This legal case, challenging Gillick competence & represented by an Anti abortion legal team (& evangelical preacher) , is that nearly all those who start hormone blockers go onto cross sex hormones. There are some very good reasons for this (thread) 1/
The children & young people who are referred to GIDS wait for 2+ years on a waiting list (27 months now), undergo 6 months to multiple years of evaluation & by psychologists & psychoanalysts who are not medical Doctors themselves but gatekeep & control access to medical care. 2/
Only the very patient, the very persuasive, & those judged "very dysphoric", by the gatekeeping service are referred for blockers. The threshold for consent is so high that it is has become a major barrier to access to care. 3/
Have you tried to persuade a teenager to do anything they don't want to do? How about making them travel 100s of miles to an appointment with 2 psychs who spend 1hr asking cringmaking questions about gender, sex, dysphoria, genitals, relationships every 6 weeks for 1-4 years 4/
I've sat in those appointments as a cis (non trans) parent & it is excruciating. Psychologists are trained to assess, diagnose & treat mental illness. Fine, except being transgender isn't a mental illness, it is now widely accepted to be a naturally occurring human diversity. 5/
There is a reason why gender identity disorder (now considered offensive & pathologising) has been removed from the latest World Health Organisation ICD (aside - Homosexuality was only removed as a mental disorder in 1987). 6/
Throughout the 20thC many, many people attempted to change individual's sexuality & also gender identity. Various harmful means were employed by psychologists & doctors, drugs, castration, hypnosis, electro-shock therapy, aversion therapy, psychoanalysis / 'talking cures' 7/
These attempts were both harmful and ineffective. In the early 1980s Domenico Di'Cegle a child psychiatrist was working with a child insistent in their self belief that they were not in fact a girl but a boy. Colleagues had concluded the child was "confused about her gender" 8/
Di Ceglie wrote about the case "I got the impression that there was something very profound about her sense of identity of being a boy which could not be easily explained and that was fundamental to her being" (Di Ceglie, 2002) 9/
Wile others called her confused Di Ceglie "discovered instead that I would become at times confused during the sessions about [his] identity, whereas [he] seemed to be very clear that [he] was a boy and that there was nothing more to find out about this". 10/
Later working in Croydon, Di Ceglie, saw more, similar cases, & learning from Richard Stoller & Richard Green, resolved to set up a gender identity service for children, moved by the words of the now young adult patient who wondered why her parents hadn't sought help earlier 11/
"[His] thoughts made me wonder why there was no service for children with these rare and unusual experiences. This planted in me the seed for the creation of such a service". In September 1989 he set up the "Gender Identity Development Clinic" in Child Psychiatry at St George 12/
In 1996 the clinic moved to the Tavistock & Portman Trust where it has remained ever since. Di Ceglie remarked in 2002, "altering the gender identity of the child "was not a primary therapeutic objective" 13/
Instead "Our task was to assist the child/adolescent & the family in the gender identity development and in the search to the best possible solution to the identity conflict". Note here that Di Ceglie is still approaching gender identity as a mind-body problem to be "solved" 14/
The methods that Di Ceglie employed & the make up (in terms of specialisms of GIDS staff) has largely remained the same "Over the years we've not had reason to radically change this model and the number of children & teenagers referred to the service has gradually increased" 15/
While there is now access to physical interventions, the focus of the service remains to distinguish "adolescents with a transsexual outcome" & gatekeeping their access such interventions - or "Life saving healthcare" depending on whether you are a gatekeeper or a gatekeeped 16/
Why is the history relevant? The UK model was birthed & remains centred in Freudian & Kleinian psychoanalysis. Psychologists interested in a "rare condition". This is vastly different from the affirmative medical (paediatric led) approach which evolved in the USA via HIV care 17/
In Los Angeles, the world's second largest adolescent gender service, the treatment for trans health started when teenage trans sex workers wanted access to hormone treatment alongside their HIV/Aids meds. 18/
To paraphrase Jo Olson Kennedy, the paediatrician who founded the service "These were adolescents living with HIV, so there wasn't this big ethical dilemma about giving them hormone blockers and cross sex hormones, it helped their quality of life, so we found a way". 19/
Meanwhile in the UK service, gatekeeping psychoanalysts fought tooth & nail to prevent access to healthcare. It was only in 2011 after 2 international conferences in 2008 which shamed the UK GIDS conservative approach that hormone blockers were made available to under 16s. 20/
Richard Green's paper "A tale of two conferences" & @christineburns podcast interviews record these events. To aid access I've added high res jpegs of the paper below. It highlights GIDS history of being last in the world to good practice. Notably Green states 21/ 
The minority UK position on hormone treatment for trans adolescents "can be very damaging". That trans adults "recall profound distress during teen years as their body changed in the wrong sex direction". That these changes which impact social integration are "preventable". 22/
Green goes further to state "The first years of puberty are crucial. Health care for the gender dyphoric adolescent in several Western nations, including the US, Canada, and the Netherlands, acknowledges the necessity for intervention" 23/
Green, continues "Puberty can be safely put on hold for a couple of years. This not only suspends unwanted body changes, it provides breathing space for the teen and clinician to explore whether to proceed with cross-sex hormone treatment". 24/
Green states "If the decision is to continue in the birth sex, then puberty-holding medication is stopped & birth sex pubertal changes progress. If extensive gender dysphoria remains, then the teen can experience the body changes of the desired sex. But, not in the UK." 25/
The theme "But not in the UK" continues. It took 3 more years for GIDS to adopt the international good (non harmful) practice of blockers at puberty stage rather than a minimum age (after all blockers at 16 at often pointless or even harmful). 26/
It took until 2014 until hormones (testosterone or estrogen) were offered at age 16 - by then the Dutch had been doing this for years. The protocol hasn't updated since, & there are many signs that the general approach has been to "slow it down" - delay, delay delay. 27/
The media lens -which GIDS (in my view wrongly) invited with a string of documentaries, turned from curious (if slightly disgusted) to obsessive & harmful in what seems to many to be an active attempt to generate a moral panic. 28/
Puberty blocking medicine not questioned when applied to 5-9 year old cis children for 40 years, when used to delay puberty in transgender adolescents is suddenly "powerful sex change drugs". 29/
In this environment of media frenzy & hand ringing, right wing press, joined anti LGBT religious groups & a radicalised white, feminist, anti trans lobby driven by manufactured outrage in the wake of the 2016 @Commonswomequ Women & Equalities Transgender Inquiry 30/
Trans adolescent healthcare & GIDS were a major target. As our 2018 research showed, few responses to the inquiry referred to trans children. Those few that were heavily weighted towards Gender Critical responses - you may recognise Julia Long, & SDA 31/ growinguptransgender.com/2018/02/09/era…
Anti trans groups sprung up in the wake of that enquiry multiplying via clone blogs & forums using the tactics of the evangelical right. They looked for any evidence that would prove the risk of trans healthcare in favour of 'reparative therapies' to change gender 32/
There wasn't much to support their ideology that 'being trans was a bad outcome', & what there was, was either from fundamentalist anti LGBT groups such as the American College of Paediatricians designated as a hate group by the SPLC for "pushing anti-LGBT junk science" 33/
They tried generating their own evidence, via meandering self published books a collection of anti trans kids propaganda from a random assortment of anti trans actors, they even 'gamed' a widely criticised & partially retracted "research survey" by Littman 34/
This attempted to fabricate a brand new medical diagnosis of "Rapid Onset Gender Dysporia" (the author & this quack theory will be familiar if you read JK Rowling's most recent legacy destroying fiction). 35/
Despite a lot of noise & sympathetic media coverage, they still didn't have anything solid, nothing that would stop the internationally accepted standard for adolescent trans health that GIDS was very slowly working its way towards. They tried other strategies 36/
They created a 'concerned parents group' (I'm informed few if any of these parents had children in GIDS) which lobbied the Tavistock & Portman. They worked with a newly appointed governor whose wife had worked for the service 12 years previously and who fronted their concerns 37/
They used media contacts & pressure (leaking letters via the resigning Governor to the Observer) to leverage meetings with Tavistock directors. One of these meetings was attende by Hannah Barnes, @BBCNewsnight Producer 38/ theguardian.com/society/2018/n…
The letter sent by this group was never published. I have been sent a copy. I suspect it could not be printed or even quoted at length because it is full of personal attacks against individual clinicians as well as trans people in the public eye, I suspect libelous. 39/
Note, this group was particularly concerned about the access to healthcare of 17-25 year olds, that is, adults. They in fact wanted these adults to stay longer at GIDS thereby further delaying access to healthcare availble with informed consent in adult services. 40/
Not in a single one of the many articles was any of those 17-25 year olds quoted or given a voice. Nor was it pointed out that this anti trans healthcare lobbying group was attempting to overturn a much wider concept of medical consent that had existed for decades. 41/
To the original post and the case of Kiera Bell. A court case was brought, originally a judicial review - launched by Marcus Evans the departing governor, his wife, Susan Evans who had worked for the service (though unclear if with GIDS or wider Tavi) 12 years previously 42/
This was centered on the mother of a 15 year old girl who may or may not be autistic & who may or may not have been on the waiting list for GIDS - details vary depending upon the publication. The lawyer in the case, Paul Conrathe, mentioned way back at the top of this thread 43/
This mother (Mrs A) & her unnamed child were later replaced by Conrathe & the Evans' by Kiera Bell a 23 year old woman. I have nothing but sympathy for Bell, you can read her story in multiple media including this interview with the BBC 44/ bbc.co.uk/news/health-51…
There are several aspects of this which are worthy of further discussion however this has been a long thread & the hour is late, so I'll focus on just one. Kiera Bell allegedly received puberty blockers at 16. There is a problem with this, she had already passed puberty. 45/
They are not puberty blockers but hormone blockers. Using them introduces a medically induced menopause in trans male adolescents. Keira describes these symptoms in an interview with Sky News. "I just went into a menopause like state and everything just kind of shut down" 46/
She continues "I felt drained & tired & had nothing but negative effects, ...I think the depression kicked in a bit more because I was without any hormones in my body, especially at such a young age when it's supposed to be at such a peak." 47/
As someone who is familiar with the international standards for transgender health & the Endocrine society clinical guidelines, these symptoms come as no surprise. In nearly all centres for transgender health, this is why hormone blockers are not given alone post puberty. 48/
Because experiencing the menapause at 13 or 14 or 16 is an unpleasant & distressing experience. A post puberty body without any hormones will make an adolescent feel 'flat' and is commonly associated with depression. 49/
This is why the vast majority of trans health services give cross sex hormones alongside blockers even in Scotland. Back to Richard Green's words, "But Not in the UK". Again, GIDS is last woefully behind in adopting the global standard of the 2017 Endocrine clinical practice /50
Just as a small no. of women regret abortions shouldn't be used to prevent access to abortion, the case of an adult regretting cross sex hormones at 17 & surgery at 23, isn't evidence those treatments should be stopped or made more difficult to access /51
The wealth of evidence puts trans healthcare as amongst the most effective of any medical treatments with regret rates between 0.5 and 3%. Timely access to trans healthcare saves lives of trans youth. /52
If we learn anything from this story it is that GIDS requirement for a mandatory 12 months on hormone blockers without cross sex hormones is potentially harmful. Recent studies have advised for 6 months or less on the blocker. /53 growinguptransgender.com/2020/06/10/pub…
GIDS is failing transgender adolescents who want access to blockers & hormones, it is also, through its outdated protocols, failing former service users such as Kiera Bell. 54/
The rigid gatekeeping did not prevent Kiera, a determined, competent 16 year old, certain in their gender identity from accessing a widely used medication. What then is its purpose? 55/
If gatekeeping does not work for a small minority of users, then it should be removed. Remove the gatekeeping of psychologists & psychotherapists determined to find a rationale for a young person being trans & instead provide accessible, local, trans adolescent healthcare 56/
It is time to remove the 31 year monopoly of an out of touch, conservative, gatekeeping service mired in defensive practice, which increases risk to vulnerable youth through inaccessible treatment (27 month wait list) & harmful protocols. 57/
We need a revolution in adolescent trans health, with local services run by medical doctors not psychoanalytical gatekeepers. The only reason why your GP can prescribe hormone blockers for early puberty & not for a trans adolescent is systemic transphobia. 58/
Being transgender is not a 'bad outcome' it is simply a variation of human diversity.
#SomekidsareTrans. Get Over It!
Phew! If you've made it this far, thanks for reading, do check out our blog growinguptransgender.com & more detail in my piece last yr inews.co.uk/opinion/trans-…
#SomekidsareTrans. Get Over It!
Phew! If you've made it this far, thanks for reading, do check out our blog growinguptransgender.com & more detail in my piece last yr inews.co.uk/opinion/trans-…
