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What does the latest research (2020–2025) say about suicide attempt rates among transgender people who received gender-affirming hormone therapy versus those who did not?
Executive summary
Recent peer-reviewed studies from 2020–2025 generally report that gender‑affirming hormone therapy (GAHT) or related medical care is associated with lower rates of suicide attempts and suicidal ideation among transgender youth: for example, GAHT was linked with 38–40% lower odds of a past‑year suicide attempt in one large survey analysis (aOR ≈ 0.62) [1], and clinical cohort studies report large reductions in suicidality after starting puberty blockers or hormones (aOR 0.27; 73% lower odds of suicidality over 12 months) [2]. Analyses of retrospective national surveys and econometric work estimate reductions in lifetime attempt risk (e.g., a 5.7 percentage‑point drop for those starting HRT at ages 14–17, or a 14.4% relative reduction) [3].
1. What the major youth studies found — consistently lower suicidal outcomes after GAHT
Large cross‑sectional and cohort studies from 2020–2023 repeatedly find associations between access to GAHT and lower suicidality in adolescents and young adults: the Journal of Adolescent Health analysis of ~11,900 transgender/nonbinary youth reported GAHT was associated with lower odds of past‑year suicide attempt among under‑18s (aOR = 0.62) [1] [4] [5], and a clinical cohort found initiation of puberty blockers or hormones linked to 73% lower odds of suicidality over 12 months (aOR = 0.27) [2]. These studies adjust for some confounders but remain observational, so they show association rather than definitive causation [1] [2].
2. Estimates from national survey reconstructions and econometric analyses
Researchers using the 2015 U.S. Transgender Survey applied event‑study and econometric methods and report that starting hormone therapy in adolescence is associated with a meaningful decline in lifetime suicide‑attempt risk: an average treatment effect of a 5.7 percentage‑point decrease when HRT began at 14–17 (a 14.4% relative reduction) [3]. Other USTS‑based reports note lower past‑year attempt prevalence among those who received needed medical care (5% vs. 9%) [6]. These analyses strengthen the case that GAHT access correlates with lower suicide‑attempt measures, while still relying on retrospective self‑report data [3] [6].
3. Short‑term clinical follow‑ups vs. longer‑term population records — mixed coverage and limits
Clinical follow‑ups commonly cover the first 6–12 months after starting hormones or blockers and report substantial reductions in depression and suicidality [2]. By contrast, long‑term registry or population studies that separate treatment stages are rarer; some cohort data show many suicides occur while people are still in active diagnostic, hormonal, or surgical treatment phases, which complicates simple conclusions about long‑term mortality after GAHT [7]. Available sources do not offer large, long‑term randomized trials comparing treated vs untreated groups for suicide attempts.
4. Evidence quality, possible biases, and methodological caveats
Authors and commentators note limitations: many studies are observational, rely on self‑reported survey recall (USTS), or have short follow‑up windows; systematic reviews describe "low quality" evidence in some areas and call for more rigorous long‑term studies [8] [9]. Critics have argued some analyses fail to fully account for pre‑existing mental‑health differences or policy/contextual confounders; conservative critiques and some studies claiming different conclusions have provoked methodological disputes in the literature and media [10] [9]. The Lancet commentary and errata referenced highlight specific misinterpretations and overreach in some summaries of the evidence [9] [8].
5. Broader context: social supports, legal environment, and non‑medical factors
Multiple reports emphasize that factors beyond GAHT — family support, nondiscrimination laws, and social acceptance — strongly affect suicide risk. The Williams Institute and other analyses found lower past‑year attempt prevalence for people who received needed medical care and for those with supportive families; states with nondiscrimination protections have had declines in suicidality [6] [10]. Thus, GAHT is typically studied as one element within a broader set of protective factors [6] [10].
6. What is not settled and what reporting gaps remain
Available sources do not offer definitive causal proof from randomized trials, nor do they uniformly report long‑term suicide mortality comparisons between treated and untreated transgender people; some population registries report suicides occurring during treatment phases but do not isolate hormone effects [7] [11]. Systematic reviewers call the evidence base heterogeneous and limited in duration for some outcomes [8] [9]. In other words, strong and consistent associations exist for youth showing short‑term reductions in attempts and ideation after GAHT access, but gaps remain on long‑term mortality and fully‑controlled causal attribution [1] [2] [3].
Bottom line: Multiple peer‑reviewed studies and survey analyses from 2020–2025 point to substantially lower rates of suicidal ideation and attempts among transgender youth who received gender‑affirming hormones compared with those who did not (examples: aOR ≈ 0.62 for past‑year attempts in under‑18s, aOR 0.27 for suicidality over 12 months, and a 5.7 percentage‑point lifetime reduction in some econometric work) [1] [2] [3]. These are observational findings with acknowledged limitations and ongoing methodological debate; social supports and legal protections are important co‑factors in risk reduction [6] [10].