Australia’s largest nursing association recently removed an article challenging the commonly asserted claim that suicide risk increases in the absence of transgender healthcare. Published in the Australian Nursing and Midwifery Journal, the article by registered nurse Jason Watson examined six long-term studies from the Netherlands, Sweden, the UK, Denmark, and Finland that explored suicide risk and mortality among transgender individuals.
The studies included participant cohorts ranging from 324 to more than 15,000 individuals and examined outcomes over periods of 5 to 46 years. Participants entered the studies at various ages, from adolescence through adulthood. Most of the studies were follow-up or registry-based analyses, either reconnecting with transgender participants or examining long-term outcomes after individuals had undergone aspects of medical transition, including hormone treatment and surgery. Several of the studies examined suicidality, mortality, and related mental health outcomes.
Below is a brief overview of the six studies and their findings relating to suicide risk among transgender youth and adults.
Wiepjes et al. (2020)
This Amsterdam cohort study examined 8,263 referrals to a Dutch gender clinic and investigated overall suicide mortality, trends over time, and the stage of transition at which suicide deaths occurred. The authors found that suicide mortality remained higher among transgender individuals than in the general Dutch population. Suicide deaths among transgender women declined over time, while rates among transgender men showed no significant change. The authors concluded that suicide risk remained elevated throughout the transition process and warranted ongoing clinical attention.
de Blok et al. (2021)
This observational study examined 4,568 transgender adults receiving hormone treatment in the Netherlands. The researchers found increased mortality compared with the general population, regardless of treatment type. Elevated mortality did not decrease over the five decades studied and was associated with causes including cardiovascular disease, lung cancer, HIV-related disease, and suicide. The authors noted that most causes of death were not directly attributable to hormone treatment itself.
Erlangsen et al. (2023)
In this Danish nationwide retrospective cohort study, 3,759 transgender individuals identified through national registers were compared with the non-transgender population. The study found significantly higher rates of suicide attempts, suicide mortality, non-suicide mortality, and all-cause mortality among transgender individuals. The authors concluded that transgender people constituted a high-risk group for suicidal behaviour and mortality compared with the general population.
Appleby (2024)
This independent review examined data on suicides among 15,032 young patients seen by the Gender Identity Development Service at London’s Tavistock and Portman NHS Foundation Trust over a five-year period. The review was commissioned to assess claims that restrictions on puberty blockers and hormones had led to a substantial increase in suicides among gender dysphoric young people.
Professor Louis Appleby concluded that claims of a large rise in suicides were not supported by the available evidence and did not meet basic standards of statistical analysis. The report found no evidence of an increase in suicides following the 2020 changes in prescribing practices. The review also noted that young people experiencing gender dysphoria appeared to be at higher risk of suicide than the general youth population, although the evidence base in this area remains limited and methodologically weak.
Ruuska et al. (2024)
This Finnish nationwide register study examined all-cause and suicide mortality among adolescents referred to specialised gender identity services between 1996 and 2019. The cohort included 2,083 gender-referred adolescents and 16,643 matched controls. Initial analyses showed higher overall mortality and suicide mortality among the gender-referred group. However, after adjusting for psychiatric treatment history, neither all-cause mortality nor suicide mortality differed significantly between the groups. The authors concluded that gender dysphoria itself did not appear to predict mortality outcomes once psychiatric morbidity was taken into account and emphasised the importance of identifying and treating co-existing mental health conditions.
Dhejne et al. (2011)
This Swedish population-based matched cohort study examined 324 individuals who had undergone sex reassignment surgery. The researchers investigated mortality, morbidity, and criminal convictions following surgical transition. Compared with matched population controls, the study found significantly elevated rates of mortality, suicide attempts, psychiatric morbidity, and completed suicide. Suicide mortality was approximately 19 times higher than that of matched controls during the follow-up period. The authors concluded that, while sex reassignment may alleviate gender dysphoria, it may not be sufficient on its own and should be accompanied by ongoing psychiatric and medical support. Because of its relatively small sample size, the study’s findings are generally considered less robust than those of more recent large-scale registry studies.
Author’s conclusion
Watson contends that the evidence supporting the claims that denying transgender healthcare raises suicide risk is weak. He also highlights the methodological limitations in much of the current gender medicine research, rendering the evidence low-quality and weak. He notes that the Wiepjes (2020) study is frequently cited as evidence that medical transition reduces suicide risk, yet the study reported declining suicide mortality only among transgender women, while rates among transgender men remained unchanged. He further argues that several of the other studies failed to demonstrate a clear reduction in suicidal behaviour following transgender healthcare interventions and instead documented elevated mortality risks compared with the general population.
In concluding his review, Watson argued that the claim that transgender healthcare reduces suicide risk is “at least tenuous and at most simply incorrect, weak or false”. He suggested that this assessment aligns with the Cass Review’s conclusions that “the significant majority of current transgender research is of a disappointingly poor quality and is ideologically rather than scientifically based.”
Original article here
Check out our other resources on the topic
Appleby L. (2024). Review of Suicides and Gender Dysphoria at the Tavistock and Portman NHS Foundation Trust: Independent Report. UK Department of Health and Social Care.
de Blok CJM, Wiepjes CM, van Velzen DM, et al. (2021). Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria. Lancet Diabetes & Endocrinology, 9(10), 663-670.
Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Långström N, Landén M. (2011). Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS One, 6(2)
Erlangsen A, Jacobsen AL, Ranning A, et al. (2023). Transgender Identity and Suicide Attempts and Mortality in Denmark. JAMA, 329(24), 2145-2153.
Ruuska SM, Tuisku K, Holttinen T, Kaltiala R. (2024). All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996-2019: a register study. BMJ Mental Health, 27.
Wiepjes CM, den Heijer M, Bremmer MA, et al. (2020). Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972-2017). Acta Psychiatrica Scandinavica, 141(6), 486-491.
