More time was spent assessing facelifts than on life-changing decisions for vulnerable kids

FOUR years ago I compiled a report raising very serious concerns about the gender identity service known as GIDS at the Tavistock. Around one third of its staff had come to me with some disturbing claims about the harm being caused to children. These children were among the most difficult and complex cases they’d seen in their long careers, they said. Many of them were girls and all of them were in a desperate state, with a history of depression, autism, trauma, a family history of sexual abuse or internalised homophobia. A lot of them were actually lesbian or gay.

And yet, the very principles on which the Tavistock had been founded – to engage with complexity and to gently explore why someone might feel the way they do – had been abandoned when it came to treating these children.

Their chosen gender was being affirmed, without question. They were being funnelled on to a medical pathway towards puberty blockers, cross-sex hormones and irreversible damage, despite there being no evidence base and sometimes after only a couple of appointments.

Few were in a position to weigh up the pros and cons of this treatment, which include sterility, sexual dysfunction and possible neurological and psychological consequences.

Yet nothing was done after those concerns were raised. GIDS and the Tavistock’s management dug in their heels, having been captured by a powerful ideological movement led by groups such as Stonewall and Mermaids.

Instead, I faced consequences. I was threatened with disciplinary action. Other staff felt intimidated for raising legitimate safeguarding concerns.

Now, with the Cass review, I and everyone else who has raised their heads above the gender parapet, including many trans people themselves who don’t agree with this approach for children, have been vindicated.

But it’s the children I feel desperately sorry for.

Thousands will have passed through GIDS’s doors between then and now – 5,000 were referred in the last year alone, compared with just 138 in 2010.

We know 98% of children placed on puberty blocker drugs go on to take cross-sex hormones such as oestrogen and testosterone to start their so-called ‘transition’. A proportion will have surgical castration, hysterectomies, breast removal and genital surgery.

We don’t know what has happened to these kids, how many have regrets, how many continue to have serious psychological problems.

We do know there are a growing number of detransitioners – those who later recognised this was the wrong treatment.

As a former patient told me, ‘I look in the mirror and I do not see a man but a woman with a mutilated body’.

GIDS misrepresented the affirmation model as giving children a voice. But any right-thinking person knows listening to a child, taking them seriously, is not the same as agreeing with them.

CLINICIANS have a duty of neutrality. To simply affirm, without exploring the child’s history – which may take considerable time – is a complete dereliction of that duty.

Consider an adult patient who was referred to me by a plastic surgeon. She was repeatedly visiting the surgeon, convinced there was something wrong with her face and wanted a facelift, but he felt something wasn’t quite right in her attitude.

After many sessions with her, it emerged that she had a long history of depression.

Within a year or so of psychotherapy, she came to see her face was like her father’s and, with help, was able to get rid of her fear of identifying with him. She also gave up the idea of plastic surgery.

Yet downstairs in GIDS, children were being ushered towards far more wide-ranging, lifechanging alterations without any adequate exploration of the roots of their gender dysphoria. Many of the GIDS therapists I spoke to said that when they mentioned the idea that there might be unconscious factors behind gender dysphoria there was laughter from senior staff.

‘Don’t give us all that psychotherapy talk,’ they were told.

Given this history of mistreatment, it would be inappropriate for any of the GIDS staff to have anything to do with the new services NHS England has announced will now be provided locally.

Hospital management had plenty of opportunities to intervene. In 2006 the then medical director raised serious concerns. In 2015 a report by an external consultant recommended they put a cap on referrals because the service was not coping. These warnings were ignored.

The trust’s chief, Paul Jenkins, has even tried to spin GIDS’s closure as a positive, writing in a letter to staff this week how ‘proud’ he is of the service, and of the ‘hard work caring for patients’.

There is no humility, no acknowledgement of the damage caused. This level of denial is very concerning.

The trust’s senior managers saw GIDS as the jewel in the Tavistock’s crown, edgy and liberal. They were so captured by ideology that they could not allow themselves to have any doubts.

Elsewhere the Cass recommendations are even being misrepresented as to do with managing long waiting lists. One needs to be clear – it was a waiting list for the wrong treatment.

The terrible sadness of this is that GIDS has stained the brilliant reputation of the Tavistock as well as causing untold harm.

What must happen now is a cultural overhaul, taking in schools as well as gender clinics.

And we must now really put children’s interests ahead of those of the ideologues.