Under a cloud
The Tavistock inquiry is having a ripple effect on gender dysphoria treatment internationally.
In New Zealand, the Ministry of Health is reviewing evidence on the safety and reversibility of puberty blockers, in line with the UK, Sweden, Norway and other countries, and a report is expected later this month. Previous advice on Te Whatu Ora Health New Zealand’s website that the drugs were safe and fully reversible has been removed.
Epidemiologist Charlotte Paul says health professionals are divided on the issue, but she’s pleased the ministry seems to be moving towards a more cautious approach. Rates of young people taking puberty blockers are many times higher than in England and Wales, the emeritus professor from the University of Otago says.
According to drug agency Pharmac, the number of under-18-year-olds being prescribed puberty blockers has jumped from 137 in 2012 to 771 in 2022.
But veteran GP Dame Sue Bagshaw, who has treated many young people at her Christchurch clinic with puberty blockers, is shocked by the closure of GIDS at Tavistock. “The UK has gone ridiculously over the top – it’s like a moral panic,” she says. The effects of blockers on sexual development are reversible, and “the misinformation that has been distributed is just frightening”.
Bagshaw has been caring for 10- to 24-year-olds at her Christchurch clinic, just renamed Te Tahi Youth, since 1995, and recently helped write a paper for the New Zealand Medical Journal on the ethics of prescribing puberty blockers. She says the main issue is around consent. If the young person lacks the mental capacity to grant consent, the parents need to be involved.
She adds young people mustn’t get started on blockers before the onset of puberty, and while there are concerns about side effects, such as reduced bone density, these must be weighed up against the deterioration in mental health that, she says, could end in suicide.
Bagshaw says she “can’t believe” what happened at Tavistock – “this is a very small percentage of young people, and this percentage has been around forever but in the past 30 to 50 years we’ve been able to do something about it.”
While most of her patients on puberty blockers do go on to gender reassignment, for some young men and women, it’s about not wanting to be categorised as either male or female to avoid stereotyping.
The Royal New Zealand College of General Practitioners also appears to support puberty blockers for gender dysphoria, saying they can help to reduce distress and allow time for young people to mature before making decisions on permanent gender-affirming options.
Medical director Dr Luke Bradford says a core principle of medicine is first do no harm, but “not starting blockers where beneficial should not be considered a neutral act, with the risk of lifelong unwanted physical changes causing distress and the potential for a negative impact on mental health”.
Paul counters this by pointing to two large, independent reviews by the UK’s National Institute for Health and Care Excellence (NICE) and Swedish researchers that show inconclusive evidence of benefits and uncertainty about risks.
The reviews, one from 2023, point to the poor quality of existing studies, with the NICE review stating: “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”
Paul says in New Zealand, there’s a divide between gender-affirming healthcare doctors and “more cautious” clinicians, who tend to be psychologists and psychiatrists, as exemplified by a 2021 statement from the Royal Australian and New Zealand College of Psychiatrists. She adds there are also many deeply concerned parents.
The ministry provides no specific directives to doctors on the issue, but a spokesperson says any medical intervention carries benefits and risks and should be considered in partnership with the health professional.
“We continue to encourage anyone considering gender-affirming healthcare for themselves or others to seek advice and guidance from a health professional.” Ruth Brown
revealed that Mermaids sent chest binders to under-16-year-olds without parental consent, and that one of the group’s trustees had spoken at a US conference organised by a paedophile support group. She was a divisive figure who helped foster a climate of debate in which there were only two types of contribution – trans-support and transphobia.
The fact that young children with a variety of mental health issues, sometimes after just three or four consultations, were effectively placed on a path towards medical transition may be a testament to how instrumental the transphobia accusation was.
LABELLED TRANSPHOBIC
A number of high-profile journalists have since expressed their frustration at being thwarted in their attempts to draw attention to the practices at GIDS and the influence of Mermaids. The columnists Suzanne Moore and Hadley Freeman both resigned from the Guardian, citing the manner in which they were prevented from writing about trans issues, and how they particularly affected young girls. Both have been accused of transphobia. “The term transphobic has become a bit meaningless,” says Barnes. “Is it transphobic to talk to people for whom the treatment has not worked?”
Barnes herself has been the subject of some nasty messages from activists. “I’ve had some horrifying things said to me, such as that I want to kill children. That was pretty unpleasant and obviously not true.”
But she has never received the sort of death and rape threats that, for example, have been directed at JK Rowling. Nowhere, though, does she write anything that passes any kind of judgment on the status of transgender people, and she is scrupulous in using the pronouns that match each young person’s chosen identity, even being careful to change back and forth in the cases – and there are a number – in which young people change their minds and return to their original gender.
For Barnes, the issue was always and only about the quality and appropriateness of care given to young people in the grip of crisis. “There’s often this refrain you hear: talk to the professionals that work directly with these young people and talk to trans people and young people. And that is all I’ve done for this book. I’ve spoken to happy trans people who had a good experience of GIDS, and I’ve spoken to some who have been harmed having been through it. The truth is complicated. But the idea that dozens of mental health professionals who’ve dedicated their lives to helping young people in distress, and who chose to work in a gender clinic, are suddenly all transphobic is just not tenable.”
SHINING A LIGHT
There are several lessons to be learnt from the Tavistock experience. Perhaps chief among them is that neither medical science nor those it seeks to help are well served by secrecy and lack of debate. GIDS got into a bad habit of suppressing internal reports that were critical of its protocols and practices.
It also took far-reaching steps in how it dealt with gender dysphoria based on flimsy evidence, and sometimes in opposition to scientific findings.
The moral, practical and political questions that the debate around transgender raises are many and varied, ranging from bathroom facilities to pronouns and terminology, and from sporting participation to access to women’s refuges and prisons. The treatment of gender dysphoria can easily be lumped together with all those contested matters and utilised by different sides in the larger cultural conflict. But that would be a mistake.
Instead, what the subject requires is cool heads, honesty, the accumulation of sound empirical evidence, and a willingness to acknowledge that adolescence is a period of turmoil, and that children caught up in its buffeting are not always best placed to make life-changing decisions about their futures.
It is to Barnes’ great credit that, in spite of the fear and timidity of publishers and the accusations of activists, she was prepared to give voice to the professionals who have not been allowed to make that case. ▮
“I’ve had some horrible things said to me, such as that I want to kill children.”