The wave of "transgender affirmation" sweeping our country is an astonishing social and medical phenomenon.  Over the past several decades, "gender specialist" doctors have been treating mentally ill children and adults who have gender dysphoria with cross-sex hormones that block their puberty and alter their bodies in unnatural and permanent ways and have even been cutting off their breasts and genitals to "transition" them to the superficial appearance of the sex they are not.  The primary defense provided by this bizarre medical cult has been that it improves the mental health of patients subjected to such radical treatments, and especially that it helps prevent suicide among young gender-dysphoric patients.

The rigorous medical evidence necessary to prove this claim — that hormonal and surgical castration reduces suicide risk in patients with gender dysphoria — is nonexistent.  For example, a highly cited Swedish study that claimed to show diminished suicide risk in patients following gender-affirming surgery (i.e., surgical castration and mutilation) used invalid statistical methods to buttress its claim.  The investigators reached the erroneous conclusion that gender surgery reduces suicide risk because they unjustifiably excluded some of the highest-risk patients, and they claimed a therapeutic effect that could be more readily explained as mere regression to the mean and as an artifact of compliance with the standard of care for mental illness in patients with gender dysphoria.  Studies that make the claim that hormonal and surgical castration reduces the suicide risk in patients with gender dysphoria are methodologically deeply flawed and often amount to little more than junk science.

There is strong evidence that suicide risk among children and adolescents with gender dysphoria is comparable to or even less than suicide risk among other depressed, anorexic, or autistic kids.  Depression, anorexia, and autism often accompany gender dysphoria.  Suicide risk is increased with social contagion, and trans activists on social media may encourage "trans" kids to threaten suicide to force parents and doctors to give them hormones or surgery.  Talk therapy and appropriate FDA-approved psychiatric medications (e.g., antidepressants) can resolve gender dysphoria in many young patients.  Puberty-blockers, cross-sex hormones, and surgical castration and mutilation can exacerbate mental illness and increase the risk of suicide.

The claim that cross-sex hormones and surgery are necessary to prevent suicide in gender-dysphoric kids is unsupported by medical science, but it's fair to ask a more fundamental question: regardless of the (apparently nonexistent) benefit of cross-sex hormones and surgery in the prevention of suicide, are hormonal castration and genital mutilation an appropriate medical treatment for suicidal ideation to begin with?  In other words, even if hormones and surgery helped prevent suicide (and it doesn't appear that they do), is it appropriate to give patients dangerous drugs and mutilating surgery just because they threaten to kill themselves?

In any other situation, such radical medical care for suicidal patients would be recognized as gross and even criminal malpractice.  I'm a neurosurgeon, and if a patient with body integrity disorder came into my office and asked me to cut his spinal cord and paralyze him because he "identifies" as a quadriplegic (this is a real thing — there are patients who request paralysis), and he told me that he may kill himself if don't do the surgery, my appropriate medical response would be to call a psychiatry consultation in order to provide him the best psychiatric care possible.  A suicidal patient in this circumstance is profoundly mentally ill, not physically ill, and he has no need for surgery at all, let alone surgery to cut his spinal cord.  It would be grossly — even criminally — unethical of me to take this patient to the operating room and cut his spinal cord and leave him permanently paralyzed just because he asked me to paralyze him and threatened to kill himself if I didn't do it.

Doctors shouldn't cooperate in a patient's delusions by providing profoundly harmful and irreversible treatments and surgery, even in response to a suicide threat.  Suicidal ideation is a psychiatric disorder — the body of a kid with gender dysphoria is perfectly normal.  Gender dysphoria is a mental illness, not a physical illness.

Hormonal castration and genital mutilation are not valid medical treatments for gender dysphoria and for the suicidal ideation that may accompany it, any more than surgically cutting a patient's normal spinal cord is a valid treatment for body integrity dysphoria even if accompanied by a suicidal threat.  The appropriate medical treatment for children and adults with gender dysphoria who threaten suicide is good psychiatric care, particularly with the goal of effectively treating the depression, anorexia, autism, and other psychiatric disorders that so often accompany gender dysphoria and are likely to be the primary source of suicide risk.

Professional psychiatric care — not unethical cross-sex hormonal castration or surgical mutilation — is the appropriate medical care for deeply troubled children and adolescents with gender dysphoria.

Dr. Egnor is a professor of neurosurgery and pediatrics at the Renaissance School of Medicine in Stony Brook, New York.

Image via Pxhere.