Death by Hate
Gender affirming care saves lives
“For the wages of sin is death”
Romans 6:23 (NRSV-UE)
Trigger warnings: suicide, self-harm, transphobia, violence.
I don’t want to write about this.
I’d much rather talk about allyship, facial feminization, makeup, voice, clothes, gender euphoria, the remake of The Little Mermaid1, or anything else, especially this early in my blog’s life.
But I have to talk about this because this is the underlying issue behind everything else: anti-trans policies and sentiment are deadly. We lost one member of the Christian trans community to suicide in March, and unfortunately I know it won’t be the last time.
Violence against trans people
Violence against trans people is common, including at least 32 murders of trans people in 2022. This violence is heavily skewed toward black trans women.
Black transgender women, such as Shawmaynè Giselle Marie, a 27-year-old nursing assistant killed in June in Gulfport, Mississippi, comprise 63 percent of all recorded victims since 2013.
This is unacceptable, and is made worse when people like conservative commentator Michael Knowles say to applause at CPAC “Transgenderism must be eradicated from public life, entirely.” This is what’s known as stochastic terrorism and rhetoric like it resulted in a bomb threat at a children’s hospital last year.
Make no mistake: many of these murders are driven by hate. But as Christians know, hate itself can be a form of murder.
We know that we have passed from death to life because we love the brothers and sisters. Whoever does not love abides in death. All who hate a brother or sister are murderers, and you know that murderers do not have eternal life abiding in them. We know love by this, that he laid down his life for us—and we ought to lay down our lives for the brothers and sisters. How does God’s love abide in anyone who has the world’s goods and sees a brother or sister in need and yet refuses help?
1 John 3:14-17
The Bigger Problem
Violence by others against trans people is certainly a very real problem. But the far more common cause of death for trans people is suicide.
40% of transgender people have attempted suicide2. If you know two trans people, it’s likely one of them has tried. Unfortunately many of those attempts succeed. My best estimate is that at least one trans person per day dies by suicide34. A summary of stats is available on The Trevor Project’s website.
In a society where hatred, discrimination, and violence are common, one can expect the hated to die by suicide more commonly. And those suicides, just like the murders, are driven by hate5.
Why does this happen?
Personal Experience
I have loved being a woman. I’ve been publicly “out” for the last four months, and getting to live as me has been wonderful. Being on estrogen, and blocking testosterone, has been excellent for my mental health, mood, sleep, etc.
But my goodness, there are days when I have the fleeting thought “why keep going?” It’s when I see something like an anti-trans voice tell me that I’m ruining my children. It’s when I see Republicans loudly and proudly announcing their latest assault on trans rights. And it’s when I hear pastors completely dismiss us as people. And it’s when I hear people who I thought were allies say nothing at all. And it’s when long-time friends doubt my faith just because I’m trans, while not expressing an ounce of humility.
But what about the trans person who has been assaulted for being trans, maybe multiple times. They tell themselves, “maybe if I get this surgery, I’ll be able to pass, and then I’ll be safe.” But what if they don’t have the money, and probably never would? What if they’d been thrown out by their family? And what if they get a message online like I did Thursday night, which simply said: “You’re Satanic.”
It’s illogical - that person still has so much to live for, but that’s the exact sort of situation that leads to tragedy.
I’ve been fine. I’m safe. Please don’t worry about me. But listen: even if the weight of the world only pushes us to have some awful mental health days, but we still survive, why is that acceptable?
Studies
The stats I opened with are alarming and should be sufficient. However, a particularly stubborn piece of misinformation just won’t go away. It states that while trans people do die by suicide at greater rates than others, it’s actually because they transition, or becomes worse if they transition. This is then used to argue against gender transition.
This is a deadly falsehood.
The Karolinska Institute Study
A 2017 book by a Christian author6 said:
According to a 2003 (sic7) Swedish study, life usually gets worse for those who undergo sex-change surgery. Many experience an increase in mental difficulties about ten years after surgery, and their suicide mortality rate ten to fifteen years after surgery is almost twenty times greater than the comparable nontransgender population. Proverbs 14:12 says, “There is a way that appears to be right, / but in the end it leads to death” (NIV).
Joe Carter wrote the following in 2014 for The Gospel Coalition:
A 2011 study at the Karolinska Institute in Sweden followed 324 people who had sex-reassignment surgery (191 male-to-females, 133 female-to-males) from 1973 to 2003. The overall rate of death was higher than expected, with suicide being the leading cause. Those who had the sex-change surgery were almost 20 times more likely to take their own lives than the non-transgender population. They were also more likely to seek in-house treatment for psychiatric conditions.
And this was written in March of this year by Equip (a “Side B”8 Christian organization):
One of the largest and methodologically robust longitudinal studies of surgical transition in Sweden found that sex reassignment surgery effectively alleviated gender dysphoria but failed to adequately reduce suicidality, as compared to the general population.
The Karolinksa Institute study referenced here is commonly used by Republican legislators and conservative commentators arguing against gender-affirming care.
There’s just one problem: the study's own author, Cecilia Dhejne, MD, has spoken out and said that depictions like these are incorrect. I recommend reading the interview with the author here: Fact check: study shows transition makes trans people suicidal – TransAdvocate. Dhejne also endorses the Huffington Post's analysis of the reporting. And finally, she did a reddit “Ask Me Anything” (“AMA”) in July 2016 about it.
Here is her summary of what happened to her research:
Researchers are happy when their findings are recognized and have an impact. However, once your study is published, you lose control of how the results are used. The paper by me and co-workers named “Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden.“ have had an impact both in the scientific world and outside this community. The findings have been used to argue that gender-affirming treatment should be stopped since it could be dangerous (Levine, 2016). However, the results have also been used to show the vulnerability of transgender people and that better transgender health care is needed (Arcelus & Bouman, 2015; Zeluf et al., 2016). Despite the paper clearly stating that the study was not designed to evaluate whether or not gender-affirming is beneficial, it has been interpreted as such. I was very happy to be interviewed by Cristan Williams Transadvocate, giving me the opportunity to clarify some of the misinterpretations of the findings.
So let’s take a look: The study tracked two cohorts of people who underwent gender affirming surgery. The first did so from 1973 to 1988. the second did so between 1989 and 2003.
Key takeaways:
The earlier cohort did show higher suicide rates than the cisgender population.
This is the finding that underlies claims like the ones above.
The latter cohort showed suicide rates similar to the cisgender population
Neither cohort was compared to a transgender population who had not received surgery, which would be the proper control group for demonstrating efficacy.
The study's author interpreted it to show that the better mental health support and greater societal acceptance allowed the latter cohort to have comparable suicidality to the cisgender population.
And this makes sense: even while the earlier co-hort may have attempted to transition, they likely would have encountered a hostile world, inability to get jobs, health care, etc. Trans healthcare was still in its infancy as well.
The latter co-hort, while still not living in an ideal world, likely would have experienced much more support and understanding.
In other words, the shows the need for support for trans people, but has been weaponized to deny exactly that support.
Furthermore:
Regret rate across all surgeries: 14%.
Regret rate for gender-affirming surgeries: less than 3%.
Study from February: Satisfaction was near universal (98%+) among those receiving gender-affirming surgery.
Similarly, Dhejne herself writes (any typos original from the reddit AMA, emphasis mine):
Thank you for asking. I have done study regarding people who applied to legally change back to the sex they were assigned at birth. Between 1960-2010 681 individuals were granted a new legal gender in Sweden. 15 (2.2%) of those applied for reversal to the gender they assigned at birth. During the studied period we saw a significant decline and 11/15 of the regret applications were made of before 2000. The numbers are similar to other studies from Germany. We couldn’t study the reason for that they wanted to retransition. There could be many reasons one is that it was the wrong treatment but there are many others as you mention. Never the less I don’t find the numbers alarming if compared to other medical care they are infact good.
Fifteen out of nearly seven hundred. And she says that the rate of reversal decreased as time went on, further bolstering her claim that greater support led to greater satisfaction. And she further notes that we don’t even know that all fifteen detransitioned out of regret, and that some may have detransitioned for other reasons (social pressure, inability to get a job, etc).9
When therapy turns deadly
On the other side, lack of gender-affirming care does lead to greater suicidality, but with support it falls in line with the general population.
All of those quotes above citing Dhejne’s study have one thing in common: the authors believe no one ever transition. And furthermore, they believe that transition is morally wrong. That is, they’re not weighing in as medical experts “following the science”, they’re weighing in as religious leaders (all evangelical Christian) saying that transition is sin. Thus, even if they knew that Dhejne’s study did prove that transition resulted in fewer suicides, they still would not support transition.
For example: a 24-yo trans woman died by suicide earlier this year after being forced into conversion therapy. She was an undocumented immigrant, fleeing Saudi Arabia due to her gender identity, and her parents managed to work with people in the states to coerce her into conversion therapy on threat of having her deported. When she continued to refuse, and they told her she was going to be sent back to Saudi Arabia, she chose death instead. This story further underscores the risk to trans people from already marginalized groups.
Wikipedia offers this summary of the effects of conversion therapy:
Conversion therapy can cause significant, long-term psychological harm.[2] This includes significantly higher rates of depression, substance abuse, and other mental health issues in individuals who have undergone conversion therapy than their peers who did not,[52][53] including a suicide attempt rate nearly twice that of those who did not.[54] Modern-day practitioners of conversion therapy—primarily from a conservative religious viewpoint—disagree with current evidence-based medicine and clinical guidance that does not view homosexuality and gender variance as unnatural or unhealthy.[2][3]
Here's the table from citation 53 above (“SOGICE” is “sexual orientation and gender identity change efforts”, which is what Conversion Therapy advocates have started to call their “treatments”).
In everything except alcohol usage, SOGICE is worse than doing nothing. And in every case, affirmative therapy is better than doing nothing. 65% of those with SOGICE had depression, vs. 27% with no intervention, and 14% with affirmative therapy. On suicide, 2.5% died by suicide with SOGICE (1 in 40!), while that drops to 0.9% by doing nothing, and 0.1% with affirmative therapy. Doing the math: those subjected to SOGICE are 25 times more likely to die by suicide than those receiving affirmative therapy. It's absolutely unconscionable that anyone would support this, unless there's major, peer reviewed research that shows something different.
And this is all why every major medical organization in the US supports gender affirming care, including for minors.
Bottom line: The hate toward trans people results in deaths and people living lives marked by depression.
Side note: I’ll save “but we wouldn’t affirm someone with anorexia” for another post, but the short answer is this:
Affirming anorexia would result in deaths.
Affirming someone’s gender identity has been proven to prevent deaths.
What do we do?
As we wrap up, I’d like to share this, which I wrote a week ago, after the death of pastor and author Tim Keller.
Two Deaths - by Celeste Irwin
Two people died on Friday.
One was famous, broadly mourned.
As with too many, we lost him to cancer.
He was a writer, a speaker.
A gifted preacher.
He stood for justice.
For some.
The other was unknown.
We don't even know who they were.
Their too-short life was one of shame.
Unwarranted shame.
Often they'd heard: "You can't follow Christ, queer."
But they wanted Jesus.
They knew he had room for them.
Though no one else did.
Churches said, "be different."
Parents spoke "truth" in "love."
And both shunned them.
Because the preacher said, "it's not God's design."
Though they fought it, they died alone.
A light banished to the dark.
And then unceremoniously extinguished.
They died of a different cancer: hate.
It spread until it choked out nearly all love.
A human isn't built to live without love.
And they both met Jesus on Friday.
For the preacher, Jesus was his first love.
For the other, Jesus was their only remaining love.
The preacher saw the other.
What must he have thought?
He knew his teaching was why the other was there that day, decades early.
Jesus asked,
"Tim, what did you do for the least of these?"
and
"How did you love your neighbor?"
"My god,"
he said through tears,
"I helped destroy them."
Keller’s work includes books I’ve loved, and sermons that were so comforting they made me cry. His preaching of the Bible changed my views on business ethics, justice, and racism. I am thankful for that.
But he also stood against LGBTQ+ people, including overseeing The Gospel Coalition, which publishes myriad articles which are anti-trans.
If you are one of many who still speaks judgment toward your LGBTQ+ neighbors, please consider this soberly. For many of us, we don’t even ask that you say we are right. In the churches I’ve been in, nearly everyone disagrees on myriad issues. But for some reason, LGBTQ+ people are called demonic, hellbound, and worse. And that is literally resulting in their deaths.
A word of encouragement
I can’t leave you on that note. Some readers will need to sit with it, or share it with a friend. But, why does this matter? Because each and every person is an image bearer of God. You matter because you are the only one who can live your life. I can’t do it, and neither can anyone else. Whether you’re early in life or in your final years, you are living a human life that has never been lived before and will never be lived again. And God looks at that, and loves that.
Look at the times that Jesus spent just hanging out with people. At a wedding, eating and drinking with friends, and more. I think he truly enjoyed just being around people and seeing the way each of them approaches this life.
You matter because you’re you. And you deserve to live your life because it’s yours.
You deserve to be loved because you are one who bears the image of God in a way that is uniquely yours.
If the phrase “died by suicide” is new to you rather than “committed suicide”, then this footnote is for you. In recent years, “dies by suicide” has become the preferred language. The reason is that suicide is what’s referred to as a “death of despair”, along with drug or alcohol addiction. A person dies by suicide when their mental health declines so far that they see no other options. Saying “died by suicide” recognizes that in that moment, the victim (and they are a victim) perceives no agency. They’re frequently pushed there by others, by hate, by circumstance. “Committed suicide” places the blame entirely on the victim, allowing those still living to not have to ask themselves: What did we do? What could we have done differently?
15-24 year olds die by suicide at a rate of 15 per 100,000. And there are ~43M people aged 15-24. That gives us roughly 6,000 dead in that age range per year, or 16 per day. 20% of youth identify as LGBTQ+, but LGBTQ+ youth are more than twice as likely to die by suicide than their peers. That gives us ~6 LGBTQ+ youth dying every day from suicide. And trans and non-binary youth are even more likely, and are historically maybe 1/5 of LGBTQ+ people. So it comes to this: just between ages 15-24, we’re losing one trans youth per day to suicide. And of course, we’re losing far more than that in other age groups.
I think there’s actually a good argument to be made that they are murder or at least manslaughter, just murder where society is guilty, rather than a specific person or group of people. I may develop that idea in some future post.
I am choosing not to disclose the author’s name at this time, as this article is not about them.
The study was in 2011, not 2003 (the study population was from 1973-2003).
“Side B” is a term that has come to mean that one believes that an LGBTQ+ person can be Christian without “fixing” their LGBTQ+ identity, but rather by choosing not to act on it. So a gay Christian may choose to live celibate or live in a heterosexual marriage. And, regarding trans people, they might say that a transgender person could still feel gender dysphoria but not transition. Contrast with “Side A”, which would be “fully affirming” - an LGBTQ+ person can embrace their sexuality or gender identity and be a Christian. And also contrast with “Side X”, which states that even saying that one is “same-sex attracted” or “wishes they were a different gender” is a sin to be repented of, and (in extreme cases) prevents one from being a Christian if they still experience those desires. I am firmly “Side A”, and wrote at length about it in June 2022. A future post will explore how these apply to transgender individuals.
Some people really do detransition out of regret, but their numbers, per the figures I’ve shared, are very, very small. By most estimates, they’re 2% or less. As with most transgender people, I fully support detransitioners and believe they should have every bit of social support and medical care that they need in their detransition. And most detransitioners appear to support those who transition. This is similar to how the recipient of a knee replacement that goes poorly may still encourage a friend who decides to get one, or a divorcee may attend and celebrate a wedding. Not all journeys are neat and tidy, and I firmly believe that “love your neighbor” means at least “make your neighbor’s journey easier, not harder.”