Review says puberty blocker curb has not led to suicide rise

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 that the way the issue had been discussed on social media was “insensitive, distressing and dangerous”.

The Department of Health and Social Care 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 claims have been led by legal campaign group, the Good Law Project, on X, formerly known as Twitter.

The group 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.

That was recommended in the Cass Review, published in April, which found “remarkably weak” evidence on the use of the treatment.

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.

A Department of Health and Social Care 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.”

The Good Law Project is thought to have based its claims on unpublished figures provided by two members of staff at the now-closed Tavistock clinic.

Project executive director Jo Maugham said: “I was not contacted in advance of the statement being released and will obviously need time to respond. I do have difficulties with the figures and analysis and will respond in due course.”