Trans youth dying in suicide “epidemic” as UK increasingly restricts gender-affirming care

Transgender 15-year-old Jason Pulman died by suicide after his country’s medical system told him he’d have to wait 26 months for his first gender-affirming care appointment. His death is at least the third to occur among trans teens in the U.K. who were recently denied similar care — advocates worry such deaths will only increase now that the U.K. seems likely to further restrict such care.

A five-day judicial inquiry at Hastings Coroner’s Court in the east English county of East Sussex has found that Pulman, a trans boy, began self-harming at age 13. He came out as trans at age 14, and in February 2020, his doctor referred him to the U.K. National Health Service’s (NHS) Tavistock Clinic for youth Gender Identity Development Services.

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However, when Pulman followed up with the clinic that following October, he learned that he’d have to wait 26 months for his first appointment, The Independent reported.

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In the following months, Pulman’s stepfather, Mark Pulman, said the teen had “given up” on his family and himself and began using drugs and alcohol. His mother, Emily Pulman, said he struggled with his gender dysphoria as well as his relationships and friends.

“In his world, that was the answer, in his world we don’t know whether that was the whole answer, but to him that appointment was everything,” his stepfather said.

Emily Pulman added, “My son died a lost boy because he was so confused by the end that he didn’t know what he was or what he was doing. He was driving himself crazy waiting for that appointment because when was it coming? When was he going to get help? He was just waiting for it all to make sense, he had so much confusion going on in his head.”

Pulman’s family last saw him on the evening of April 18, 2022. The next morning, they found his bedroom door tied shut and the window open. They repeatedly contacted the police, but the police made them wait for hours before responding. Police classified his being missing as a “medium-risk” concern because there was “nothing to suggest immediate risk of suicide.” An hour later — on April 19, 2022 — he took his own life in an East Sussex park. The nearby suicide note read, “I’m sorry, mum.”

“Jason’s emotional and mental health needs were inadequately assessed and provided for,” a jury at the aforementioned court ruled this week, declaring that both the police and NHS inadequately handled the teenager’s needs. The medical clinic that referred him to Tavistock made no note of his history of self-harm, submitted his referral on a medical form meant for adult patients, and didn’t show Pulman’s general practitioner before submitting the form (even though the doctor’s name appeared on it), The Telegraph reported.

“Systemic communication and administrative failures by all of the organizations involved in his care… may possibly have been contributing factors,” the court ruled. Both the police force and NHS have issued apologies, the BBC reported.

The U.K.’s restrictions on gender-affirming care are expected to worsen as the NHS recently closed the over-burdened Tavistock clinic. While 210 trans youth were referred to Tavistock’s GIDS from 2011 to 2012, that number rose to 3,500 referrals in 2021 and 2022, Pink News reported. The NHS also recently ordered all adult clinics to deny services to any clients younger than 18 and also told clinics to stop prescribing puberty blockers to minors, leaving many without a way to quickly receive care.

The NHS’ orders follow the recent release of the Cass Review, a 400-page review of oft-cited research on gender-affirming care for minors. The review concluded that there’s little reliable evidence showing positive outcomes from such care, but outraged trans activists say it excluded hundreds of studies showing such outcomes.

Trans rights advocates worry the Cass Review will give conservative political leaders a pretext for ending gender-affirming care for minors and younger adults. Indeed, the review urged “extreme caution” before giving minors puberty blockers or hormone replacement therapy and championed the use of psychological therapy instead. The review also said that “life-changing” decisions on gender-affirming care should be put off until adulthood since the brain continues maturing into age 26.

Every major medical and mental health association in the U.S. has endorsed gender-affirming care, including puberty blockers, as evidence-based, safe, and necessary for the treatment of gender dysphoria in young people.

“There has been an epidemic of suicides in the UK of trans youth as a result of care being restricted,” queer civil rights lawyer Alejandra Caraballo recently wrote via X. She cited recent media reports of Alice Litman, a 20-year-old trans woman who died by suicide after spending 1,000 days on NHS waiting lists, as well as Charlie Miller, a 17-year-old trans boy who died by suicide after being denied medical care due to his other alleged mental illnesses.

Pulman’s mother said, “We hope CAMHS [Counseling and Mental Health Services] will be properly resourced. We hope the police will learn how to risk assess, and not set the bar too high… Above all, we hope the government will stop toxifying this whole issue, and just look at the children.”

“He was a kid that wanted to change the world, that wanted to fight for causes he believed in… He was just so genuine and just wanted everyone to be happy and feel comfortable, which is what he wanted as well.”

Editor’s note: If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. The Trans Lifeline (1-877-565-8860) is staffed by trans people and will not contact law enforcement. The Trevor Project provides a safe, judgement-free place to talk for youth via chat, text (678-678), or phone (1-866-488-7386). Help is available at all three resources in English and Spanish.