The Times view on the Tavistock clinic and hormone-blocking drugs for the young: Informed Consent 12.10.19

The original article is here.

A child gender clinic in London is being threatened with legal action. The question of whether children can agree to life-altering treatment must be carefully weighed.

The moment a pregnancy is announced, expectant mothers are asked whether they are awaiting a boy or a girl. As children get older, most have a straightforward relationship with their gender. Yet for a growing minority, the question becomes vexed and can cause immense distress.

In recent years the number of children reporting gender dysphoria — the conviction that the sex on their birth certificate is the wrong one — has rocketed. Five years ago, 468 children were referred to the Tavistock and Portman NHS trust’s gender identity development service in north London, while last year alone, 2,519 children were referred.

Today we report that the clinic is being threatened with legal action by a parent who wants to stop it from prescribing hormone blockers to her 15-year-old daughter. These are powerful drugs that work on the brain to stop the eventual release of oestrogen or testosterone.

In 2014 the Tavistock changed its policy to allow puberty-blocking drugs to be prescribed to children as young as 11. Only those deemed by clinicians to have sufficient maturity and intelligence to understand the risks and consequences of treatment can undergo it without parental permission. It is always open, however, for parents to apply to the courts for orders preventing medical treatment.

This child’s mother argues that her daughter has autism and is not in a position to give informed consent. The mother is being supported in her case by a former psychotherapist who worked at the clinic for four years and became concerned by how quickly children were being cleared to begin medical treatment.

Neither the children nor their parents, they argue, are being given enough information about the risks of hormone-blocking treatment, including the possible loss of fertility and the likely loss of the ability to orgasm.

The debate around gender identity has seldom seemed more ferocious. Yet for all its heat, the question of whether children should be able to choose to take medical action to change gender is not simple.

There are two groups whose needs must be taken into account. First, children with gender dysphoria who will change their minds and settle into their natal gender in the fullness of time.

Second, children who will forever feel enclosed in the wrong gender unless they receive medical treatment. For both groups, the clock is ticking as puberty will further fix their bodies into their birth gender. Studies show that the vast majority of youngsters who begin puberty blockers go on to have irreversible hormone treatment at 16.

The concern is that the Tavistock clinic is prioritising the needs of the second group by providing too swift and smooth a pathway to medical treatment. This is not the first time concerns have surfaced.

Last year, a group of parents of transgender children wrote to the board of the Tavistock trust, alleging that it was “fast-tracking” children into life-altering decisions. The Times reported in April that five clinicians had resigned from the service with concerns that vulnerable children struggling with their sexuality were being wrongly diagnosed as transgender without adequate assessments.

Many of the children seeking treatment will have been waiting for months to set foot in the clinic. Many will have done so in anguish. A 2017 study found that 8 out of 10 trans young people have self-harmed and almost half have attempted to take their own lives. The pressure on the clinic to provide quick solutions for these children is immense. Yet haste must not prevail over long-term wellbeing.

To change gender is momentous. Children should not be rushed into setting out on that path. And they should be fully aware of the risks, both psychological and physical. As things stand, with evidence on the long-term effects of hormone blockers still thin on the ground, it is not clear that any child, whether autistic or not, is in the position to make that decision.