Just Read: The exceptionally higher suicide attempt rate for trans* persons who have sought medical care

“In looking at the percentages reporting a lifetime attempt within various subgroups of the overall sample, we repeatedly found “lows” in the range of 30 to 40 percent, while the “highs” exceeded 50 or even 60 percent.”

“Our findings suggest that non-disclosure may function differently for transgender and gender non-conforming people.”

“Sixty percent of respondents who said they had been refused medical care because of anti-transgender bias reported a lifetime suicide attempt.”

Taking these quotes one by one:

  • Do we know of any other population whose average rate of suicide attempts, is 41%? That makes suicide attempts a normal occurrence.
  • For Lesbian, Gay, Bisexual people, disclosure, being who you are, is protective, supportive of health. For people who are transgender, it is not. It is associated with increased threat.
  • Medical care, which is frequently (21% of the time) denied to people who are transgender, (this number does not take into account routine exclusions for medically necessary care in insurance) is associated with an even higher suicide attempt rate, 60%. To heal, you have to not harm; what is health care here for, to quote Gary Cohen?
What should not be deduced from this data, due to the methodology
  • Death rate from suicide. That was not assessed.
  • Whether or not medical care reduces suicidality. The question was asked as “have you ever” so it is not related temporally to pre- or post- medical care (this is addressed in other studies that show benefit from care)
  • The actual attempt rate may be slightly lower, due to the way the question was asked

Feel free to review yourself, and reporting in the Los Angeles Times,  commentary in Slate, and American Foundation for Suicide Prevention.

More than one physician has implied to me that the health of transgender people is not a life or death situation. I hope this clears things up. That and the fact that our generation of physicians is going to change everything 🙂

Let us learn from others

In terms of what it means to change everything, I am finding a lot of innovation in eliminating implicit bias outside of health care as part of the upcoming LGBTQI symposium (see: Crowdsource Request: Being a transgender ally and unconscious bias).

Check this out from a UK Army LGBT Forum training:

Create a culture of acceptance. If there is one bisexual man in your unit his fitting in depends on how open to diversity your unit is. It is NOT based on how hard he tries to fit in.

As usual, I find many analogies to health care. Let us learn. Comments welcome.

Ted Eytan, MD