Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Heritage Explains

Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Studies finding that “gender-affirming” interventions prevent suicide fail to show a causal relationship and have been poorly executed.

The left continues to push the narrative that so-called “gender-affirming care” for kids (puberty blockers and cross-sex hormones) is necessary to prevent youth suicide. But in reality, the data tell a totally different story, and parents are often kept in the dark. On this episode, we talk with Jay Greene about his new report that shows “gender-affirming care” is not only dangerous for kids, but also why parents (not government) must be empowered to make decisions for their kids. 

Tim Doescher: From The Heritage Foundation, I'm Tim Doescher. And this is Heritage Explains.

Clip: Did you know that almost 2% of us high school students identify as transgender and that number is growing.

Clip: And unfortunately transgender and non-binary teens are four times more likely to suffer from mental illness when compared to their peers. Many feel isolated, misunderstood, or are outright bullied.

Clip: There are medical options to help these teens align with their gender like puberty blockers, and later in life, hormone therapy and surgery.

Clip: And preliminary data does suggest that gender-affirming care can improve mental wellness, but many states outright ban transgender care citing that it's harmful for teens under a certain age.

Doescher: That clip was taken from a recent PBS special that examines gender-affirming care for kids. Yes, PBS, the same place your kids watch Sesame Street, your tax dollars hard at work, but that's a separate issue entirely. Let's ask this question. What is gender-affirming care? Well, it's a supportive form of healthcare consisting of an array of services that may include medical, surgical, mental health, and non-medical services. Early gender-affirming care is crucial to overall health and wellbeing. Now, that definition and statement of gender-affirming care was not taken from a special interest group or a PBS special or a left-leaning think tank. It was taken from the Biden administration's Health and Human Services website. They rely on a few studies that claim if gender-affirming care is not promoted and provided, there's an increased risk of mental health problems, including an increase in the suicide rate among kids. Now, one thing that's absent from the HHS, any mention of a parent's role. Here's Senator Mike Braun questioning HHS, Secretary Xavier Becerra about gender-affirming care, puberty blockers, and sex change surgery.

>>> Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Senator Mike Braun: In what case would it be appropriate to perform irreversible sex change surgery on kids?

Xavier Becerra: Those decisions are made by that individual in consultation with physician and caregivers, and no decision would be made without having consulted appropriately.

Doescher: So to sum it up, the federal government is now in the business of supporting a child's confusion about what gender they are, giving them puberty and hormone blocking drugs, and then potentially supporting surgical procedures to eventually finish the transition all without consulting their parents. Now, I have questions. I'm sure we all have questions. Now, we're told we must support a child's confusion and that these are just temporary drugs that have no lasting impact on kids. We can just pause puberty with virtually zero consequences. But what do the facts actually say? Is the claim that increased suicide risk if we don't allow unfettered gender-affirming care true?

Doescher: Jay Greene is a senior research fellow here at the Heritage Foundation. He decided to take this head on and go in depth on the so-called science that supports use of puberty blockers, cross-sex hormones, and youth suicide. On this episode, he exposes the shotty science guiding the left's claim about so-called gender-affirming care. And he'll contradict the left showing that easing access to puberty blockers and cross-sex hormone for minors without any parental consent actually increases suicide rates. Now we're going to talk about why parents need to not only have a role in these decisions, but the leading role, right after this.

>>> Tired of hoax stories? Fed up with toxic partisan coverage? There is a better option. The Daily Signal delivers news that matters to you on culture, politics, and current events. Stay up to date on the real news of the day, subscribe to the Daily Signal wherever you get your podcasts, because you can handle the truth.

Doescher: Well, Jay, now you've gone and done it. You've poked this hornet's nest and you have actually done this thing in a way that demands, it demands, we could probably spend hours talking about this. But your effort here to expose so much of the left's folly in how they're basically just saying, "Hey, puberty blockers on demand. If you think that you've got an issue with gender dysphoria, let's get you on those puberty blockers. Let's slow that process down. And by doing this, we're going to prevent things like suicide, things like depression, all that stuff." Well, you have released this report now that completely turns those arguments, just 180, right, right over. You throw them over. And I wanted to give you a chance here just to kind of set into what inspired this. And now that this effort is out, what do you think some of the next steps are with it?

Jay Greene: Sure. So look, this is what we do at Heritage, we go on the offense. And the other side has been making their offensive argument, which is, if we don't make puberty blockers and cross sex hormones widely and easily available, that kids will die, that they'll despair and kill themselves. And this is being used to coerce policy makers into making these drugs more widely available, and also to coerce parents into agreeing to let these drugs be given to their kids.

>>> Does “Gender-Affirming Care” For Trans Kids Actually Prevent Suicide? Here’s What The Data Say

Doescher: All right, let me stop you here. So let's say I am 11 years old and I'm in my public school classroom. And my teacher says, "Hey, you think you're a girl? You might think you are a boy, actually. They start putting this in there. That's okay. That's fine. And then the little kid says, "Hey, I think I might actually be a girl." A boy says that. Says, "I think I might be a girl." They go to their guidance counselor. Just go through this process here of how we actually get an 11 year old on puberty blockers.

Greene: Yeah. The first step is what's called social transition. So this is before the medical transition of people attempting to change the appearance of their sex. They socially change by beginning to identify as having a different sex, change their name, change their pronouns, change how they're recorded in the school or other official records, change what dorm rooms they sleep in and what bathrooms they visit. And that social transition process can occur at a young age and is unfortunately, and this is the real tragedy is occurring with the exclusion almost always of parents. Parents are not being involved in these processes. So look, it's tough to be a kid, it's tough to grow up and it's hard to figure out what it is to be a man, what it is to be a woman. And the transition into adult man and woman status is complicated for everyone. And as people are struggling with this process of growing up into adult decent humans, kids encounter guidance counselors and teachers at school who may detect these troubles and may begin to encourage children to consider that the difficulties they're having are related to being in the wrong sex, that the sex that they were assigned at birth as it's called, is not their true sex.

Doescher: We've been talking about this for years, just the corruption of the classroom, how we're getting a hold of kids' minds and allowing them to justify delusion basically instead of correcting, instead of guiding, we're playing along right with it. Now, what would it say? So they say, well, Hey, you think that you might be a girl, well, let's pause this puberty process before it starts. [inaudible 00:09:55] Yeah. Well, they keep using that word and I want to make sure that we engage their argument here.

Greene: Well, pause sounds like that's the conservative approach, the cautious approach.

Doescher: Right, right, right, right.

Greene: Of just slowing things down. But actually I think what they're doing is the aggressive intervention. And what I think we are advocating for are policies that would actually pause. That is, when kids are having these difficulties with their gender identity, that instead of pushing them along for social transition and then medical transition with puberty blockers and cross sex hormones, and then eventually surgery. Instead of rushing them down that runway, we should instead give kids time and space and get parents involved so that families together can think through these issues and work out kids problems. And look, this is affecting particularly kids with mental health issues where they think maybe the solution to the problems they're having with depression, anxiety, or kids on the autism spectrum are particularly being targeted for this. And what we're doing is we're not attending to those problems, we're instead suggesting to these kids that their problem may have to do with being in the wrong body and we're going to change their body pharmacologically.

Doescher: Yeah. And when they say pause, it's like, can you pause something so ingrained into our ... That's what we do, we go through puberty. We grow up, we are born the gender we are born with, period. The notion that we are somehow implanting in kids' mind that we can pause that and then you can choose is a complete corruption.

Greene: Right. They claim that children despair when how they identify in their mind does not correspond to their body. And the one-two punch of puberty blockers, and cross-sex hormones, puberty blockers stop the development of what are called secondary sex characteristics. These are things like body hair, facial hair, fat distributed in either a male or female way on the body. Puberty blockers block that, stop that because it stops the development of these secondary sex characteristics. That's the one punch. The two punch is the cross-sex hormone, which then develops the secondary sex characteristics of the sex that the child is aspiring to be. So it creates facial hair for people who are born girls, and it creates breasts for people born boys. And so they're developing secondary sex characteristics with the use of these hormones. So that's the one-two punch of this intervention.

Greene: And they claim that if you don't do this, that kids will despair because of the discord between how they think of themselves and how they look, and they will then kill themselves. And I should talk a little bit about why they believe that. First, they only have a handful of studies. I believe there are three studies total.

Doescher: Wow.

Greene: That examine the relationship between puberty blockers and cross-sex hormones and suicide rates. Two of which are done by the same person led by Jack Turban at Stanford Medical School. One by something called the Trevor Project, which is a trans-advocacy organization. And both of these efforts, the Turban-led effort and the Trevor Project effort, all they do is they survey young people and they ask them, did you ever seek these drugs? And did you get them? And then they just compare the mental health outcomes of the people who sought and got them to the people who sought and didn't get them. And by the way, importantly, one of the criteria for getting the drugs is being psychologically stable. So of the people who sought and didn't get, one of the big reasons why they might not get it is because they weren't psychologically stable to begin with. These studies don't collect that information. They don't control for it, statistically, they can't. And so then all they're finding is that people who start out with more serious psychological issues report thinking about suicide more later, which has nothing to do with the benefit of the drugs, but has to do with their psychological condition when they started.

Doescher: That's-

Greene: That's the existing literature.

Doescher: That's what you have to then build on.

Greene: That's what I-

Doescher: For your research and then you can confront that as you have in this report. So so again, like we said, you have kind of pushed this on its side, these "studies". Tell us a little bit about what you found.

Greene: Sure. So what we did is we looked at the fact that these drugs didn't even come along in the United States as a one-two punch until 2010. It was not a thing in the US. Puberty blockers were not prescribed for this reason at all in the United States before 2007, with one clinic in Boston, with only a handful of patients. And then it went kind of national around 2010 and it became widespread in its usage by 2015. So we took advantage of the fact that this was something that didn't exist and then did exist. And we also looked at the fact that in certain states, minors could get them more easily than in other states because those states had laws that allowed minors to access healthcare without parental consent, while other states didn't have these laws. And these laws, by the way, predate the transgender issues. So they have nothing to do with the transgender issue. So there are different kinds of states. This treatment comes along. And then what we do is we compare these different kinds of states before and after the drugs come along. And what we find is that in the states where it's easier for kids to get it, after the drugs are introduced, there's a spike up in suicide rates.

Doescher: I wanted to pause just for a second. We're talking about suicide here. We're talking about kids taking their own lives and evidence to suggest that almost an institutionally accepted, certain institutions, certain states, a practice that's accepted could be leading to this, Jay.

Greene: And it's leading to it because it's a craze that's getting everyone caught up in a movement about something that won't solve their problems and leaving unaddressed the real problems they have. Look, we have to help kids when they're in trouble, and we have to be compassionate and caring about kids who are struggling with various mental health issues and who also are trying to sort out what it is to be a man and what it is to be a woman.

Doescher: Sure.

Greene: And look, a lot of this kind of sorting out process that used to occur in the past is now being weaponized into this issue now. We've always had girls who were tomboys, who like sports, and we've always had boys who liked things that were more feminine.

Doescher: Sure.

Greene: And we didn't say just because you liked those things that you are now a girl or now a boy. And in some ways we're reinforcing rigid gender stereotypes with this gender ideology movement, when before, we actually allowed people to be more complicated.

Doescher: But Jay, this isn't like a fringe movement, the White House is talking about this stuff.

Greene: Yeah. Yeah.

Doescher: The highest office in all the land is talking about this.

Greene: And look, it's not-

Doescher: As if it's valid.

Greene: It's also not evenly affecting the entire population right now. Right now, it's particularly affecting highly educated, high income families. So the kind of elite of our society are disproportionately having their kids get caught up in this. But it's going to make its way into all corners of the country eventually, but it's starting there, and that is giving it also disproportionate political power. I think reasonable policy solutions would include raising minimum age for receiving these drugs, tightening eligibility criteria, and ensuring that parents are involved in providing consent.

Doescher: Let's talk about that.

Greene: Sure.

Doescher: Because you talk about a parent's bill of rights. And I wanted to explain that to our listeners because I really do think that could be, it's a huge acknowledgement and it takes back a lot of ground that the left has been trying to take away. BLM, let's abolish the nuclear family. Let's put our hope in the village kind of a thing and not in the individual family unit. Talk about a parent's bill of rights.

Greene: Look, if we recognize the fact the natural right that parents have to raise their children, And that means controlling their education and their healthcare. This is the building block of a decent society and has been throughout history. And it's something that I think Heritage really understands and emphasizes heavily, that that's how we get a decent society is that we have to first protect the family. And if we don't acknowledge that in law and empower families to be in control of these decisions, we're going to have a lot of, because monstrous things can happen when people are messing with other people's kids, but it's much less likely to happen when parents are in charge. And in part, I think it's less likely to happen because parents, when they have children, have hopes and dreams for their children and their hopes and dreams usually include things like getting married, having grandchildren. These are things that they want for their children.

Greene: On average, they don't wish for their sons to become daughters and their daughters to become sons. This is not a thing that most parents are sitting around dreaming of when they have babies. And I think they're being coerced into this process to a high level because they're being told that if they don't go along, their kids will kill themselves. It's this emotional manipulation, it's this extortion that is driving this way beyond where it would otherwise be. If we empower families, we slow this whole thing down and we let families figure it out. And sometimes it's to address serious mental health problems that are unrelated to gender issues. Sometimes it's sorting out gender issues for kids because kids have to figure out what it is to be a grown man or a grown woman, and have to navigate that process to adulthood. And we have to help families do that on their own terms, in their own way, rather than hijack it from the parents and those families.

Doescher: Puberty blockers, cross-sex hormones and youth suicide. Jay, thank you so much for being here with us on this episode.

Greene: Thank you.

Doescher: Wow. That was incredibly eyeopening. And Jay, we are so grateful for you doing that for us. Now folks, if you want to read his report, it's in depth and it's very well documented, log onto the show notes and click the link that we've linked to. If you are compelled by the content of this episode, please go ahead and share it. You can leave us a comment, let us know what you thought. Or you can email us at managingeditor@heritage.org. We check them and we respond. Michelle's up next episode and we'll see you then.

Heritage Explains is brought to you by more than half a million members of The Heritage Foundation. It is produced by Michelle Cordero and Tim Doescher with editing by John Popp.