One in every two adolescents who are born female but identify as male has attempted suicide in the past year, according to a new study.

The study, “Transgender Adolescent Suicide Behavior,” was published in Pediatrics, the official peer-reviewed journal of the American Academy of Pediatrics.

It raises serious questions about how families, schools, doctors, government, and the media should grapple with the increasing number of children and teens who self-identify as transgender.

In addition to the alarmingly high rate of suicide attempts among transgender boys, the study reported an attempted-suicide rate of over 40 percent for adolescents who identify as gender nonconforming (neither exclusively male or female) and nearly 30 percent for transgender girls (children and teens who were born male but identify as female).

Researchers said they did not find any evidence that transgender youth of color were at a higher risk compared with white transgender adolescents. Higher levels of education among parents and geographical location—urban or rural—did not have a significant effect on suicide attempts.

To arrive at the results, three researchers from the University of Arizona analyzed a survey filled out by more than 120,000 young Americans between the ages of 11 and 19.

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