Efforts to change people’s gender identity to match what they were assigned at birth are associated with dramatically higher rates of suicide attempts, the first large-scale study of the topic has found. The results back up the positions of several professional associations, who have stated that gender identity conversion efforts (GICE) harm the mental health of transgender people, who already suffer far worse mental health, on average, than the general population.

As more people have started to publicly identify as having a gender different from the one in which they were raised, GICE, also known as “trans conversion” programs have become more prominent. Parents, teachers, or other authority figures who reject a child or adolescent’s gender identification often try to force them into such programs, spurred on by high-profile endorsements and social media, which seek to align gender with genitalia.

Dr Jack Turban of Massachusetts General Hospital asked more than 27,000 transgender adults across the United States whether they had experienced GICE, as well as questioning them about their current and past mental health. Fourteen percent reported one or more GICE, representing almost 20 percent of those who had spoken to a mental health professional about their gender identity.

Those who had experienced a GICE were 2.3 times as likely to have attempted suicide. Where this occurred before the age of 10 suicide attempts quadrupled compared to other transgender people. Results were the same when GICE was provided by psychologists and religious figures.

The study, published in JAMA Psychiatry, also demonstrated the effects last, even for those who survive the suicide attempts. People who had experienced a GICE were 56 percent more likely to describe suffering severe psychological distress in the month before answering the study, as well as being 49 percent more likely to have attempted suicide in the previous year.

The paper acknowledges the study’s nature prevents it providing absolute proof that GICE caused the suicide attempts. People who were more distressed and vulnerable may be more likely to get pushed towards conversion efforts. Nevertheless, the burden of proof now rests with GICE advocates to demonstrate they are not responsible for damage on a vast scale.

GICE supporters will undoubtedly point out the study only included adults who identify as trans, excluding any whose gender was converted to match their assignment. They’ll be less keen to acknowledge the other group who could not participate – those whose suicide attempts proved fatal.

“Gay conversion therapy” programs which attempt to change the sexuality of non-heterosexual people have a well-established association with increased risk of suicide and self-harm, leading to widespread bans. 

However, some vocal opponents of attempts to change sexuality are advocates for GICE. Turban’s work enhances the suspicion the two have similar consequences.