Compared to the rest of their peers, children with gender dysphoria are reported to have a significantly increased risk of suicide. However, the risk of suicide is also dramatically increased in children diagnosed with depression, autism and eating disorders and other conditions that commonly present in children with gender dysphoria.1,2,3,4 This raises the question whether the gender dysphoria itself increases suicide risk, or if it is the concomitant psychiatric conditions that increase suicide risk.
A review of adolescents and young adults who accessed gender identity services in Finland between 1996 and 2019 concluded: “Clinical gender dysphoria does not appear to be predictive of all-cause or suicide mortality when psychiatric treatment history is accounted for.”5
A wide range of studies have reported high rates of suicidal thoughts or attempts in children with gender dysphoria.
- In New Zealand, 20% of transgender students reported attempting suicide in the past 12 months, compared to 4% of all students.6
- In the United States, 15% of transgender students reported a suicide attempt requiring medical treatment in the last 12 months, compared to 3% of all students.7
- In another American survey, 41% of transgender students reported having attempted suicide during their lifetime, compared to 14% of all students.8
However, as noted by Biggs et al.9:
Respondents who report suicide attempts are not necessarily indicating an intent to die. One survey of the American population found that almost half the respondents who reported attempting suicide subsequently stated that their action was a cry for help and not intended to be fatal.10 In two small samples of non-heterosexual youth, half the respondents who initially reported attempting suicide subsequently clarified that they went no further than imagining or planning it; for the remainder who did actually attempt suicide, their actions were usually not life-threatening. To an extent then, “the reports were attempts to communicate the hardships of lives or to identify with a gay community”.11 Although such elaborate survey methods have not been used to study transgender populations, there is anecdotal evidence for a similar disjuncture. The pediatric endocrinologist who established the first clinic for transgender children in the United States stated that the majority of self-harmful actions that I see in my clinic are not real suicide attempts and are not usually life threatening.”12
Rates of Actual death by suicide have been reported in large studies of individuals with gender dysphoria as follows:
- 1.6% in Holland.13
- 3.1% in Sweden.14
- 2.2% in Belgium. Five adolescents seen by a gender clinic committed suicide over a ten year period.15
- 0.013% in the UK. Most recently the UK Gender Identity Development Service for children and adolescents aged under 18 reported 4 deaths from suicide over a 10-year period (2010 – 2020). This was out of a population of approximately 15000 patients, and equates to an annual suicide rate of 13 per 100 000 or 0.013%.16
Individuals who have hormonal or surgical interventions to treat their gender dysphoria continue to have similar rates of suicide.14 There is no good evidence that attempts at social transition or the use of puberty blockers, opposite sex exogenous hormones or surgery reduces these rates.
Reference list
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2. de Vries ALC, Noens ILJ, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents. Journal of Autism and Developmental Disorders. 2010;40(8):930-6.
3. de Vries AL, Steensma TD, Doreleijers TA, Cohen‐Kettenis PTJTJoSM. Puberty suppression in adolescents with gender identity disorder: A prospective follow‐up study. 2011;8(8):2276-83.
4. Frew T, Watsford C, Walker I. Gender dysphoria and psychiatric comorbidities in childhood: a systematic review. Australian Journal of Psychology. 2021;73(3):255-71.
5. Ruuska SM, Tuisku K, Holttinen T, Kaltiala R. 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 Ment Health. 2024 Feb 17;27(1):e300940. doi: 10.1136/bmjment-2023-300940. PMID: 38367979; PMCID: PMC10875569.
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Sexual Behavior. 2022;51(2):685-90.