Comment on Turban et al. 2022: Estrogen is associated with greater suicidality among transgender males, and puberty suppression is not associated with better mental health outcomes for either sex

Using an online survey of Americans who identified as transgender, nonbinary, or cross- dressers, Turban et al. (2022) find that respondents who accessed cross-sex hormones are less likely to report suicidal ideation and severe psychological distress than those who desired but did not access those hormones. The analysis assumes that the effect of estrogen on males is the same as the effect of testosterone on females. This assumption is falsified by reanalysis of the dataset. Controlling for other variables, females who took testosterone report better outcomes than those who did not, but males who took estrogen are more likely to plan suicide, to attempt suicide, and to require hospitalization for a suicide attempt. Reanalysis also shows that puberty suppression has no statistically significant effect on mental health, which refutes Turban et al.’s (2020) previous claim.