It feels like conversion therapy for gay children, say clinicians Lucy Bannerman in The Times 08.04.19
The original article is here.
Ex-NHS staff fear that homophobia is driving a surge in ‘transgender’ young people.
Inside the clinic rooms of the Tavistock, the private heartache of a new generation of “transgender” youngsters is being laid bare. There used to be about 50 referrals a year, mainly males with a history of gender issues.
Now there are thousands of young females reporting a sudden gender crisis for the first time. Many are convinced that transition — and the powerful drugs that make it happen — will be the solution to their problems.
Until now the specialists struggling to keep up with caseloads have stayed silent, but alarm over the number of adolescents being prescribed body-altering drugs, has prompted five former clinicians to speak out for the first time.
All five have resigned from the Gender Identity Development Service (GIDS) in the past three years as a matter of conscience.
“This experimental treatment is being done not only on children, but very vulnerable children, who have experienced mental health difficulties, abuse, family trauma, but sometimes those [other factors] just get whitewashed,” one female clinician said. “If someone was suggesting plastic surgery or any other permanent change we’d be saying, hang on a minute.”
The clinicians have warned that complex histories and adolescent confusion over possible homosexuality are being ignored in the rush to accept and celebrate every young person’s new transgender identity.
Clinical psychologists carry out each initial assessment at the Tavistock. They are the gatekeepers who decide whether to refer transgender youngsters to the endocrine clinic for the next stage of treatment. Therapists once had months to work through underlying issues before making decisions on medical intervention, but the clinicians claim that young people are now routinely referred for hormone therapy after as few as three hour-long sessions.
They believe that physically healthy children are being medicated in response to pressure from transgender lobby groups and parental anxieties.
So many potentially gay children were being sent down the pathway to change gender, two of the clinicians said there was a dark joke among staff that “there would be no gay people left”.
“It feels like conversion therapy for gay children,” one male clinician said. “I frequently had cases where people started identifying as trans after months of horrendous bullying for being gay,” he told The Times.
“Young lesbians considered at the bottom of the heap suddenly found they were really popular when they said they were trans.”
Another female clinician said: “We heard a lot of homophobia which we felt nobody was challenging. A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realised I’m not a lesbian, I’m a boy. Phew.’”
The specialists expressed concern at how little confusion over sexuality was explored when a young person requested treatment to change their body.
“I would ask who they wanted to have relationships with, but I was told by senior management that gender is completely separate to sex,” a third female clinician said. “I couldn’t get on board with that, because it isn’t. Some people were transitioning their gender to match their sexuality.”
The service said it was “a welcoming place for people from all sections of the LGBT community”, adding that it had made exploration of sexuality a “more explicit” part of the assessment in response to staff concerns.
Nevertheless, the clinician said that her unease grew after meeting an adult woman whose transition to become a man involved having a double mastectomy. She had since changed her mind.
“What can we do? We can’t reverse that. Do we suggest fake breasts?” she said. “We have such a duty of care to these confused young adolescents, but I think we are failing them.”
The clinic rejected the claims. “We always place a young person’s wellbeing at the centre of our work,” it said. “GIDS staff are engaged daily in thinking about the serious ethical dimensions of our practice. The diversity and complexity of individual cases will always be respected.”
Several clinicians suspected that some of the “transgender” adolescents were reacting to homophobia at home.
“For some families, it was easier to say, this is a medical problem, ‘here’s my child, please fix them!’ than dealing with a young, gay kid,” the third female clinician said. At the service’s “family days”, a parent was allegedly heard saying that they did not want their child to have gay friends because they “didn’t want them mixed up in that hedonistic lifestyle”. “It is converting people into heterosexuals,” one of the clinicians said. “We had so many families who would talk about not wanting their daughters to be lesbian.” Young people “repeatedly” confided their own “disgust” that they may be gay, according to the clinician.
In other cases, she felt young people had concluded they were trans because they didn’t fit traditional gender roles.
“Children’s bodies are being damaged in order to treat societal issues,” she warned. She recalled a case of a 13-year-old child “whose parents were really pressurising us for puberty blockers”. When the clinician refused to refer him, she claims one of the parents, a lawyer, wrote threatening legal letters to the service. The child was eventually referred for blockers.
She would have nightmares about her years at the Tavistock. “I would talk about it as an ‘atrocity’. I know that sounds quite strong, but it felt as if we were part of something that people would look back on in the future, and ask, what were we thinking? In the future I think there will be lots and lots of de-transitioners who feel their bodies were mutilated as young people and who will ask, why did you let me do this? It is very disturbing.”
Studies show that the vast majority of youngsters who begin puberty blockers go on to have irreversible hormone treatment at 16. Some go on to have gender reassignment surgery as adults.
All five clinicians expressed concern over how little young people and their families were being told about the impact of hormone treatment on fertility and sexual function as adults. One claimed young people were unable to give “informed consent” because it was regarded as taboo to discuss the impact of medical intervention on later sexual function in such a young cohort.
The clinic said there were no “taboo” subjects in its work, and that it did not “recognise this allegation as reflecting what happens in the service”. It rejected allegations of conversion therapy and insisted that youngsters were being properly advised on the risks of and about what is unknown about medical intervention. Time and care was taken at every stage to ensure that individuals grasped the potential consequences of their choices, it said, adding that the service had become “increasingly aware” of the need to discuss the impact of treatment on future sexual function.
The GIDS’s own internal review identified procedures around consent as an area of concern. It has recommended that written consent should be obtained before referral for blockers.
Another clinician described how youngsters entered his room enthusing about Alex Bertie, a transgender YouTuber, and My Life: I Am Leo, a documentary about a transgender teen broadcast in a teatime slot on CBBC.
“These are very simplified stories about how easy it would be to transition into being trans. . . that transition is a solution to feeling shit. That is very appealing to lots of teenagers,” the first male clinician said. I felt for the last two years what kept me in the job was the sense there was a huge number of children in danger and I was there to protect them from the service, from the inside.”
One female clinician estimates that she referred about 50 young people for puberty blockers. She now believes she referred too many. Their outcomes remain unclear. “When you start them on puberty blockers, you’re putting them on a pathway that could lead to sexual dysfunction problems and, for the younger kids, will definitely make them infertile. In what other specialism would physical intervention that leads to permanent change to the body be the first line of treatment for a vulnerable child? Activists will tell you it’s unethical not to intervene. But we know that not everyone with gender dysphoria will go on to identify as trans for the rest of their lives.”
One case has haunted her. “All the pushing was coming from the father to put the kid on puberty blockers. Thinking back on it now, I fear that the father was a paedophile and the child was being abused.” There is no suggestion the service knowingly ignored the case, and the outcome is unknown.
The clinic, which is run by the Tavistock and Portman Foundation Trust and whose director is Polly Carmichael, says it is tracking the progress of 44 young people who began puberty blockers in 2011, and that all available evidence is discussed with families. “This is a rapidly developing field and psychosocial and medical professionals are working hard to ensure that we respond to emerging evidence in an appropriate and considered way,” a spokesman said. The growing body of international evidence showed that “thus far, there is little reported evidence of harm,” he added.
“The service undertakes careful assessments over time and continues to see young people whether or not they attend the endocrine clinic following this assessment,” the spokesman said.
The clinic said it was aware of concerns and tensions between different perspectives raised by staff and “clinicians have a duty of care to raise safeguarding concerns”, adding that there were “safe spaces” and structures in place for staff to discuss anything that worried them. It would not comment on specific cases but stressed that a young person’s motivations and choices were discussed at each step.
What began in 1989 as a specialist clinic for gender issues is now under intense scrutiny. A report by David Bell, a former governor at the trust, revealed ethical concerns over “woefully inadequate care”. Staff were furious with the GIDS executive’s response to the report, which stated that its own review found no safeguarding concerns.
The whole service should have been halted when the number of “transgender” cases first exploded, one of the clinicians said. “That’s the point we should have stopped because we didn’t know what we were doing. Are we a service for kids with gender dysphoria, a medical disorder? Or are we a service for ‘transgender kids’?”
A GIDS spokesman said: “We are aware of tensions between different perspectives. These differences are inevitable in such complex work.”
One clinician said it was understandable if her former employer was defensive, saying: “If they are getting it wrong, you have to ask, are they making kids infertile by mistake? Because if they are to truly acknowledge [our concerns], then they will have to ask themselves, what the f*** have we done to thousands of children?”
Gires, GI and Mermaids all denied they viewed transition as a cure-all or that they exerted any undue pressure. Susie Green of Mermaids said the charity “does not encourage parents to demand any particular treatment.” Gendered Intelligence said the allegations against it were “unfounded”. Bernard Reed, founder of Gires, said: “In medical literature . . . failure to provide timely treatment is described as ‘psychological torture’. As far as we are aware, GIDS has adequate safeguards against irreversible treatments being given inappropriately.”