A little supplemental reporting on Hilary Cass and the deaths of trans kids in the UK

You thought trans kids dying was bad, but now you have to have math, too.

Check out these bad ass union organizers doing their thing at the University of Michigan last year.

PJ is working with Wonkette on some reporting on a horrifying surge in deaths by suicide among trans youth stuck on the NHS’s forever waitlists. The wait times now average 5 years even though the average child joins the wait list at 13 or 14 and is bumped off the list on their 18th birthday, less than 5 years later. No, they don’t actually ever get care. They’re forced off the child/adolescent waitlist for aging out of a program which never gave them the time of day.

While the NHS has not technically said that minors can no longer receive gender related care, in practice this care is now entirely inaccessible, and kids know it. The results have been shocking. While there was one death on the waitlist during the seven years before December 2020, there were 16 while-waitlisted deaths that whistleblowers are saying were suicides during just 3 years after the strong restrictions on care ended any hope that patients would get actual treatment.

This upswing has been covered other places, but we still hope to provide new and useful information. We’re also hopeful that the main story can be cut down to a readable length — right now it’s thousands of words. So we’re going to try something unique: because I’m a boring as hell math nerd and endless navel gazer, I’m going to lift some of the bits that are important — but that don’t fit in a narrative telling — out of the story-reporting that will eventually be published on Wonkette¹ and drop it here in less-linear chunks. Our first drop will be some math, but I’ll be editing and updating this post over the next little while to make sure that all the important bits end up somewhere — either Wonkette or here — and the people who need the story can access a reasonable version over there, while people obsessed with the details and math can get their fix here.

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So! Math! Here’s your Clump-of-Detail number 1:

The GIDS waitlist seems to have plateaued with about 5,000 minors on it, mostly though not exclusively teenagers. The list may or may not still be growing, but what I’ve read makes me think that we’re now at a place where approximately the same number of newly-minted 18 year old adults are aging off the list as younger people are being added. The 5k number is recent, however, so if the list has been growing rapidly over the last few years, then assuming 5k on the list each year for the past three will tend to overstate the population and thus understate the risk of suicide for minors on that list. The numbers are appalling by any measure, so I prefer to use more conservative estimates when numbers are in doubt lest anyone think I’m overhyping the problem.

There are 7.6 million children and teens in the UK age 10-19. The total number of  deaths by suicide seems to be 200 per year or a little higher. The 16 deaths on the waitlist took place over 3 years. So that’s 5.33 per year, about 1/40th of all deaths in the general 10-19 age population are deaths of trans kids.

With ~5 per year and 5k on the list, we conclude that each year the chance of death on the NHS new “forever waitlist” is one in one thousand or a bit less.

Each year the chance of death by suicide for all UK residents age 10-19 is about one in 38,000.

The quick and dirty calculation, then, would tell you that trans youth on the waitlist have a suicide risk thirty eight times their non-trans peers.

But it’s even worse than that, because suicide rates are elevated at age 18 and 19 compared with earlier ages (in the UK and in many Western nations). It’s very rare to have a 13 year old hurt themselves so badly that they die. At age 18 and 19, there is greater independence to take harmful actions that require time to take full effect and also greater access to different methods. Because of how UK demographics are reported, it’s not easily possible to tease out what the incidence of suicide would be for UK residents age 10-17, but whatever it is, it’s not even as high as 1-in-38,000.

That means that x38 is almost certainly an underestimation of the true relative risk for trans youth on the NHS waitlist for GIDS care compared to all children of the same age in the UK.

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COD 2: Bell v. Tavistock

Without going too deep into the background, an anti-trans activist who had received services at Tavistock — the sole national centre for in England and Wales — “took over” a previously filed suit against the clinic. That suit was initiated by a woman who wanted to prevent NHS from being able to provide any services at all to her 15-year old child. The rationale was that it was literally impossible to obtained informed consent for treatment, partly because the cissexist mom believes gender related care to be “experimental” and partly because cissexist mom believes being trans is evil, bad, sick and wrong, and who would ever really consent to being evilbadsickandwrong?

For various reasons, including that it’s completely insane to think that there’s magically no such thing as informed consent for experimental medicine, the initial case fell apart. This is when Keira Bell stepped in, arguing that she was harmed by doctors who weren’t sufficiently blocking access to therapies, thus leading to outcomes like hers, in which she detransitioned several years after a chest reconstruction (that included mastectomy) at age 20.

The Tory government immediately put restrictions on GIDS in response to the trial court’s ruling (released by the judge on 1 December, 2020). And while the decision was quickly overturned for being, in legal language, “ZOMGLOL, trans health care is different from all other health care based on WHAT?” the government continued restricting care as the waitlist grew.

Very few, if any, children moved off the waitlist and into treatment from the beginning of 2021 on. While Bell v. Tavistock and the Cass Report are kind of separate things, there’s no doubt that the Cass Report was commissioned in response to Bell, nor that the ongoing Cass Report and its “interim findings” were used as excuses to hold to the informal moratorium on care originally imposed as a result of the Dec 2020 trial court ruling.

While policies now might be said to be a response to the final Cass Report, before the end of January this year it’s just as fair to blame the infinite wait list policy on Bell v Tavistock as it is on a wait-and-see stance encouraged by the ongoing Cass review.

This means that for the 3 year period of vastly increased incidence of suicide we’re studying here, it’s not possible to distinguish between the effects of the CR and BvT.

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COD 3: Gender, suicide, and the Cass Report

There are different challenges being a cis man in this world as opposed to being a cis woman. Likewise being a trans man as opposed to being a trans woman, or an AFAB non-binary person compared to being an AMAB non-binary person. We’re all socialized in this highly gendered world, and we all absorb greater or lesser doses of its toxins.

One of the things that I’ve yet to confirm, but appears to be true just from paragraph 5.65 of the Cass Report is that AFAB youth on the GIDS waitlist appear to die of suicide at rates equalling or exceeding AMAB youth on the list. Among cis people, cis men are consistently more likely to complete a suicide than cis women. Part of this comes from women’s tendencies in method of attempt, but there are other aspects to this. (See, for example, the concluding paragraph of this study on suicide and gender.)

While Hilary Cass seems endlessly interested in the fact that requests for GIDS care have increased much faster among AFAB persons than AMAB persons, if the sex ratio of completed suicides seems at odds with the sex ratio among cis persons, the gender ratio may in fact be consistent (though we would need much more information to be sure, and — as impossible as this is — I would rather never acquire another data point on trans youth suicides).

I don’t have a point here so much as more questions. At the minimum, however, if we’re going to adequately prevent suicide among trans youth, we should see detailed, individual idiographic studies of trans suicidality. I have a long history interacting with gender researchers, advocates, and gender-care clinicians. The sad truth is that even among those who should know better, expectations and stereotypes about trans people will too-frequently set professional consensus at odds with fact. As a result, I have no faith that even experienced clinicians know what it is that they should be doing to help prevent trans suicide even if they were to get the funding and the political permission to get trans youth off the waitlists and into care settings.

1. Well, that’s the plan anyway. I do promise folks that if this doesn’t work out with Wonkette I put that other story up here. I have every reason to think that we’ll get a good story up over there, but I think it’s important to stress that Wonkette isn’t owned by me. Ultimately what does or doesn’t go up isn’t my decision, so I don’t want anyone to yell at Wonkette if things don’t work out for some reason.