What are the facts regarding trans youth and suicide?

Taking a second look at the trans youth suicide narrative By Jason Watson RN, MEd Recently published in Jul–Sep 2026 Volume 29, No. 2 Australian Nursing and Midwifery Journal.

There is a narrative that states 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 (1) 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 genderaffirming care. The US Assistant Secretary for Health in 2022 stated that “Genderaffirming care is medical care. It is mental healthcare. 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”.(2)

However, is the trans youth-suicide narrative correct, what does the research say? WPATH believes this narrative to be factual and states it is scientifically proven. However the Cass Review 2024, which is the most up to date and thorough review of current transgender research, states 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.(3) The US Department of Health in 2025 also reviewed the research regarding transgender healthcare (2) and have come to a similar conclusion- that the majority of current research is unreliable.

So if the research pool is built on such shaky foundations (4) how do we know whether this narrative is fact or fiction? To investigate this narrative, I examined the outcomes of six long term historical follow up studies to see what they uncovered. These studies were produced in the Netherlands, Sweden, the United Kingdom, Denmark and Finland.

The strength of these studies lies in their ability to provide a clear before-and after perspective, and that they were published across a range of Western countries. However, most of these studies were initiated decades ago so are less likely to be, as the Cass Review claims, ideologically based’. They also have a significant number of participants in each study increasing the likelihood that the findings are generalisable. The number of participants in these studies ranged between 324 and 15,032, though the average number in each study was 5,667. The duration of each follow-up study ranged between five and 46 years with the average study running over about 31 years.

HOW WERE THESE STUDIES CONDUCTED?

The studies were follow-up in nature either reconnecting with trans participants or re-examining data after individuals had progressed through the transgender pathway. They re-evaluated a number of themes previously examined (at the beginning of the study) including suicidality. Participants ranged in age from as young as 11 at the time they entered treatment and joined the studies, to those in their late twenties and early thirties.

STUDY RESULTS

The Wiepjes 2020 study of 8,163 trans persons (5) over 45 years followed up contact every five years with its original participants. It found that over the period of the study there had been eight transgendered men (*TGM) complete suicide and 41 transgendered women (*TGW). The study suggested that the frequency of suicide for TGM was constant over time- meaning that the rate of suicide did not improve once transgendered healthcare began and was completed. They also stated that the rate of suicide for TGW did decrease over time, and that it decreased once transgendered healthcare began and was completed.

The de Blok 2021 study of 4,568 trans persons (6) over 46 years found that the TGW client group, post receiving transgendered healthcare 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 (7) found that rates of attempted and completed suicides were significantly higher for these trans clients who 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 generalisable.

The Erlangsen 2023 study of 3,759 trans clients over 41 years (8) found there was 92 post treatment TGW suicide attempts and 12 completed suicides. These rates for suicide attempts 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 five years (9) found there were 12 completed suicides during this period of time. They stated that half of these people were aged over 18, when transgendered healthcare 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- indicating that trans suicide rates may be influenced by the presence of mental health diagnoses that commonly co-occur. The study also stated that 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 found there was no increase in the rate of completed suicide or statistical change for trans youth in completed suicide post 2020 when there was less access to puberty blockers and cross sex hormones begun, despite predictions of a ‘suicide surge’ at this time. However, the study noted that where there was an increase, the rate of completed suicide in this group was the exposure to media reports stating that ‘there is a link between gender dysphoria and suicidality’- meaning that exposure to media messages suggesting they would or should experience suicidal thoughts or behaviours contributed to them developing such thoughts or behaviours.

The Ruuska 2024 study of 2,083 trans persons over 23 years (10) indicated that the average age of those entering their study was 18.5 years. This was the only study with a control group of Cis young adults of similar age, stage and from similar location. There were 16,643 in this control group. The study found there were 55 deaths in the study group over this 23-year span. Of those deaths, 20 were by completed suicide (36%). This indicated that compared to the control group, general mortality was 66% higher and death by suicide was 300% higher. That trans people who received transgender healthcare were significantly worse off compared to similar Cis peers. It indicated that receiving transgender healthcare increased the likelihood of experiencing suicidal thoughts and completing suicide.

CONCLUSION

One finding from this analysis that appeared to support the narrative that lack of access to transgender healthcare increases suicide risk comes from the Wiepjes (2020) study, which reported that suicide rates among TGW decreased over time - specifically after transgender healthcare was initiated and completed. However, other results from this study indicated that the rate of completed suicide for TGF’s did not change despite having received transgender healthcare. The four other studies without a control group also clearly indicate that there was no evidence of a reduction in suicidal behaviour from receiving transgender healthcare. They also highlighted an increase in ‘other’ mortality related to receiving transgender healthcare. The Ruuska (2024) study, which included a Cisgender peer control group produced an interesting conclusion, that over the duration of 23 years there was a 66% higher ‘other’ mortality rate and 300% higher completed suicide rate with trans clients. 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. If you or someone you know is in need of support, please reach out to Lifeline on 13 11 14 (available 24/7 in Australia).

Author Jason Watson RN, MEd.

References

1. SOC8, WPATH. wpath.org/publications/soc8

2. opa.hhs.gov/gender-dysphoria-report

3. webarchive.nationalarchives.gov.uk/ ukgwa/20250310143933/https:/cass.independentreview.uk/home/publications/final-report

4. theguardian.com/society/2024/apr/10/gender-medicinebuilt-on-shaky-foundations-cass-review-finds

5. Wiepjes 2020. pubmed.ncbi.nlm.nih.gov/32072611

6. de Blok 2021. sciencedirect.com/science/ article/abs/pii/S2213858721001856

7. Dhejne, 2011. journals.plos.org/plosone/ article?id=10.1371/journal.pone.0016885

8. Erlangsen, 2023. pubmed.ncbi.nlm.nih.gov/37367977

9. Appleby, 2024. gov.uk/government/publications/ review-of-suicides-and-gender-dysphoria-at-thetavistock-and-portman-nhs-foundation-trust/reviewof-suicides-and-gender-dysphoria-at-the-tavistock-andportman-nhs-foundation-trust-independent-report

10. Ruuska, 2024. mentalhealth.bmj.com/content/ ebmental/27/1/e300940.full.pdf

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