Too young to decide? The questions dividing real-life Butterfly families
Behind ITV’s drama about a transgender child is a fierce debate that has led parents to challenge a pioneering clinic over the speed at which life-changing decisions are made. Jamie Doward reports
Many viewers who watched the finale of ITV’s drama Butterfly last Sunday were left in tears when transgender child Maxine, 12, was finally able to take the hormone blockers necessary for her to begin the transition from natal boy to girl.
The show, starring Callum Booth-Ford as Maxine and Anna Friel as her mother, has won plaudits for breaking new ground. But some parents of children who have transitioned, or have explored the possibility, question whether Maxine should be on such a journey in the first place.
In their reading of the drama, she was possibly a gay boy who had no need to transition. Similar, real-life concerns were raised recently when a group of parents with transgender children met Paul Jenkins, the chief executive of the Tavistock and Portman NHS foundation trust, which operates the UK’s only NHS gender identity development service (GIDS) for children, to express reservations about the speed with which some young people are going through the transitioning process.
The meeting took place after the parents – who describes themselves as “critical friends of the Tavistock” – wrote a letter to its board, now shared with the Observer, about what they see as its failure to fully recognise that both psychological and social factors can play a role in a person’s decision to transition. For many in the trans community these views are anathema, implying that the decision to seek a change in gender can be influenced by non-biological factors, in particular the way social media has helped popularise trans culture.
The parents’ decision to go public comes as a huge rise in referrals places acute pressure on the GIDS; it can take 18 months to get an appointment, compared with a target time of 18 weeks.
“My son was referred to the Tavi in March,” one mother of a transgender child told the Observer. “We’re still waiting for an appointment. In the meantime we have paid for private healthcare for him, which I know we are very lucky to be able to do, and not everyone can afford.
“It’s not at all fair that there is a two-tier system – one for trans children with well-off parents, and one for trans children who just have to wait and wait for the one NHS provider to give them the help they need.”
But one mother who signed the letter to the Tavistock told the Observer that there was a fear the pressures were leading to some teenagers being “fast-tracked” to the clinic’s adult services, which did not fully explore the psychosocial factors that may influence someone’s decision to transition to the same extent that the GIDS does for children.
“The adult service did not explore trauma or autism,” she said. “It seemed very obvious to us that [our child’s desire to transition] was a mental health problem.” She added that the justification for “physical intervention” was “that these people are very unhappy and that nothing else works in the short term – give them hormones and surgery and they feel better, but the evidence base is very weak.”
And she suggested that “some families were terrified they’ve got a gay child and would much rather transition them to the opposite sex”.
The mother of the transgender child who is waiting for an appointment at the Tavistock rejected the claims. “I find the idea that changing gender would be seen as easier than being gay a really difficult one to accept,” she said. “Are people seri-
ously suggesting it’s easier to be trans than gay?”
However, after a member of staff at the Tavistock flagged concerns that psychosocial factors influencing a person’s decision to transition were not being given adequate weight, the clinic confirmed to the Observer that its staff were being encouraged to share views via an internal review.
This will be welcomed by the parents who met Jenkins. They say they have been contacted by about 400 others who share their worries “that activist pressure may seek to limit the psychosocial assessment which precedes medical involvement, and is aimed at understanding the young person’s development and gender identification in the context of their family background”.
They add: “In a zeitgeist which encourages unquestioning affirmation of gender identity statements, we fear that confirmation bias may lead to children being prematurely diagnosed and ‘treated’ as trans, regardless of the complexity of family circumstances, the presence of neurodevelopment disorders or of psychopathology.”
The Tavistock said it had sought to allay the parents’ concerns: “The service is unusual in that a comprehensive psychosocial assessment precedes any referral to the endocrine clinic for consideration of physical treatments. While it is the case that most young people attending the service have a wish to pursue physical interventions, 59% of those attending under 15 chose not to pursue an endocrine clinic referral.”
In recent months a battle has been fought around “rapid-onset gender dysphoria” (ROGD) – a term popularised in certain academic circles that describes the alacrity with which young people are deciding that they do not identify with the gender with which they were born.
According to its proponents, ROGD is at least partially a social phenomenon, one that may help explain why there has been a rise in the number of young people, especially girls, seeking gender reassignment.
Of the 2,519 young people referred to Tavistock’s GIDS in the last financial year, more than 70% were born female. The mother of one child who had contemplated transitioning told the Observer that she feared a plethora of YouTube and other social media videos featuring young people, especially natal girls, discussing their decision to opt for physical intervention was, at least in part, driving the trend.
But trans support groups are deeply critical of any term that implies that gender dysphoria is akin to social contagion. The mother of a child waiting for an appointment at the Tavistock explained: “There isn’t anything rapid about the onset of being trans, though for some parents I can understand it feels like it happens suddenly – their child just suddenly comes out with it and wants to immediately start living as their true gender, at least at home.
“It’s a lot, but for the child, they’ve probably been waiting an incredibly long time to feel able to tell everyone.”
The idea that the media had helped popularise trans culture, leading to a rise in referrals, was equally misplaced, the mother suggested.
“They would absolutely love it if being trans was somehow a cool and desirable identity – because they can’t help it. That’s what they are. Instead, so many of them hide it and are really suffering as a result – they have very low mood and are often very distressed, including talking about selfharm and even ending their lives. It is absolutely heartbreaking.”
‘They can’t help it. That’s what they are. So many of them hide it and are really suffering as a result’
Mother of transgender child
Callum BoothFord as Maxine and Anna Friel as her mother, Vicky, in Butterfly.
RIGHT Paul Jenkins, the Tavistock’s chief executive, met parents of transgender children to discuss their concerns.
LEFTThe Tavistock Centre, where the gender identity development service for under-18s is based.