Keira Bell: ‘I couldn’t sit by while so many others made the same mistake’ Janice Turner in The Times 01.12.20
Standing outside the High Court yesterday, Keira Bell said that she hoped the judgment marked the end of gender clinics “playing God with our bodies [by] experimenting on the young and vulnerable with untested, harmful drugs”.
With her deep masculine voice, facial hair and the loss of her breasts to a double mastectomy, Bell bears on her own body the scars of irreversible treatments she began at Tavistock’s GIDS (gender identity development service) clinic at the age of 16. This quiet, reserved young woman, now 23, took on the NHS and publicly funded activist groups such as Stonewall and Mermaids — which successfully lobbied for medical interventions in ever younger children — and won.
In particular, the court’s judgment on puberty-blocking drugs will reverberate around the world. Judges ruled that a 13-year-old was “highly unlikely” to have the competence to understand their effect on future fertility and sexual function, that they were “doubtful” that a 14 or 15-year-old could knowingly consent, and that these drugs were so “experimental” and “truly life-changing” that it was “appropriate” for doctors to seek a court order before prescribing them to a 16 or 17-year-old. In response, GIDS announced a moratorium on prescribing blockers and NHS England has declared that under-16s will not receive them without a court order.
Bell’s story echoes those of thousands of teenage girls who now make up 75 per cent of referrals to GIDS and gender clinics worldwide. As a little girl growing up in Letchworth, she was a classic tomboy who loved football, superheroes and TV wrestling. She hated dresses, preferring clothes from the boys’ range, and her friends were mainly male. “No one tried to change me and I didn’t feel any discomfort in my body,” she says. “Lots of adult women would say, ‘Oh, I was like that at your age.’”
Yet Bell’s home life was turbulent. Her “quite distant and very religious” Christian father left when she was four, leaving Bell and her sister with their mother, an alcoholic. “We didn’t speak about her problem, but we were both embarrassed and didn’t bring friends home.”
Then Bell started high school and “there was that parting of the ways you get at puberty”. Her male friends no longer wanted to know her, while she felt a growing pressure to be “feminine and girly and to fancy boys”. Feeling stuck in the middle, judged for her “butch” appearance and struggling with the realisation that she was attracted to girls, she grew socially awkward and isolated. By 14, increasingly anxious and depressed, she stopped going to school.
“I just stayed at home, locked in my room, playing video games,” she says. “And on the internet I read lesbian bloggers, but felt something else was wrong with me because I was so uncomfortable with my body and puberty and becoming a woman.” On YouTube she discovered US trans activists. “I thought, ‘That’s me. I need to do this, to medically transition to make myself better and live my life as I’m supposed to.’”
Bell asked friends to call her Quincy and use male pronouns, while secretly buying a breast binder to flatten her chest. Then at 16, when home life with her mother deteriorated, she begged to move in with her father and his new partner, who, seeing she was troubled, suggested she see a GP. She was referred to GIDS.
“I had a one-hour appointment and it was very general, surface-level stuff. ‘What is your preferred name? Do you want to transition?’ And a lot of stereotype talk about whether I played with boys’ toys, preferred boys’ clothes. There was no discussion about my sexuality.”
After three further equally superficial sessions, Bell was referred to the endocrinology department, which prescribed a year on puberty-blocking drugs. “It was briefly mentioned this might damage my fertility. They said I could freeze my eggs, but that isn’t available on the NHS and I couldn’t afford to go private. It seemed like a box-ticking exercise. Besides, I was a teenager; I couldn’t imagine wanting a baby.” She was told that blockers were fully reversible and would give her time to decide whether she wanted to proceed to male hormones.
That blockers are a harmless “pause button” is highly contentious. The NHS recently changed its advice from stating they are “fully reversible” to saying that “little is known about the long-term side-effects” on a teenager’s body or brain.
These GnRH agonists release a form of the human hormone gonadotropin to stop testicles and ovaries from producing sex hormones. The most commonly used, Triptorelin, is licensed to treat advanced prostate cancer and endometriosis, “chemically castrate” male sex offenders and halt rare precocious puberty in children.
However, they have been increasingly used “off-label” to treat child gender dysphoria, and in 2010, under activist pressure, GIDS reduced the age of prescription from 15 to 10 years old. A very young child who proceeds from blockers to cross sex hormones — as almost 100 per cent do — will be infertile because sperm or eggs have had no chance to develop.
For Bell, puberty blockers threw her into instant menopause. “I couldn’t sleep or think. I had hot flushes, night sweats, brain fog, concentration issues. My bones ached and I felt less strong.” Moreover, while in this supposed thinking period before she committed to her full transition, she received no psychological counselling from GIDS, just brief catch-up sessions. “There was no discussion of my future, whether I was on the right path.” Nor were her underlying problems — anxiety, depression, social isolation and troubled home life — ever examined.
After 12 months, GIDS prescribed testosterone and Bell had her first injection at her GP’s surgery. Her voice deepened, facial hair began to grow and she “passed” as male at sixth-form college where no one knew her history. By now she was living alone in a youth hostel in Cambridgeshire, ever more isolated. “I still felt out of place, but I had something to latch on to. It felt like my life was progressing. Transition gave me a focus, took my mind off a lot of other things.”
At 20, sick of the discomfort of still binding her breasts, which she hated even more on her now masculine body, she underwent a double mastectomy on the NHS. “I wasn’t really briefed on how serious and extreme this was,” she says. “I found all my advice on how to heal more quickly online. You were given treatment, then they just left you to cope.” Taking testosterone caused painful vaginal atrophy, where the vaginal walls thin and dry out. “Doctors didn’t know what to do about it. We are guinea pigs.”
Once her “top surgery” was complete, and she decided not to proceed with a more complex, risky operation, which creates a non-functional penis from a sleeve of skin stripped from the forearm, Bell felt a sense of anticlimax. “I started to nit-pick about my appearance. I looked at my small hands and feet, my jawline, my short stature. I started asking what makes me a man. And I could never come up with an answer. I will always be a woman whatever changes in my body. I was invested in a fantasy.” Moreover, her other problems had not, as she had hoped, gone away.
Finally, “sick of being a medical experiment”, she stopped taking testosterone. While her periods returned and she found herself able to cry again, her deep voice and facial hair are irreversible. Now happily living with a female partner, she is coming to terms with her double mastectomy and “trying to accept my body for what it is”. However, she grew increasingly angry and troubled that online blogs spoke of transition only in glowing terms, promoting it to children, based, she says, “on lies and sex stereotypes”.
In particular, she felt that “butch” young lesbians like her were under intense online pressure to become trans men. “Gender is polarised: you have to look a certain way. You feel you have to fit in with expectations, even if that means using experimental drugs and surgery.”
Indeed, Bell is part of a 3,000 per cent spike in girls being referred to GIDS in the past decade, a phenomenon noted in every other western nation from Australia to Finland. So far, attempts to explain this have been denounced by the LGBT groups as bigotry. When Dr Lisa Littman of Brown University analysed “rapid onset gender dysphoria” among teenage girls, often clusters of friends, often same-sex attracted, with high exposure to online trans forums, her paper was removed from her college website. James Caspian, a psychotherapist, was told by Bath Spa University that he could not research a rise in trans people detransitioning because it was “not politically correct”.
Yesterday, High Court judges criticised GIDS for their own lack of research data, in particular failing to publish a 2011 study into the outcome of children who took blockers. (Early data so far released from that project “noted that there was no overall improvements in mood or psychological wellbeing” among recipients.) Judges also queried why the sharp rise in natal girls and children on the autistic spectrum has not been analysed, saying it was “surprising that such data was not collated . . . given the young age of the patient group, the experimental nature of the treatment and the profound impact that it has”.
Bell believes the LGBT community should stop trying to shut down academic inquiry and “accept that the trans experience is not a monolith”, that the reasons an adult male wishes to transition may not be the same as a legion of troubled 13-year-old girls with other psychological issues.
She launched her legal case because she felt she had made a “brash decision as a teenager, as a lot of teenagers do” and “couldn’t sit by while so many others made the same mistake”. Since it began she has since been contacted by many other young women with similar stories. She does not see restrictions on prescribing puberty-blocking drugs as an end in itself, but the beginning of a move towards proper, in-depth psychological counselling for gender-questioning young people.
“They need proper mental health support. I just wish someone had analysed my situation and the problems I had without changing my body. My body was fine.”