Suicide by adolescents who identify as transgender

Perhaps the most influential argument for endocrinological interventions on trans-identified teenagers is that it prevents suicide. This argument is encapsulated in the slogan—said to parents of a male child who identifies as a girl—“Better a live daughter than a dead son”.

When looking for evidence for this claim in 2018, I found surprisingly little. One of the first articles to use a high-quality sample survey (Toomey et al. 2018) emphasized the unique vulnerability of transgender teenagers. Scrutiny of the article’s findings, posted on the blog 4th Wave Now (October 2018), reveals that bisexual girls were just as likely to report suicide attempts as girls who identified as ‘transgender female to male’, with lesbian girls and also highly likely to report suicide attempts./

The divergence between suicidality as reported in surveys and actual death by suicide is well known, but there was no information on the actual suicide rate of transgender adolescents. Using Freedom of Information requests to the Tavistock’s Gender Identity Development Service (GIDS), I found that suicides were fortunately very rare. ‘Suicide by Trans-Identified Children in England and Wales’ was a blog post on Transgender Trend (October 2018) and was reported by the Sunday Times (14 October 2018).

Years later, after a huge increase in referrals to the GIDS, I repeated the exercise, using reports to the Tavistock’s Board of Directors as well as Freedom of Information requests. The suicide rate for teenagers referred to the clinic was significantly higher than for the general population of the same age and sex, but the absolute rate was low: an annual rate of 13 per 100,000. Despite (or because of?) this reassuring finding, my analysis was rejected by four journals before being published as ‘Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom‘ (Archives of Sexual Behavior, vol. 51, pp. 685-90, 2022; though labelled a ‘letter to the editor’, it underwent peer-review).

An American study of 315 teenagers given cross-sex hormones concluded that the intervention improved their mental well-being. Tragically, two committed suicide during the study. My letter to the New England Journal of Medicine (vol. 389, 2023, pp. 1536–37) pointed out that this suicide rate is far higher than I found at the GIDS, where only a minority of patients were receiving cross-sex hormones.

(See also my critique of the claim that puberty suppression reduces suicidality.)