Thread by @_oatc_

@LisaTMullin @WhatTheTrans 1/ No the both of you, that is BS. LGB, ever since "coming out" was named, have done so in their teens & peaking in 30s was never a thing. Trans is very different. Perhaps if you spoke to us who have been advocating on kids for decades?

@LisaTMullin @WhatTheTrans 2/ Paediatric clinic referrals have rocketed, relatively, for a succession of reasons that the Tavi know well but never discuss because it wants the "panic" reaction - it is a psyschoanalytic centre & wants the ban on trying to "cure" NHS trans (of all ages) by that means ended.

@LisaTMullin @WhatTheTrans 3/ Not because that would work - it never, ever has - but because psychoanalysts at the Tavi have huge personal investments in promoting their belief. Remember that the Tavi now owns CX adult GIC too, as well as GIDS - both the world's largest.

@LisaTMullin @WhatTheTrans 4/ Let us first understand that referrals to GIDS =/= diagnoses or treated cases - very few get that far at GIDS. Referrals are by non-experts from all sorts of places. If ever GIDS starts to accept self-referrals there will be another boost, & more "panic".

@LisaTMullin @WhatTheTrans 5/ GIDS treats these referrals is if they are diagnoses for panic purposes, but doesn't take any seriously, doesn't triage urgent cases. It is still maintains no one can be sure until adult. Hence England still refusing #GenderRecognition & SRS until 18.

@LisaTMullin @WhatTheTrans 6/ …Because GIDS are the monopoly "experts" to whom the civil service listens.

So, why have referrals risen… GIDS was founded in 1989 & soon cemented a monopoly - they believe it is clinically harmful for trans people to be allowed a choice of treatment providers. By 1996…

@LisaTMullin @WhatTheTrans 7/…they were on national TV & in the press - so there was publicity. By 1999 GIDS had both psychiatric & endocrine guidelines accepted which effectively made them a monopoly & determined there could be no endocrine help in the UK until the wrong puberty had been suffered fully.

@LisaTMullin @WhatTheTrans 8/ But to even be referred for taking therapy - helping kids to cope with suffering that cruelty - in London (the sole location in the whole of UK & NI - required funding by their local NHS. Usually that required referral by the local child adolescent mental health team.

@LisaTMullin @WhatTheTrans 9/ Even then those CAMH were over stretched. They prioritised, & trans kids were low priority. It was often years. They usually knew zero about trans & disbelieved such patients. Approvals, & therefore funding, & referrals were few.

The 🇳🇱 clinic was prescribing agonists…

@LisaTMullin @WhatTheTrans 10/…at 12 (an arbitrary limit based on 🇳🇱 law) & hormones at 16 (whereas GIDS left hormones for the adult GICS), but GIDS ran the HBIGDA/WPATH children's committee, writing the under section of the SOC, so even that said no did not approve of agonists & banned hormones until…

@LisaTMullin @WhatTheTrans 11/…16. The one private psychiatrist in the UK who followed the SOC got "disciplined" into retirement. In 2004 the adult trans pressure group Press for Change witnessed to the Commons committee on #GenderRecognition that no one could be sure until 18. They excluded anything on…

@LisaTMullin @WhatTheTrans 12/…trans minors from their website too, so there was no pressure from them to improve. There was still publicity but it emphasised that in UK no intervention was allowed. By 2009 🇳🇱&🇺🇸 videos clearly evidencing trans at 2yo onwards were online, & parents were organising on FB

@LisaTMullin @WhatTheTrans 13/ GIDS rode that to get a national contract where by local NHS no longer paid. GPs still usually refused to refer unless local CAMH approved. Richard Green organised a London conference with clinicians from 🇺🇸🇳🇱🇨🇦 & 🇳🇱 teens to try to persuade that 🇬🇧 provide agonists, but…

@LisaTMullin @WhatTheTrans 14/…it took years more until their peers made GIDS trial the same, 🇳🇱 written "diagnostic tools" before they agreed there was no longer a basis to say it was impossible to say which patients would benefit from agonists, & announced they would provide them. At that point…

@LisaTMullin @WhatTheTrans 15/…there started to be real value in being referred there. In 2010 local control of the NHS had devolved in Wales, Scotland & NI, and the latter 2 opened their own paediatric clinics which accepted easier referrals, & GIDs followed suite. So the CAMH bottleneck gradually…

@LisaTMullin @WhatTheTrans 16/ …disappeared, releasing people stuck in it as well as those freshly seeking referral, & those to GIDS leapt up. GIDS had lost control at WPATH & the SOC recommended agonists at Tanner2 (not waiting until 12), & removed age limits on hormones, but endocrine guidelines based…

@LisaTMullin @WhatTheTrans 17/… on the old SOC (& not on research, as claimed) were referred to & were an excuse for some clinics (like GIDS) to not update their practises. At this point GIDS collaborated with the Cambridge Autism centre, which pushes that autism is an "extreme male brain" & stopped…

@LisaTMullin @WhatTheTrans 18/…rejecting those with or seeking an autism diagnosis - mostly AFAB of course, since AMAB with "extreme male brain" would not be trans. Then the NHS generally stopped rejecting referrals to gender clinics of non-binary people. The increased numbers generated "concerns"…

@LisaTMullin @WhatTheTrans 19/…and the resulting publicity generated more referrals, which no longer had to be from GPs but can be from social & youth workers, & more. Even though, in the meantime, more refined DSM diagnostic criteria came into force which should have cut numbers, they still soared.

@LisaTMullin @WhatTheTrans 20/ Because only GIDS have the data - & they may not record everything relevant, & many are stuck, un-assessed on the nearly 2yr wait list - we have no way to know how many of those inexpert referrals (seeking expert assessment) actually meet the criteria, but what we have…

@LisaTMullin @WhatTheTrans 21/…gleaning is that the numbers referred in time to prevent any pubertal damage is small & in line with historic incidence in 🇳🇱; & the numbers - mostly of those emerging at puberty - in time to limit pubertal damage nowhere near justify the headlines that GIDS stokes.

@LisaTMullin @WhatTheTrans 22/ Hope that nuanced analysis helps.

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