“Better a live son than a dead daughter" - Suicide claim is not supported by the evidence. A blog post by @prof_curiosity1

This phrase is frequently used to justify early social or medical transition for gender distressed children on the assumption that non affirmation substantially increases suicide risk. While emotionally compelling, the claim is not supported by the available evidence and rests on several critical misunderstandings.

1. Suicide risk is complex and not causally attributable to non-affirmation There is no high quality evidence demonstrating that failure to socially or medically affirm a child causes suicide. Elevated suicidality among (gender) distressed youth is strongly associated with pre existing mental health conditions, including anxiety, depression, autism spectrum conditions, trauma exposure, and family or peer difficulties - factors that are highly prevalent in this population. Systematic reviews (including the Cass Review, 2024) have found that claims linking affirmation or medical transition to suicide prevention rely on methodologically weak studies, often cross-sectional, lacking controls, and unable to establish causation.

2. The framing presents a false binary The statement implies only two options: affirm and live, or do not affirm and die. This is a false dichotomy. Evidence based alternatives exist, including: - Comprehensive psychological assessment - Trauma informed psychotherapy - Treatment of comorbid mental health conditions - Family support and environmental stabilisation - Allowing development to proceed without irreversible intervention These approaches have historically been associated with high rates of distress resolution without medicalisation.

3. Medical intervention does not reliably reduce suicide risk Long term outcome data do not demonstrate that puberty blockers or cross sex hormones reduce suicide risk in children or adolescents. Some of the highest quality long term studies in adults show no reduction- or even elevated - rates of psychiatric morbidity and suicide compared to population controls, even after medical transition. Presenting medical transition as suicide prevention therefore exceeds the evidence and risks overstating benefits while understating harms.

4. The statement exerts coercive pressure on parents and clinicians Framing decisions in terms of a child’s death creates moral duress and undermines informed consent. In paediatrics, ethical decision making requires proportionality, uncertainty tolerance, and safeguarding, not fear based urgency. No other area of child medicine treats suicide risk by affirming a child’s explanation of distress as diagnostically determinative without rigorous evaluation.

5. Protecting life does not require affirming a theory. Supporting a child’s safety and wellbeing does not require endorsing a contested explanatory framework about identity. Children can be protected, supported, and kept safe without asking them, or their parents, to accept an unproven theory with irreversible consequences. Conclusion The claim “better a live son than a dead daughter” is rhetorically powerful but scientifically unsound. It has been the go to argument of the transactivist movement seeking to push their ideology onto families and children. It conflates correlation with causation, presents a false choice, and places undue pressure on families under distress. The repeated invocation of suicide as an inevitable outcome of non affirmation functions less as an evidence based risk assessment and more as a rhetorical device that weaponises fear, forecloses clinical judgment, and pressures families and professionals into irreversible decisions unsupported by robust data.