(022) Gender Diversity and Suicidality: Evidence from Population-Based Studies and Intervention Outcomes

Abstract Introduction Suicide attempts are markedly elevated among individuals with gender diversity compared to cisgender populations. Large population-based studies and meta-analyses consistently report lifetime suicide attempt rates between 20% and 43%, with the highest prevalence observed in transgender men and nonbinary youth. Risk is particularly elevated in adolescents and young adults, driven by discrimination, victimization, lack of access to gender-affirming care, and social exclusion. Protective factors include family acceptance, social inclusion, and affirming healthcare environments. Objective To synthesize evidence on the prevalence of suicide attempts among transgender and nonbinary individuals and evaluate the effectiveness of gender-affirming interventions in reducing suicidality, while identifying key methodological limitations in existing research. Methods Findings are drawn from large population-based cohort studies, randomized clinical trials (RCTs), longitudinal observational studies, and umbrella reviews. Data sources include national registries, survey-based cohorts, and clinical studies assessing the impact of gender-affirming hormone therapy (GAHT), puberty blockers, and social transition on suicidality. Analyses typically adjust for age, sex assigned at birth, and calendar period, though control for confounding variables such as baseline mental health and minority stress is often limited. Results Population-level studies demonstrate persistently elevated suicide attempt and mortality rates among transgender individuals compared with cisgender peers, even after statistical adjustment. The American Psychiatric Association estimates suicidality rates of 30–80%, highest prior to gender-affirming treatment. Minority stress, including discrimination and harassment, remains a major driver of risk. Gender-affirming interventions are consistently associated with reduced suicidality. Initiation of GAHT or puberty blockers reduces odds of suicide attempts and suicidal ideation by 38–73% compared to individuals who desire but do not receive treatment. A recent open-label RCT of early testosterone access in transgender and gender-diverse adults found a 73% reduction in suicidality and significant improvement in depression over a three-month follow-up, though limited by small sample size (n=31) and short duration. Observational studies in youth similarly report lower suicidality following initiation of puberty blockers or GAHT. Social transition, particularly when supported by family and community, is associated with improved mental health, although medical and psychosocial interventions appear necessary for maximal benefit. Despite consistent directionality, most studies are limited by small samples, short follow-up, self-reported outcomes, and incomplete adjustment for confounders. Meta-analyses confirm protective associations but emphasize the low-to-moderate overall quality of evidence and the need for rigorous longitudinal and interventional designs. Conclusions Transgender and nonbinary individuals experience a several-fold higher risk of suicide attempts compared with cisgender populations, particularly among transgender men and nonbinary youth. Gender-affirming interventions-including hormone therapy, puberty suppression, and social transition-are consistently associated with reductions in suicidality, especially when embedded in supportive social and family environments. However, the evidence base is constrained by methodological limitations. Future research should employ larger, long-term, and controlled designs to strengthen causal inference and optimize suicide prevention strategies in gender-diverse populations. Disclosure No