Why have nearly half of transgender Australians attempted suicide?

Gender identity is at the core of our sense of self.

Transgender people (commonly known as trans) have a gender that is different to what was presumed for them at birth and includes people with a binary (male or female) and non-binary gender.

Being trans is not a choice and trans people have existed throughout history.

Not surprisingly, trans people are diverse and come from all walks of life. Yet transgender Australians are arguably among the most marginalised and socioeconomically disadvantaged groups in our community – a disadvantage that has been magnified by the COVID-19 pandemic.

Our research shows that the situation will only improve if we reduce societal discrimination and ensure safe, low-cost and accessible mental health support services as well as gender-affirming medical and surgical interventions for those who need them.

And trans health research and suicide prevention must also be prioritised.

Grim statistics

The first peer-reviewed study of the health and wellbeing of transgender adult Australians paints a grim state of health.

Of the 928 participants, lifetime diagnosis of depression was reported in 73 per cent and anxiety in 67 per cent.

Most concerningly, 63 per cent reported previous self-harm and 43 per cent had attempted suicide. These statistics are many times higher than rates for the general Australian population.

Shockingly, 33 per cent reported discrimination from employment as a result of being trans, and the unemployment rate of 19 per cent was more than three times the national rate.

Being unemployed is already associated with a 54 per cent higher chance of reporting a lifetime history of suicide attempts.

The COVID-19 pandemic has created additional challenges.

Rates of clinically significant depression have escalated among trans people and, in the midst of lockdown in June 2020, 49 per cent of trans Australians reported thoughts of self-harm or suicide. This is more than three times the national rate.

These statistics were more likely if a person experienced cancellation or postponement of gender-affirming surgery, financial strain or felt unsafe or afraid in their household.

Fear of discrimination

Most Australians take it for granted that we can see a doctor when needed, safely.

However, discrimination when accessing healthcare results in nearly a third of transgender people avoiding medically necessary care.

Being subject to physical assault and widespread institutional discrimination because of a person’s trans status is also associated with over 60 per cent higher odds of reporting suicide attempts.

Outright verbal and physical assault were reported by 63 per cent and 22 per cent of participants respectively.

Many have been subject to past trauma, leading to mistrust and fear of discrimination. These results show that trans people need safe, affirming, and low-cost accessible health services which must be trans-led or co-created with trans community members.

More research is also needed to provide the highest level of evidence to reverse these alarming statistics, lower suicide rates, improve mental health and provide the best gender-affirming interventions enabling trans people to live a life without barriers.

Gender affirmation

Many trans people share an intense, severe distress or discomfort related to parts of their body and/or how other people perceive their gender – known as gender dysphoria. This compels trans people to make steps to affirm their gender, which can ameliorate much of this distress.

Some will affirm their gender socially or legally, by changing their name and pronouns or by wearing new clothing, and some will affirm their gender with hormone therapy to either masculinise or feminise their bodies, or by having surgeries.

This can be lifesaving for trans people, with studies showing access to gender-affirming surgery is associated with better mental health and quality of life. We have found that desiring but not having had gender-affirming surgery is associated with a 71 per cent higher chance of reporting a lifetime suicide attempt.

Despite the clear need, this surgery is difficult to access in Australia.

A lack of experienced surgeons and public funding has resulted in prohibitive out-of-pocket expenses of more than $A20,000. Improving surgical training and public funding for gender-affirming surgeries is critical to address this healthcare gap.

Governments and policymakers must prioritise trans health if this situation is to improve.

A ‘FAIR GO’

As our research suggests, widespread discrimination in almost all aspects of life is arguably the biggest issue for many trans people.

Societal interventions to increase social inclusion and reduce transphobia are needed, but even simple acceptance by family, friends, schools, workplaces and colleagues has been shown to reduce suicide attempts and improve mental health.

This is even more critical during the COVID-19 pandemic which has disproportionately impacted an already vulnerable community.

We all have a role to play to be open minded, to be respectful and to call out discrimination.

Together, we can help create an inclusive Australia that embraces diversity and supports all people, including our most vulnerable, to have a ‘fair go’, receive quality evidence-based healthcare, work, study, live safely and reach their full potential.

If you or anyone you or anyone you know needs help or support, you can contact QLife, which provides trans-inclusive phone/webchat counselling support 3pm-midnight everyday. https://www.facebook.com/qlifeaus/

Banner: The Gender Spectrum Collection/Zackary Drucker