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

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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

ITV

Cal­lum BoothFord as Maxine and Anna Friel as her mother, Vicky, in But­ter­fly.

HSJ

RIGHT Paul Jenk­ins, the Tav­i­s­tock’s chief ex­ec­u­tive, met par­ents of trans­gen­der chil­dren to dis­cuss their con­cerns.

Alamy

LEFTThe Tav­i­s­tock Cen­tre, where the gen­der iden­tity de­vel­op­ment ser­vice for un­der-18s is based.

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