Do transgender people have a higher suicide rate than victims of slavery and the Holocaust? [2023]

No.

Apr 06, 2023

Two myths about transgender suicide rates refuse to die:

First, that 40%, 41%, or 42% of trans people kill themselves.
Second, that this rate is higher than Jewish victims of Nazi concentration camps AND Black victims of American slavery.

Steven Crowder -- an extremely popular reactionary pundit with 5.9 million subscribers -- has boosted these myths for years. More recently, he promoted these myths in a 2023 tweet:

And it's not just Crowder -- fellow reactionary pundit Matt Walsh recently tweeted out the exact same argument:

As you'd expect, Crowder is wrong. Absurdly wrong. And we can use his own sources to prove it.

What does Crowder believe?

Crowder's argument is fairly simple: Trans people have suicide rates higher than Jewish victims of the Holocaust and Black victims of slavery, because trans people are insane and dysphoria cannot be treated.

He says as much in a 2022 tweet:

More substantively, Crowder gave a source for each of the claims below in a 2022 video:

Attempted suicide rate for transgender individuals is somewhere around 40%, 'kay? And by the way: Doesn't get much better pre- or post-op. It's always between about 40% to 42% based in the data that we have. [....] So, okay, so we have this dramatically high attempted suicide rate. Okay. Now: You might say, well, hold on a second, pre- and post-op, it's because of how mistreated they are.
For that to hold water -- and there might be something there, of course, that transgender people ostracized, I'm not saying they don't -- you would have to compare it against a control. Are there other groups that are minorities that have been marginalized and have their suicide rates been comparable?
Well, gays: It's 7 to 20%.
Blacks during slavery: It's about 7.2%, according to surgeon logs.
Jews in concentration camps: About 25%.

The point of Crowder's argument is clear: Trans people have insanely high suicide rates, which means they're insane and society is not to blame:

So: You have to ask yourself: Is the suicide rate pre- and post-op likely due to societal ostracization? Or, hold on a second, maybe not, because I don't believe that current transgender students have it worse than Jews in Auschwitz or American slaves. We have control after control after control of people who experienced the worst conditions[.] [....]
Got everything you want, you look like a woman, you have all the same rights, you can compete wherever you wanna compete, you're on puberty blockers, you got the estrogen you want, you got the whatever hormones you want -- if you're a woman-to-man, testosterone -- and the suicide rate is still a multiple of Jews in concentration camps, American slaves, and gays, lesbians, not to mention, of course, every other racial minority. It's not even close.

In short: Crowder argues that trans people have astronomically high suicide rates, which don't get better with medical transition or social acceptance, and which are "multiples" of those of American slaves and Jewish concentration camp inmates.

Background: Terminology and measurement of suicide

To understand why Crowder is wrong, all you need are two concepts:

Terminology: Levels of suicidal behavior
Measurement: Prevalence of suicidal behavior

Terminology: Levels of suicidal behavior

Crowder and other reactionary pundits love to compare suicide attempt rates with suicide death rates. This is completely unscientific.

Most suicides fit the 5-step model shown below, taken from Florentine 2010:

A triggering negative life event occurs
That trigger may cause emotional distress
That distress may cause suicidal ideation (vividly imagining or seriously desiring suicide)
That ideation may cause a suicide attempt
That attempt may result in death, injury, or lesser health consequences

Note the four times "may" appears above. Each step is an intervention point: A suicidal person might lose distress (ex: from positive events), stop ideation (ex: stop rumination), stop considering an attempt (ex: if receive emotional support), or survive the attempt (ex: from a less-lethal method).

In fact, this happens in the vast majority of cases, as the graphic below from the Suicide Prevention Resource Center makes clear:

In the USA in 2020, ~12,197k people had suicidal ideation (4.72%), ~1,203k made a suicide attempt (0.47%), and ~46k died from suicide (0.013%). [1] Or:

About 1 in 10 people (9.8%) who ideated later attempted.
About 1 in 26 people (3.8%) who attempted later died of suicide.

Why does this matter? When Crowder compares suicide attempt rates with suicide death rates, he's comparing behaviors at different steps in a process -- one where the number of people at each step is 10 times less than the step before.

Measurement: Prevalence of suicidal behavior

Crowder and other reactionary pundits also love to compare lifetime suicide rates with past-year suicide rates. This is completely absurd. To understand why, let's talk about prevalence.

The "prevalence" of any condition -- such as a disease or behavior -- is the proportion of people who had that condition in a specific time period. For example:

The lifetime prevalence of smoking is the % of people who have ever smoked. (~40% of Americans in 2008)
The past-month prevalence of smoking is the % of people who have smoked in the last month. (~20% of Americans in 2008)
The past-day prevalence of smoking is the % of people who have smoked in the last day. (~16% of Americans in 2008)

In the previous section, I showed that prevalence is enormously different for different kinds of suicidal behavior. The same is true for different time periods of suicidal behavior:

Lifetime suicide attempt rate: Between 4.6% (Kessler Borges Walters 1998, n=5877, higher-quality sample) and 2.4% (Baca-Garcia et al 2008, n=42862+43093, larger sample) of American adults report attempting suicide in their lifetime.
Past-year suicide attempt rate: In the 2015 National Survey on Drug Use and Health (NSDUH), 0.6% of American adults report attempting suicide in the past year. (0.5% in 2008-2009 NSDUH.)

In short: Among American adults, the past-year attempt rate is 5x to 8x lower than the lifetime attempt rate.

Why does this matter? When Crowder compares various "suicide rates", he compares lifetime attempt rates with per-year death rates. This is obviously absurd: It's akin to comparing the number of people currently attending high school with the number of people who ever received high school degrees.

Putting it together: Looking at Crowder's sources

John Oliver says that social acceptance and medical transition helps trans people. In response, Crowder asks:

Are there other groups that are minorities that have been marginalized and have their suicide rates been comparable?

(Crowder calls this "comparing against a control", which is not what "control" means in statistics.)

Crowder answers his question by listing off a bunch of other suicide rates. Crowder shows his sources on-screen, but most aren't linked in his "show notes" sources. I've compiled the claims and correct sources below:

Group: Transgender people; Metric: 40% lifetime suicide attempt rate (the real source is the 2015 USTS; Crowder wrongly cites Toomey Syversten Shramko 2018)

Group: Homosexual adults; Metric: 7%-20% lifetime suicide attempt rate (Paul et al 2015)

Group: Jewish people in concentration camps; Metric: 25% per year suicide death rate (Lester 2010)

Group: Enslaved African people on slave ships [2]; Metric: 7.2% suicide death rate during the Middle Passage (about ~80 days; annualized, that would be would be a ~33% suicide death rate per year) (Snyder 2010)

Crowder's sources are fine. It's his interpretation that's garbage. Here's a table that should make it extremely obvious why:

It should be obvious that comparing per-year suicide death rates (#3 and #4) with per-lifetime suicide attempt rates (#1) is absurd. They're different behaviors: One is attempts, one is deaths. And they're different timeframes: One is lifetime, one is per-year.

Crowder doesn't care about these details. He just wants you to see that one number ("40%") is bigger than another ("25%") and conclude that trans people are inherently suicidal and society is not to blame:

You have to ask yourself: Is the suicide rate [high] due to societal ostracization? Or, hold on a second, maybe not, because I don't believe that current transgender students have it worse than Jews in Auschwitz or American slaves.

If Crowder understood his own stats (or even bothered to read the words on screen), he'd understand why this is absurd:

1 in 4 Jewish people in concentration camps and 1 in 3 enslaved African people on slave ships killed themselves every year. Does Crowder think that more than 1 in 3 trans people kill themselves every year? At that rate, there would be no trans people left alive!

In short: Crowder's comparisons are only persuasive if you don't understand the stats he's citing. He certainly doesn't, which is why he tries to compare lifetime attempt rates with per-year death rates.

A graph is worth a thousand words

The evidence above should make it very clear why Crowder's choice to treat these stats as comparable is nonsense. (Hell, some common sense should make that clear.) But most people won't read a long blogpost on suicide measurement to understand why.

We can do one step better: With a little math, we can create comparable death rate statistics and show how absurd Crowder's comparison is.

As far as I'm aware, no high-quality data exists on the suicide death rate of transgender people in the USA. Back in 2012, the Department of Health and Human Services explained that "it is not known whether LGBT people die by suicide at higher rates than comparable heterosexual people", despite the wealth of evidence that suicidality is higher among queer people, because "neither the U.S. death certificate nor the NVDRS identify decedents’ sexual orientation or gender identity".

The world-leading Center of Expertise on Gender Dysphoria (CEGD) at the VU University Medical Center (VUmc) treats nearly all trans people who seek medical transition in the Netherlands. Wiepjes et al 2020 used the CEGD's records to estimate that their trans patients had a suicide rate about 3.6x higher than the Netherlands general public:

The mean number of suicides in the years 2013–2017 was higher in the trans population (40 per 100 000 person years; 43 per 100 000 trans women and 34 per 100 000 trans men) compared with the Dutch population in this time frame (11 per 100 000 person years; 15 per 100 000 registered men and 7 per 100 000 registered women).

That gives us one estimate, based on high-quality data -- though it is from the Netherlands, where social acceptance of trans people is higher than the USA.

As an alternate method, one which uses napkin math to yield a much higher estimate, we can use data on last-year suicide attempt rates from the 2015 USTS. In short, trans respondents to the USTS were 10x more likely to report a suicide attempt than the general public (in the 2015 National Survey on Drug Use and Health (NSDUH)):

If we assume that suicide attempts and suicide deaths follow the same pattern [3], then we can take this ratio (10x) and multiply it by the 2015 general public suicide death rate (13 per 100,000) to get a rate of 130 per 100,000 per year.

For reference: A suicide death rate of 130 per 100,000 per year over 60 years yields a lifetime suicide risk of ~7.5% (compared to ~0.8% for the general public). If we use the Netherlands rate of 40 per 100,000 per year, that yields ~2.3%.

We can take this higher death rate -- about 3 times higher than the actual data from the Netherlands -- and show in one graph how absurd Crowder's comparison is, even against this excessively high rate:

Remember, Crowder said that the trans "suicide rate is still a multiple of Jews in concentration camps [and] American slaves". "It's not even close."

Crowder is right, if the "multiples" he's using are fractions: Among trans people in the US, the suicide death rate is about 1/192x that of Jewish prisoners in concentration camps and 1/252x that of African prisoners in slave ships.

In short: The trans suicide death rate is nowhere close to that of Jewish prisoners in concentration camps or African prisoners in slave ships -- because it's around 200 times lower.

Why does it matter?

It's bad enough that reactionary pundits produce blatant misinformation. We live in an increasingly post-truth era because pundits like Crowder don't care about truth.

But Crowder and Walsh use their misinformation to spread two harmful lies: Neither social affirmation nor medical transition helps trans people. For example, Walsh tweeted:

That’s because the trans suicide rate has absolutely nothing to do with alleged oppression or bullying. The data and history definitively debunks that claim. Trans people kill themselves because of the deep despair that stems from an inability or refusal to accept your own fundamental nature

They're wrong. Here's how the American Psychological Association (APA) summarized the literature in 2015: Affirmation improves trans people's life outcomes:

Guideline 11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans-affirmative care.
Research has primarily shown positive treatment outcomes when TGNC adults and adolescents receive TGNC-affirmative medical and psychological services[.] [....] In addition, TGNC people who receive social support about their gender identity and gender expression have improved outcomes and quality of life[.]

The APA cites dozens of studies to support these claims. This article is already long, but here's a few articles which relate more directly to suicide.

First, there's good reason to believe that gender-affirming medical care reduces suicide attempt rates among trans people. Here's two studies in that direction:

Murad et al 2010: Meta-study: Overall, found that about 80% of patients across studies saw improved life outcomes after gender-affirming hormones + surgery (HRT + SRS). In particular, found that "78% of individuals with [gender identity disorder] reported significant improvement in psychiatric symptoms". In four studies, "suicide attempt rates decreased after sex reassignment but stayed higher than the normal population rate".
Green et al 2022: Large survey: Among 11914 trans or nonbinary youth respondents, gender-affirming hormone therapy correlated with 0.61x rates of depression and 0.62x rates of suicide attempts:

Second, there's good reason to believe that social affirmation reduces suicide attempt rates among trans people. Here's three studies in that direction:

Russell et al 2018: Youth survey: Among 74 trans youth, each additional context where one can use one's chosen name (home, school, work, with friends) correlated with 29% lower suicidal ideation and 56% lower suicidal behavior.
Bauer et al 2015: Adult survey: Among 380 trans adult respondents, lower experienced transphobia correlated with 0.34x lower past-year suicidal ideation and 0.24x lower past-year suicide attempts.
Seelman 2016: Adult survey: Among 2316 trans adult respondents, those denied gender-appropriate housing were 1.54x more likely and those denied gender-appropriate bathrooms were 1.32x more likely to report a suicide attempt in the last year.

In short: Walsh and Crowder want you to believe that trans people are fundamentally broken because they are transgender. As a result, neither social affirmation nor medical transition can help them. They're wrong on all three claims.

Conclusions and shilling

In short: Both Crowder's direct claims (of astronomically high suicide rates) or his argument (that affirmation does not help trans people) are wrong. Really, really wrong. Scientific consensus rejects the latter claim and basic statistics rejects the first claim.

Crowder is full of shit. He and his team are also morally repugnant people. After Crowder cites the 40% stat, his crew jokes:

cohost: You go to a therapist and he just flips a coin.
Crowder: Oh, yes, exactly!
cohost: "Well, looks like you're gonna be pre-pay!"

The cruelty is the point.

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Notes

[1] In 2020, the USA had 258,300k adults and 331,400k people. The ideation and attempt rates are per adult, the death rate is per person.

[2] Crowder incorrectly calls this group "Blacks during slavery". Enslaved black people in the USA had very different suicide rates than enslaved Africans during the Middle Passage.

[3] More formally: Assume that the ratio of [trans suicide death rates] and [overall suicide death rates] is equal to the ratio of [trans suicide attempt rates] and [overall suicide attempt rates]. Or: Assume that trans:general death rates are proportional to trans:general attempt rates.

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