A top British expert on suicide prevention, who was commissioned to conduct an independent review of claims that a ban on puberty blockers would increase suicide in children with gender dysphoria, has found such claims are unfounded and “dangerous”.
The claims had been made by UK transgender activist group Mermaids, and by a legal campaign organisation, the Good Law Project, who asserted that there had been an increase in gender-questioning young people ending their own lives after bring unable to access puberty blockers.
Prof Louis Appleby, a psychiatrist and leading adviser on suicide prevention, said that the data “does not support the claims” – and hit out at the “insensitive, distressing and dangerous” language being used by some activists. He also pointed out that the false claims had been repeated by leading journalists and that there was nothing to suggest that the journalists have examined the evidence for themselves.
He also said that the unfounded claims would risk leaving young people and their families “terrified by predictions of suicide as inevitable without puberty blockers” – and that they risked leading to imitative suicide or self-harm.
He named the Good Law Project as one such source of the false claims. Lawyer Jolyon Maugham, director at the Good Law Project, said that banning puberty blocker for those under-18 would “kill trans children”.
Susie Green, former chief executive of trans charity Mermaids and director at GenderGP, accused British Health Secretary, Wes Streeting of having “blood on his hands”.
“I am so angry and desperately sad right now. How dare Wes Streeting put so many trans kids at risk by continuing this murderous ban. I was hopeful that a new Government meant a new start and less transphobia by those in charge. Blood. On. His. Hands,” she wrote on X.
But Prof Appleby found no evidence that this was the case – and was highly critical of those making the claims saying that the way that the “issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide”.
He said that the “central claim” made by activists was that “there has been a large rise in suicide by current and recent patients of the Gender Identity Development Service (GIDS) service at the Tavistock since an earlier restriction of puberty-blocking drugs that followed a High Court decision in a case (Bell v Tavistock) in December 2020.”
“The rise is described as a “surge” in suicides and “an explosion”, indicating a substantial and, by implication, unequivocal increase. There are multiple references to children dying in future because they are unable to access puberty-blocking drugs,” he said.
“This claim is said to be based on unpublished data provided by 2 members of staff at the Tavistock, described as whistleblowers. On Twitter/X the evidence is presented in screenshots of extracts from the records of Tavistock Board meetings and other documents. These variously refer to suicides, deaths from unspecified causes and “safety incidents”,” he explained in his report.
“A specific claim is that there was one suicide by a patient on the GIDS waiting list in the 3 years before the High Court judgment, and 16 deaths (rather than suicides) in the 3 years after the judgment. The whistleblowers are said to have alleged a cover-up by NHSE,” he added.
And he pointed out that “these claims have been retweeted thousands of times by other campaigners and members of the public.”
“They have been repeated by some leading journalists, though there is nothing to suggest that they have examined the evidence for themselves,” Prof Appleby added. “They too have adopted the language of “dying children”.”
Having examined the data, Prof Appleby said it does “not support the claim that there has been a large rise in suicide by young patients attending the gender services at the Tavistock since the High Court ruling in 2020 or after any other recent date. The figures for the 6 years covered in this review are 12 suicides in total, 2 per year on average, of whom half were under 18.”
“With small numbers, single-figure differences can be expected and causal explanations are unreliable,” he added.
And the expert in suicide prevention hit out at how such a sensitive topic was discussed on social media – saying it was “distressing and dangerous”, and went against guidance on reporting around suicide.
“The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide. One risk is that young people and their families will be terrified by predictions of suicide as inevitable without puberty blockers – some of the responses on social media show this,” said.
“Another is identification, already-distressed adolescents hearing the message that “people like you, facing similar problems, are killing themselves”, leading to imitative suicide or self-harm, to which young people are particularly susceptible.”
“Then there is the insensitivity of the “dead child” rhetoric. Suicide should not be a slogan or a means to winning an argument. To the families of 200 teenagers a year in England, it is devastating and all too real.”
Previously, a major review of treatment being offered to children with gender dysphoria, the Cass Review, found that children have been let down by a lack of research and evidence on medical interventions being offered in such care, and that the long term effect of puberty blockers were not well understood. Dr Hilary Cass said that there was no evidence that puberty blockers “buy time to think” or “reduce suicide risk” – and that children who present as transgender should not be given any hormone drugs at all until at least 18.
Dr Cass, a leading pediatrician, also warned that the debate around treatment for children with gender dysphoria had become exceptionally toxic.
Prof Appleby, who leads the National Suicide Prevention Strategy for England, said that “children with gender distress may face bullying, isolation and family conflict” and that these were reasons “to be alert to suicide risk”.
“Empathetic support is vital but evidence that puberty blockers reduce risk is weak and unreliable,” he said, adding that “invoking suicide in this debate is mistaken and potentially harmful”.
In his conclusion, the leading psychiatrist said: “The claims that have been placed in the public domain do not meet basic standards for statistical evidence. To be reliable, evidence should be objective, unbiased and open to independent scrutiny. It should admit uncertainty.”
“Campaign groups are often selective about evidence – there is nothing wrong with this until it becomes misleading and potentially harmful. The evidence put into the public domain for an “explosion” of suicides is not unbiased nor has it been independently verified. There seems to be no suicide expertise behind the claims.”
“Suicide by any young person is a profound tragedy: it should be seen as an indictment of our society. Young people with gender dysphoria may well have experienced ostracism and abuse, and their distress is likely to be heightened if services are perceived as rejecting. It is unfortunate that puberty-blocking drugs have come to be seen as the touchstone issue, the difference between acceptance and non-acceptance. We need to move away from this perception among patients, staff and the public.”
“This is a group of young people who need compassion and security, skilled clinical assessment, early treatment for mental illnesses such as depression, support within their families and schools and online, and an expectation of recovery and a fulfilling future. It is vital that these are the assurances the NHS and its partner agencies are able to convey.”
“In the end this is about a group of young people at risk of suicide and our collective responsibility to their safety. This means specialist health services with the capacity to respond to rising demand and appropriate skills in general services. It means a measured public discourse, making sure we do not stoke up prejudice or cause unnecessary alarm to the young people and their families.”