Puberty blocker curb has not led to suicide rise – review

There is no evidence of a large rise in suicides in young patients attending a gender identity clinic in London, an independent review has found.

Professor Louis Appleby was asked by Health Secretary Wes Streeting to examine the data following claims made by campaigners of a rise in suicide rates since puberty-blocking drugs were restricted at the Tavistock and Portman NHS Trust in 2020.

Prof Appleby's review concludes "the data do not support the claim", and he added the way the issue had been discussed on social media was "insensitive, distressing and dangerous".

Jo Maugham, founder of the Good Law Project which has led the claims, said he had "profound difficulties" with the review.

Unsafe language

The Department of Health and Social Care (DHSC) said it was vital that public discussion around the issue was handled responsibly.

Prof Appleby, who is a professor of psychiatry and experienced suicide researcher from the University of Manchester, said online discussions about the issue had gone against guidance on safe reporting of suicide.

"One risk is that young people and their families will be terrified by predictions of suicide as inevitable without puberty blockers - some of the responses on social media show this," he said.

There was also the risk that distressed adolescents hearing that message could be led to copy the behaviour warned about.

He also said the claims placed in the public domain about an "explosion" in suicides "do not meet basic standards for statistical evidence".

The Good Law Project is challenging the decision by the previous health secretary to end the prescription of puberty-blocking drugs by private clinics to children and young people with gender dysphoria.

The case follows the Cass Review, published in April, which found a lack of evidence on the use of the treatment for under-18s.

In response to their claims, the new health secretary launched an independent review led by Prof Appleby which analysed data from NHS England on suicides of patients at the Tavistock clinic, based on an audit at the trust.

Covering the period between 2018-19 and 2023-24, he found there were 12 suicides - five in the three years leading up to 2020-21 and seven in the three years afterwards.

"This is essentially no difference," Prof Appleby says in his report, "taking account of expected fluctuations in small numbers, and would not reach statistical significance."

He adds: "In the under 18s specifically, there were 3 suicides before and 3 after 2020-21."

The patients who died were in different points in the care system, including post-discharge, suggesting no consistent link to any one aspect of care, Prof Appleby noted.

However, he said it was likely there had been a rise over a longer period as more young people at risk came forward with gender identity problems.

'Insufficient evidence'

The Good Law Project based its claims on information provided by whistleblowers at the now-closed Tavistock clinic.

Project executive director Mr Maugham said in a lengthy response to the review on X, formerly Twitter, that this had been combined with public evidence of Tavistock's own minutes.

He said freedom of information requests for official figures had been “rebuffed”, and that Tavistock and NHS England had declined to comment on his findings when approached.

Mr Maugham said the review considered "current and former" Gender Identity Development Service patients, while his figures were directed to the larger group of "those on the waiting list".

The DHSC has insisted that patients on waiting lists were included in the review as well.

A DHSC spokesperson said decisions on children's healthcare must follow the evidence at all times.

“Dr Cass' review found there was insufficient evidence to show puberty blockers were safe for under 18s which is why the NHS has already stopped their routine prescription for children with gender dysphoria.

“We are committed to ensuring children questioning their gender receive the best possible multidisciplinary care, led by expert clinical guidance. That is why we are reforming gender identity services.

“It is vital that the public discussion around this issue is handled sensitively and responsibly.”