Transgender children are at greater risk of mental health problems

Amid a flurry of cabinet appointments and immigration policies, the Trump administration has announced one thing it will not do: pursue policies that protect transgender children in public schools.

The Feb. 22 announcement rescinds Obama administration guidelines that, among other protections, allow transgender kids to use bathrooms and participate in sports that correspond with their genders, and to be called by their preferred names and pronouns.

In a Feb. 23 news briefing, White House press secretary Sean Spicer said that this is a states’ rights issue. “States should enact laws that reflect the values, principles, and will of the people in their particular state,” he said. “That’s it, plain and simple.”

But this “plain and simple” move could be quite dangerous, even deadly, science suggests. Transgender children, who are born one biological sex but identify as the other, already face enormous challenges as they move through a society that often doesn’t understand or accept them. Consider this: Nearly half (46.5 percent) of young transgender adults have attempted suicide at some point in their lives, a recent survey of over 2,000 people found. Nearly half. For comparison, the attempted suicide rate among the general U.S. population is estimated to be about 4.6 percent.

What’s more, a 2015 study in the Journal of Adolescent Health found that transgender youth are two to three times as likely as their peers to suffer from depression and anxiety disorders, or to attempt suicide or harm themselves. These troublesome stats, based on a sample of 180 transgender children and young adults in Boston ages 12 to 29, applied equally to those who underwent male-to-female transitions and those who underwent female-to-male transitions.

The science is clear: Many transgender kids already have to overcome big challenges. To have the federal government proclaim that it won’t stop states from denying equal protection to transgender children makes a difficult situation even worse.

The American Academy of Pediatrics agrees. On February 23, AAP president Fernando Stein issued a statement condemning the new guidelines. “Policies excluding transgender youth from facilities consistent with their gender identity have detrimental effects on their physical and mental health, safety and well-being,” he wrote. “No child deserves to feel this way, especially within the walls of their own school.”

As that statement points out, policies that run counter to a child’s gender identity can cause harm in several ways. One obvious way comes from the physical effects of not having access to bathrooms. In a study of 93 transgender adults, 68 percent reported having been verbally harassed while trying to use a public bathroom, and 18 percent said they had been turned away from a bathroom. To avoid these confrontations, transgender people often resort to not drinking water or simply holding in their urine, measures that can cause dehydration or urinary tract infections, that same survey found.

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Those are the experiences of transgender adults who were aware of the health effects of not using the bathroom. Now think about how a young transgender child in school might navigate that situation. A school bathroom can be a scary place for any first grader, let alone one who risks ridicule or worse for walking into the boys’ or girls’ room.

Beyond the physical harms of not having access to a bathroom, restrictive policies also carry heavy psychological harms. Rules that fail to recognize these children’s genders create stigma, and these policies may have harmful consequences on mental health.

The story of same-sex marriage legalization, an issue that’s been around for decades, holds lessons in how policy can influence mental health. Before the U.S. Supreme Court’s 2015 decision to uphold the right of people of the same sex to marry, states had piecemeal policies, creating a natural experiment of sorts. In states that had recently legalized same-sex marriage, fewer teenagers attempted suicide, scientists reported February 20 in JAMA Pediatrics. In the states’ study, the drop was particularly steep for gay, lesbian and bisexual teens, health and social policy researcher Julia Raifman of Johns Hopkins Bloomberg School of Public Health and colleagues found. Although that study can’t determine the cause of the drop, Raifman suspects that the same-sex laws helped reduce negative stigma, and as a result, improved mental health. Mental health benefits have been documented in gay, lesbian and bisexual adults who are in legally recognized relationships. Marriage bans, on the other hand, had a negative effect.

Raifman says that the announcement from the Trump administration “suggests that transgender youth are different, negatively stereotypes transgender youth, gives transgender youth lesser rights, and allows for states or municipalities to use their power to enforce lesser rights.”

Gender is not a choice. Transgender children are quite clear on their gender identity, often from an early age. It’s easy to lose sight of the fact that behind these dreary statistics is someone’s daughter or son, a vulnerable child that the science clearly shows is at a greater risk of suffering simply because of how he or she was born.