After misrepresenting the widely discredited Cass Report to ban healthcare for TS young people, Wes Streeting, the Secretary of State for Health and Social Care of the United Kingdom appointed professor Louis Appleby, who is described as the "Department of Health and Social Care adviser on suicide prevention" at Manchester University. He did so to refute claims made by whistleblowers of an increase in suicides of 2800% over 4 years highlighted by Jo Maughan of "The Good Law Project", following the ban on puberty blockers for young people after the Kira Bell case which was later overturned.
His "report" is found here.Those used to reading academic work, and studies are used to a clear description of their methodology, presenting accurate data, and analysis and synthesis of ideas. His report shows nothing of this kind of academic rigour. It attempts to present itself as academic, but can best be described as "opinion", containing but a single misrepresented reference which we will describe later. I will address some significant issues of his report as he presents them.
Appleby claims that "The data do not support the claim that there has been a large rise in suicide in young gender dysphoria patients at the Tavistock." However, he fails to refute the issue raised by The Good Law project because he has used a different data set. Appleby used his own data set of "deaths among current and former GIDS patients", the dataset he included specified as "between 2018-19 and 2023-24". Jo Maugham of "The Good Law Project" describes his dataset being deaths "of young trans people on the waiting list"at the Tavistock during the same time period. These two datasets are unequivocal.
Louis Appleby claims that "The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide." However, when there is real evidence that the risk of suicide is being ignored for political ideology, NOT discussing it will not make suicide go away. It will inflate it because the underlying cause is not being addressed. In his reply, Jo Maugham provides multiple documents evidencing expert opinion and knowledge by his whistleblowers of the increased risk of deaths of children, young people and young adults. The only conclusion one can come to is that the "dangerous insensitivity" in raising significant safeguarding concerns is dangerous only to political ideas of anti-trans activists, rather to the real life experiences of TNBI children and young people, and the grief and suffering to those who have lost loved ones.
Furthermore, Appleby does exactly what he claims that Maugham should not have done by saying on you tube, published 13th July 2017, that "there is an increased risk in suicide of young people who suffer a bereavement", and highlighting that students "faced an increased risk". By doing so Appleby is giving the impression that suicide could be "expected" in these groups. This equates to a clear double standard by Mr Appleby, and suggests a high risk of bias in his report.
3. Appleby claims that "The claims that have been placed in the public domain do not meet basic standards for statistical evidence." However, this does not appreciate that in a context when evidence of an increased risk of suicide is being covered up for political motivations, and that all available means for gathering that evidence have been exhausted, sometimes there are valid safeguarding concerns that require the publication of incomplete evidence. Just because evidence has not been extensively validated does mean that it cannot be a significant child protection concern.
4. Appleby adds a spurious and bizarre claim without evidence which can only be his bizarre opinion on the matter, claiming that "There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care." No evidence is made for this claim whatsoever. What we do know is that trans healthcare as a whole is highly politicized in the UK by those who wish to eradicate it. The Yale report describes it thus:
Transgender people of all ages face a critical inflection point in the UK and across the globe today. If politics continue to interfere with transgender healthcare, clinical services and research in this field may not recover. Peoples’ lives will be drastically—and needlessly—upended. Further, the politicization of healthcare is a concern not just for transgender people, but for all people. Every person deserves the opportunity to make private and deeply personal medical decisions in consultation with healthcare providers whose work is guided by sound evidence, appropriate training, and clinical expertise.
Skinner (2023) frames the current political context as "trans people in general and trans young people in particular remain heavily stigmatized and marginalized, contributing to a disproportionate burden of mental health concerns ... Trans people presently find themselves at the center of a highly politicized “culture war” questioning the legitimacy of their identities, their legal rights, and their healthcare." This reflects the real, broader context to trans people's lives.
5. "Suicide risk in gender dysphoria". Appleby fails to provide a single reference for most of his claims. There are no analysis or synthesis of issues and can only be framed as an opinion from a lay person with no expertise in transgender and non-binary people. This is an astonishing level of incompetence - how does Appleby apply recognised academic tools to come out with a label of "poor" level of evidence? He says that "most studies are poor", but does not expand on those he does not consider to be poor. While he is right that the risk factors for transgender people of any age contribute to the risk of suicide, his inference that "a non-judgemental attitude" might help reduce risk does nothing to address the real issues that transgender people face (including access to timely healthcare), reflecting his ignorance in transgender healthcare. His thought process that non-judgemental professionals mitigate the vast social oppression that trans people face in their every day life is naive. Skinner et al (2023) and the Yale report (2024) both recognise the sociopolitical context and the vast swathes of evidence that support gender affirming care. Even the social context of placing fully transitioned trans women on men's wards can cause significant distress and sense of hopelessness distinctive in the motivations of people considering suicide. Appleby finally misrepresents his only reference in this paragraph, suggesting that psychiatric care alone reduces the risk of suicide for young people who seek to physically transition, rather than the combination of medical transition AND psychiatric care reducing suicide risk to normative levels. The study did not compare children and young people denied gender affirming HRT and/or puberty blockers and psychiatric care alone and cannot be used to claim that preventing trans children from accessing puberty blockers does not increase the risk of suicide. Finally
In such a toxic sociopolitical context it is essential that "experts" are called who have direct experience in treating and supporting transgender young people and adults, and that special consideration is given to avoid political bias. The culture in the United Kingdom of dismissing the worries and experiences of actual transgender people runs contrary to the development of mental health services when compared to any other mental health issue. "Experts by experience" are now paid to support mental health services deliver care. It is a perverse double standard that our experiences and narratives are negated as "biased" when we have lived experience and cisgender non-experts do not.
Comments