Clinic ac­cused of ‘play­ing God’ with chil­dren’s lives Treat­ment stops pu­berty and may do long-term harm

The Mail on Sunday - - Front Page - By Sanchez Man­ning and Stephen Adams

CHIL­DREN as young as nine will be given con­tro­ver­sial drugs on the NHS to pre­pare them for sex-swap surgery, The Mail on Sun­day can re­veal.

The treat­ment, which halts the on­set of adult­hood, is aimed at young­sters who be­lieve they are trapped in the wrong body. But crit­ics ac­cused the clinic of­fer­ing the pu­berty-post­pon­ing in­jec­tions of ‘play­ing God’.

‘I think many peo­ple will be hor­ri­fied at the thought of a nine-year-old be­ing pro­vided with a drug that ef­fec­tively stops them de­vel­op­ing and ma­tur­ing nat­u­rally,’ said Con­ser­va­tive MP An­drew Percy.

Oth­ers in­sisted that undis­puted re­search shows that the vast ma­jor­ity of un­der-16s who

are trou­bled about their gender do not go on to take the dras­tic step of surgery. Many turn out to be gay, but no longer feel con­fused about whether they are male or fe­male.

Al­though the gender treat­ment is re­versible, there are con­cerns about the long-term ef­fects on brain de­vel­op­ment, bone growth and fer­til­ity.

The drugs, known as hy­potha­la­mic block­ers, stunt the de­vel­op­ment of sex­ual or­gans so less surgery is re­quired if a child chooses to change sex af­ter reach­ing ado­les­cence.

Monthly in­jec­tions into the stom­ach sup­press the pro­duc­tion of testos­terone and oe­stro­gen. In girls that halts the men­strual cy­cle and the de­vel­op­ment of breasts. In boys, they stop fa­cial hair grow­ing and voice changes.

Doc­tors at The Tav­i­s­tock And Port­man NHS Foun­da­tion Trust in North Lon­don have just com­pleted a three-year trial in­volv­ing 12- to 14-yearolds, as­sess­ing the ‘psy­cho­log­i­cal, so­cial and phys­i­cal ben­e­fits and risks in­volved’. Be­cause the trial was deemed such a suc­cess, medics have de­cided to make the drugs more widely avail­able – and to much younger chil­dren. Yet only five years ago na­tional guide­lines stated that treat­ment for ‘gender dys­pho­ria’ should not start un­til pu­berty had fin­ished.

Dr Polly Carmichael, who led the Tav­i­s­tock trial, said decisions will now be based on the ‘stage’ of sex­ual de­vel­op­ment rather than age.

‘We’re talk­ing about stop­ping pu­berty in the nor­mal range of pu­berty, so I guess the younger age might be ten or nine,’ she said. Asked if she ex­pected chil­dren younger that the sur­vey group to now come for­ward, she replied: ‘Yes, def­i­nitely... be­cause some will be start­ing [pu­berty] ear­lier.’

Re­search has found pu­berty is start­ing ear­lier in Western chil­dren. A re­cent study found the av­er­age age for Amer­i­can girls was nine years and ten months – a full year ear­lier than a sim­i­lar study 15 years ago.

Tory MP Mark Pritchard said: ‘With com­pet­ing NHS re­sources, es­pe­cially for life­sav­ing can­cer drugs, there needs to be an im­me­di­ate in­ves­ti­ga­tion into why these drugs are be­ing pre­scribed to those so young.’

The Tav­i­s­tock and Port­man is the UK’s only spe­cial­ist clinic for young­sters di­ag­nosed with gender dys­pho­ria.

It was pre­vi­ously caught up in con­tro­versy in 2012 when it di­ag­nosed Zach Avery – a fiveyear-old boy al­lowed to live as a girl – with the con­di­tion.

The clinic was first given pub­lic fund­ing in 2009 when, on av­er­age, it treated about 100 un­der-18s ev­ery year for the con­di­tion, which af­fects one in 4,000 peo­ple in Bri­tain.

The num­ber of an­nual re­fer­rals has now in­creased to about 500, re­flect­ing the growth of a new, largely tax­payer-funded in­dus­try.

There are now about 150 trans­gen­der sup­port groups in Bri­tain. Those di­ag­nosed with gender dys­pho­ria can be pri­ori­tised by lo­cal coun­cils for hous­ing as ‘vul­ner­a­ble peo­ple’.

One pub­lic fig­ure, who re­fused to be named, said: ‘This is about polic­ing the be­hav­iour of lit­tle girls and boys.

‘So tomboys and boys who like to play with dolls are im­me­di­ately seen as trans­gen­der. All the lib­er­als think they are sup­port­ing trans­gen­der rights with this, but what they are re­ally do­ing is mu­ti­lat­ing healthy bod­ies to help peo­ple “fit in”.’

But sup­port­ers of the in­jec­tion treat­ment say the drugs give chil­dren who are con­fused about their gender a much­needed ‘win­dow’ be­fore they take on too many mas­cu­line or fem­i­nine fea­tures. This, they

say, pre­vents men­tal an­guish – and will re­duce the amount of surgery needed if they do go ahead with an op­er­a­tion.

Dr Carmichael said that the treat­ment takes ‘away some of the fear and dis­tress young peo­ple go through if they feel their body is go­ing in the wrong di­rec­tion’.

But Pro­fes­sor Anne Dreger, a lead­ing bioethics ex­pert, said: ‘Putting chil­dren on pu­berty-block­ing hor­mones, may, for some, ce­ment the idea that they are trans­gen­der when per­haps they are not.’

Only eight of the 32 chil­dren di­ag­nosed with gender dys­pho­ria who

How can a child so young give in­formed con­sent?

took part in the Tav­i­s­tock trial went on to start the sex change process.

But Dr Carmichael said: ‘Now we’ve done the study and the re­sults thus far have been pos­i­tive we’ve de­cided to con­tinue with it. So we’ve de­cided to do “stage not age” [as the cri­te­rion] be­cause it’s ob­vi­ously fairer. Twelve is an ar­bi­trary age.

‘If they started pu­berty aged nine or ten in­stead of 12, as long as they’re mon­i­tored and the bone den­sity doesn’t suf­fer, then it is right that the aim is to stop the de­vel­op­ment of sec­ondary sex char­ac­ter­is­tics.’

Dr Carmichael stressed that the in­jec­tions are only given to chil­dren who meet strict cri­te­ria. They must have parental con­sent, nor­mal bone den­sity and weight, and no se­ri­ous men­tal health prob­lems.

The best-known brand of blocker is Gon­apeptyl, which costs £82 per dose, and pos­si­ble side-ef­fects in­clude de­pres­sion, rashes, asthma and ovar­ian cysts.

The Tav­i­s­tock ac­cepts that while the ef­fects of the drugs are tem­po­rary, and pu­berty will re­sume if you stop tak­ing them, there are risks. To be con­sid­ered for the treat­ment, chil­dren need to have ‘demon­strated an in­tense pat­tern of cross-gen­dered be­hav­iours and iden­tity’ for at least five years. This means nine-year-old boys would have had to be­haved like girls, and vice-versa, since the age of four.

While the clinic makes clear that the ‘young per­son’ must be ‘able to give in­formed con­sent’ for the pro­ce­dure, crit­ics ar­gue that it is be­yond the grasp of even the bright­est nine-year-old to fully un­der­stand the full im­pli­ca­tions. Dr Carmichael be­lieves the rise in num­bers at­tend­ing the clinic is be­cause more peo­ple are aware of gender iden­tity is­sues. Pre­vi­ously, par­ents who wanted their chil­dren to un­dergo gender treat­ment in the early stages of pu­berty had to travel to coun­tries such as Hol­land, Bel­gium and the United States.

As a re­sult, cam­paign groups sprang up to try to per­suade the UK to fol­low their ex­am­ple.

One par­tic­u­larly in­flu­en­tial cam­paign group is the Gender Iden­tity Re­search and Ed­u­ca­tion So­ci­ety (GIRES), founded in 2010 by Ber- nard and Terry Reed, whose adult daugh­ter is a trans­sex­ual.

The group’s in­flu­ence ex­tends to giv­ing pol­icy ad­vice to the NHS, the As­so­ci­a­tion of Chief Po­lice Of­fi­cers, the Crown Pros­e­cu­tion Ser­vice, the Depart­ment for Chil­dren, Schools and Fam­i­lies, and the Home Of­fice

How­ever, with the bat­tle to lower the age of chil­dren re­ceiv­ing hor­mone block­ing jabs in the UK seem­ingly won, even Dr Carmichael cau­tioned: ‘Some peo­ple think this is ab­so­lutely the way to go and ac­tu­ally I don’t think it’s right for ev­ery­body in this sit­u­a­tion.

‘It has to be about bal­anc­ing risks and ben­e­fits.’

MONTHLY SHOTS: Lead­ing brand of blocker costs £82 a time

‘BEN­E­FITS’: Dr Polly Carmichael

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