Every parent faced with a child claiming they think they are transgender will have heard the terrifying statistics about high suicide rates when transgender children are not supported in their preferred gender identity. It is frequently mentioned in news reports covering transgender issues and is often a strong emotional motivator for parents to support their child’s wish to transition. It is suggested that ‘affirmation’ and social and medical transition is the only answer to help children with gender dysphoria.

However, is this really true? Is there strong evidence to support this widely held view? We strongly believe that the answer is no.

Although there is no doubt that children and young people suffering gender dysphoria are an extremely vulnerable group deserving of our support and care, the oft-quoted suicide statistics are from surveys which are not robust and there is no evidence that transition is a ‘cure.’

Any risk of suicide is terrifying for parents, every suicide is an awful tragedy and for this reason we feel that exaggerating the risk and constantly using the threat of suicide is extremely unhelpful and irresponsible. We have attempted to sort out the actual facts of this emotive subject, and we present our findings here.

There have been two studies conducted in the UK. We have analysed both in detail as well as contacting the academic groups who carried out the studies. We believe there are fundamental weaknesses in both studies which seriously undermines the claim that suicide is a major risk. We present our findings below.

STUDY 1:

The RaRE study was a lottery-funded project set-up by the LGBT charity PACE. The lead academic was Dr Nuno Nodin from the Royal Holloway University of London (RHUL). A number of different aspects relevant to the LGBT community was investigated. One part of this included asking transgender people about their history of suicidal thoughts and attempts. The full report is here

The study was conducted by questionnaire using a non-probability sampling method. This means that the questionnaire was promoted within the LGBT community and people chose whether or not to fill it in. In total 2078 questionnaires were analysed, however only 120 of these were transgender people, and only 27 of these were under the age of 26 years old. It is only the results from the 27 young trans people that was reported in relation to suicide. Of these 27 young trans people 13 of them reported having attempted suicide at some point in the past. This is where the 48% of all trans youth attempt suicide stat comes from.

We have a number of problems with this study:

We don’t believe that the suicide history of just 27 self-selected trans people is sufficiently large for parents to make life-changing decisions for their children. Participants were not randomly selected. This will mean that trans people who have experienced the most difficulties in life may be more likely to fill in the form. This risks artificially increasing the % of participants with a suicide history. We don’t know when these suicide attempts occurred. Some or all may have occurred after social and/or medical transition and so may not reflect the true suicide risk if trans children are not supported to transition. We also are not told if these 13 young trans people consider themselves gay or straight. Other data from the study shows that people who identify as lesbian, gay or bisexual are almost twice as likely to have attempted suicide that those who identify as straight (34% compared to 18%). This data is more robust than the trans data because it includes 289 LGB and 196 straight people. As LGB is clearly a risk factor for attempting suicide then surely we need to know if the trans people were gay or straight. If the majority of the trans people with a suicide history were gay whereas the majority of trans people with no suicide history were straight then this may have skewed the data making it look like a trans-related increase in suicide when actually it more accurately reflects the fact they were gay.

There is also disturbing evidence that the transgender charity Mermaids has misrepresented the study to make it appear stronger than it really is. This occurred during a presentation at a conference in front of an audience of lawyers, press, NHS representatives and government officials. See article here.

We contacted the lead academic who conducted the research and asked him these questions. He agreed with the limitations of the study that we pointed out. We then asked whether he was aware that his data had been misrepresented by others and presented without making these limitation clear. He agreed it was unfortunate when “research is used by non-scientists in the context of their own agendas” and that he would “continue to clarify the nature and breadth of the RaRE study findings.”

Link to Pace study emails

STUDY 2:

In 2016 Stonewall commissioned the Centre for Family Research at the University of Cambridge to conduct a survey with young people who are lesbian, gay, bi or trans (LGBT), or who think they might be, on their experiences in secondary schools and colleges across Britain. Between November 2016 and February 2017, 3,713 LGBT young people aged 11-19 completed an online questionnaire. The study report is here. Many aspects of LGBT life were asked about in this study. We have summarised the results relating to self-harm and suicide in the table below (Figure 1)

Once again the study was conducted by questionnaire using a non-probability sampling method. This means that the questionnaire was promoted to LGBT students in Secondary Schools and children chose whether or not to fill it in. In total 3717 questionnaires were analysed and of these 594 were from young people who self-identified as transgender. This is significantly higher than the 27 trans respondents in the earlier PACE study. The reported data shows that transgender young people experience high levels of self-harm (84%), suicidal thoughts (92%) and suicide attempts (45%). However, very high albeit slightly lower levels are seen for the non-trans young people.

Figure 1:

Despite the high number of respondents we have a number of major problems with this study. We asked the lead researcher for a methodology report but none was available. In the absence of such a report we followed up with a serious of detailed technical questions (see Figure 2). However, despite repeated requests no answers were forthcoming. There has also been no publication based on this study in any peer reviewed journal so it is impossible to verify the validity of the results. For these reasons we have serious doubts over the robustness of this study and do not believe the data is sufficiently reliable.

The issues with the study include:

The questionnaire used non-probability based sampling methodology and so has all the same limitations as described above for the PACE study. All the data is presented based on self-declared gender identity and not natal sex. This is important since suicide attempts are known to be more common for natal girls compared to natal boys in the general population. Recent GIDS referral data shows that trans-identification is more common in natal girls than in natal boys. These underlying trends will bias the final outcomes. (We have done further work to uncover natal sex of the trans children in this study. Link here) It is unknown what % of the trans respondents also identified as LGB. Was this based on being attracted to people opposite to their natal sex or opposite to their transgender identity? There is also no definition of transgender and it is unclear whether non-binary is included under trans. 13% of respondents reported as non-binary and 16% reported as trans. It is unclear what percentage of trans students were also non-binary. Obvious confounding factors that affect self harm/suicide such as mental health issues were not controlled for in the study.

Link to email

CONCLUSION: There are fundamental methodology issues with both UK studies that report that almost half of transgender young people attempt suicide. This data is poor quality and should not be relied upon by parents when considering how best to support their children. The misuse of suicide figures is ethically questionable.

Our findings were confirmed by the UK Independent Factchecking charity Fullfact, after trans activist Paris Lees made this claim on the BBC 2 Question Time programme in March 2018:

“45% of young trans people in this country, modern Britain, have attempted suicide. Not thought about, attempted.”

Fullfact found:

“We can’t say how representative this is of the young trans community in Britain as a whole – the overall sample was not adjusted to try and be representative.”

(Link here)

The Tavistock and Portman GIDS clinic states that amongst children referred to the clinic “suicide is extremely rare” (taken from the Tavistock evidence base page here).

At a conference in Bristol in October 2017, Dr Polly Carmichael, Director and Consultant Clinical Psychologist at the Tavistock, stated that the PACE survey is “deeply flawed” and that rates of self-harm, distress and suicidal ideation are similar to CAMHS figures overall. Dr Carmichael’s full talk is available on this page and we summed it up in this thread.

Dr Carmichael expressed concerns about the use of suicide statistics in the discourse around gender dysphoric young people which is so negative, and suggests a lack of agency and resilience.

A more rigorous study was published in the journal Pediatrics in 2018: Transgender Adolescent Suicide Behaviour (Toomey et al) uses data on 121,000 adolescents aged from 11 to 19, who were surveyed at schools across the United States. In this study all the risk factors for attempted suicide, including sex and gender identity, sexual orientation, age, race, and parental education, are statistically analysed. Michael Biggs analysed the study results and his finding was that, statistically, the group most likely to report a suicide attempt is gender-non-conforming females, irrespective of how they identify or their sexual orientation.

Michael Biggs’s full analysis was published on the website 4thWaveNow here: Attempted suicide by American LGBT adolescents.

This tallies with our finding that using the word ‘trans’ in the Stonewall school report may be hiding the fact that the highest rates actually apply to young females, now hidden by their identity as ‘boys’. Our analysis is here:

Stonewall School Report: What Does the 45% Attempted Suicide Rate Really Mean?

We have published a previous analysis of the PACE study and how it has been used by lobby groups here:

A Scientist Reviews Transgender Suicide Stats

You can also read a comprehensive analysis by Michael Biggs of the Tavistock GIDS and national suicide figures here. The good news is that suicide amongst young children in England and Wales is vanishingly rare:

Suicide by trans-identified children in England and Wales

Finally, the critical question is does transition help to reduce suicidal ideation? There is evidence to suggest that it doesn’t. This robust, long-term follow-up study showed that after transition transgender people have a 19x higher rate of suicide than matched controls:

The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

This US study from the National Center for Transgender Equality showed increased rates of attempted suicide after both medical and surgical transition.

Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively). https://web.archive.org/web/20150213054306/http:/transequality.org/PDFs/NCTE_Suicide_Prevention.pdf

In a report first published by Transgender Trend, Michael Biggs found worrying negative outcomes for children after one year on puberty blockers in an unpublished report to the Tavistock Board of Directors.

Only one change was positive: ‘according to their parents, the young people experience less internalizing behavioural problems’ (as measured by the Child Behavior Checklist). There were three negative changes. ‘Natal girls showed a significant increase in behavioural and emotional problems’, according to their parents (also from the Child Behavior Checklist, contradicting the only positive result). One dimension of the Health Related Quality of Life scale, completed by parents, ‘showed a significant decrease in Physical well-being of their child’. What is most disturbing is that after a year on blockers, ‘a significant increase was found in the first item “I deliberately try to hurt or kill self”’ (in the Youth Self Report questionnaire). https://www.transgendertrend.com/tavistock-experiment-puberty-blockers/

Every suicide is a terrible tragedy and we must be extremely careful in any message we send to young people on this subject. The Samaritans guidance states that we should avoid speculation about any one ‘trigger’ for suicide and that we need to exercise caution in repeating suicide statistics. We would like to see this advice followed more carefully in the case of young people struggling with gender identity issues.

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