What are the Facts about the Relationship between Transgenderism and Suicide?

Taking a second look at the trans youth suicide narrative. Jason Watson RN, MEd.

Republished with permission from Jason’s substack.

---

What are the facts regarding trans youth and suicide? One narrative states that if trans youth are not provided with transgender healthcare suicide risk will increase. The World Professional Association for Transgender Health (WPATH) in its latest standards of care (SOC-8) published in September 2022 state that transgender people are at increased risk of mental health issues, including suicidality, particularly if they face barriers to accessing gender-affirming care. The U.S. Assistant Secretary for Health in 2022 stated that “Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice” (8) p. 23.

At age twelve Clementine  Breen’s parents were told by Dr. Johanna Olson-Kennedy the Director of Trans-youth Health at the Los Angeles Children’s Hospital and the president of USPATH that if she did not start cross-sex hormone therapy she would “commit suicide” (1). The mother of Max Lazzara when she was fourteen was told by her clinicians that transgender youth were suicidal because they were “born in the wrong bodies” and suggested that denying her transgender care would put her at serious risk (2). The psychologist of Ky Schevers at fourteen told her mother that she was at risk for suicide if she would not agree to testosterone treatments (3) and Keira Bell aged sixteen states that during her time at the UK's Gender Identity Development Service (GIDS), she was explicitly told that if she did not receive transgender care she risked severe mental health decline and even becoming suicidal (4) and lastly, Chloe Cole in her testimony before the U.S. House Judiciary Committee in 2023 said doctors told her parents “Would you rather have a dead daughter or a living transgender son?” (5). In all of the above examples, the young person testified that they were not experiencing suicidal ideation or demonstrating suicidal behaviour before being diagnosed with Gender Dysphoria and starting transgendered healthcare. They also stated that their mental health in general worsened once the started these interventions including suicidal thoughts and behaviours.

So, is the trans youth-suicide narrative correct, what does the research say? As you see above, WPATH believes this narrative to be factual and states this is scientifically proven. However the Cass Review 2024 which is the most up to date and thorough review of current transgender research states that there is a dearth of robust research in this field, that the current research is of a disappointingly poor quality and is ideologically rather than scientifically based (6). The U.S. Department of Health in 2025 also reviewed the research regarding transgender healthcare (8) and have now come to a similar conclusion. That the majority of current research is unreliable. So if the research pool is built on such shaky foundations (7) how do we know whether this narrative is fact or fiction?

In order to investigate this narrative, I will examine the outcomes of six long term historical follow up studies to see what these uncover. These studies were produced in the Netherlands, Sweden, the United Kingdom, Denmark and Finland. The advantage of these studies are that they give a before and after view, are published by different western countries, for the majority were initiated decades ago so are less likely to be as the Cass Review claims ‘ideologically based’ and have a significant number of subjects in each study which makes the outcomes more likely to be generalisable.

The number of subjects in these studies ranges between 324 and 15,032, but the average number in each study is 5,667. The duration of each follow-up study ranges between 5 and 46 years but the average study runs over about 31years. So how were these studies run? These were follow-up studies. They reconnected with trans people or re-examine data after the subject had been through the transgender pathway and re-evaluated a number of themes previously examined (at the beginning of the study) including suicidality. The ages these subjects were when they entered treatment and joined the studies were eleven at the youngest and late twenties/early thirties at the oldest.

So what do the studies find?

The Wiepjes 2020 study of 8,163 trans persons (10) over 45 years had follow up contact every five years with its original subjects. It found that over the period of the study there had been eight transgendered men (*TGM) complete suicide and 41 transgendered women (*TGW). They state that the frequency of suicide for TGM was constant over time. That is the rate of suicide did not improve once transgendered healthcare is begun and completed. They also state that the rate of suicide for TGW did decrease over time, that is it decreased once transgendered healthcare is begun and completed.

The de Blok 2021 study of 4,568 trans persons (11) over 46 years found that the TGW client group, post receiving transgendered health care demonstrated significantly higher rates of mortality by heart disease, lung cancer, HIV related death and by completed suicide compared to expected mortality rates in the general Dutch population. With TGM clients post receiving treatment there was also a higher ‘non-natural causes’ mortality rate (which includes completed suicide) compared to expected mortality in the general Dutch population.

The Dhejne 2011 study of 324 trans persons over 30 years (12) found that rates of attempted and completed suicides were significantly higher for these trans clients who have received transgendered healthcare than expected rates for non transgendered peers. The most at-risk stage for these trans clients was post transgendered surgeries where the completed suicide rate was 19 times higher than non-trans peers. The number of clients in this pool however was the lowest of all the studies at 324 and may be less generalizable.

The Erlangsen 2023 study of 3,759 trans clients over 41 years (13) found there was 92 post treatment TGW suicide attempts and 12 completed suicides. These rates for suicide attempt and completed suicide were described as ‘significantly higher’ compared to the expected rates of the general population.

The Appleby 2024 study of 15,032 trans youth (from the Tavistock Clinic in London) over 5 years (14) found that there were 12 completed suicides during this period of time. They state that half of these people were aged over 18, when transgendered health care was well underway or complete, and half of the completed suicides when these youth were under 18 years of age and had started but not yet completed the transgendered healthcare process. These completed suicide rates were similar to the rate for age similar peers who had a mental health diagnosis but did not identify as trans. That is trans suicide rates may be influenced by the presence of mental health diagnoses that commonly co-occur. Also the study states that the completed suicide rates were higher for trans youth than for age similar non trans youth and higher than age similar peers who did not have a mental health diagnosis.

The study also found that there was no statistical change for trans youth in completed suicide post 2020 when restrictions around hormone use began. There was no ‘suicide surge’ which many predicted. This indicates that despite less access to puberty blockers and cross sex hormones there was not an increase in the rate of completed suicide. The study notes that what did increase the rate of completed suicide in this group was exposure to media reports that stated that ‘there is a link between gender dysphoria and suicidality’. So hearing in the media that they would/should be experiencing suicidal thoughts/behaviours, led to them experiencing suicidal thoughts/behaviours.

The Ruuska 2024 (9) study of 2,083 trans persons over 23 years states the average age of those when they entered the study was 18.5yrs. This is the only study with a control group of trans young adults who have NOT received transgendered healthcare. There were 16,643 in this control group. The study found that there were 55 deaths in the study group over this 23yr period. Of those deaths, 20 were by completed suicide (36%). So, compared to the control group general mortality was 66% higher and death by suicide was 300% higher. That is trans people who receive transgender health care are significantly worse off compared to trans people who do not receive transgender health care. This is the clearest indication of all these studies that transgender healthcare does not reduce general mortality and completed suicide. It does indicate however that receiving transgender healthcare increases the likelihood of experiencing suicidal thoughts and completing suicide.

Conclusion:

One piece of data from this examination the seems to support the narrative that if trans youth are not provided with transgender healthcare suicide risk will increase was from the Wiepjes 2020 study where it states that the frequency of suicide for TGW decreased over time, that is it decreased once transgendered healthcare is begun and completed. However, the rest of the results from this study indicate that the rate of completed suicide for TGF’s does not change despite having received transgender health care. The four other studies without a control group also clearly indicate that there is no evidence of a reduction in suicidal behaviour from receiving transgender health care. They also highlight an increase in ‘other’ mortality related to receiving transgender health care. The Ruuska 2024 study which has a control group of trans individuals who have not received transgender health care also has interesting conclusions. They clearly state over the duration of the follow up study of 23 years, that there is a 66% higher ‘other’ mortality rate and 300% higher completed suicide rate with trans clients who do receive transgender health care than with those who do not. The personal narratives from the testimonies above also disagree with the narrative that if trans youth are not provided with transgender healthcare suicide risk will increase. These of course are simply individuals and are not necessarily indicative of all trans or once trans individuals. I think it is safe to state that the pro trans suicide narrative is at least tenuous and at most simply incorrect. This seems to fit with the Cass Reviews narrative that the significant majority of current transgender research is of a disappointingly poor quality and is ideologically rather than scientifically based.