian perspective

“…The provision of gender-affirming care can be lifesaving for TGD people. [15][16][17][18] Social transition typically involves the disclosure of one's gender identity to others, changes in gender expression and changes in names or pronouns. Some may subsequently pursue medical intervention through hormonal or surgical management.…”