For 24 years, the Gender Identity Development Service (GIDS), headquartered at the Tavistock and Portman NHS Foundation Trust in North London, has been seeing, counselling and treating adolescents and children diagnosed with ‘gender dysphoria’. This, as the NHS describes it, is ‘the sense of unease that a person may have because of a mismatch between their biological sex and their gender’.
For much of GIDS’ existence, few paid it much attention. But over the past 10 years all that has changed. Not only have transgender issues become the object of fierce public controversy and mooted government legislation, but diagnoses of gender dysphoria among children and adolescents have skyrocketed. As The Sunday Times reported last year: ‘Since 2009-10… there has been an increase of more than 3,200 per cent in patients referred to GIDS, from 77 that year to 2,590 in the year to April.’ Moreover, 2019 was the first time the majority (54 per cent) of patients referred to the clinic were 14 or under – some patients were as young as four.
That is a huge increase in just one decade.
Unsurprisingly, GIDS’ activity at the Tavistock has been subject to increasing public attention, and, more recently, scrutiny. In 2018, an internal report, by then staff governor Dr David Bell, effectively accused GIDS of fast-tracking children and adolescents for gender transition. Featuring damning quotes from whistle-blowing clinicians and unhappy staff members, it reinforced the growing sense that GIDS has been a little too eager to encourage young people to transition and potentially undergo life-changing medical treatment. Indeed, since 2017, over 35 clinicians have quit GIDS because they are worried about ‘overdiagnoses’ of gender dysphoria. Sonia Appleby, who works at GIDS as its Named Professional for Safeguarding Children, is even bringing a case against the Tavistock on the grounds that it is failing in its duty to safeguard children, by encouraging staff not to report any child safety concerns to her.
If their own clinicians are quitting, it sounds like a real problem.
It is a difficult area because there is no doubt that many people do have gender dysphoria and transitioning is the right thing for them to do. I’m all in favour of people being able to live their lives in the way that will make them happier.
It gets more difficult though when the person involved is not an adult. I don’t think you should ban people from receiving treatment for transitioning until they are 18, because sometimes it will be very clear that is the best course of action and you may be certain about this at age 17 oe age 15.
But you should be very cautious about allowing what is effectively a permanent change through treatment for a young person, and the younger they are the more cautious you should be.
Hormone therapy, for instance, is a serious, life-altering treatment. ‘It should try to not be at all for children’, says Susan, citing the potential for future ‘sterility or infertility’. She points out how absurd it is that we are encouraging some young people to take a decision that could change their lives forever. ‘There’s a reason we don’t let children marry or have tattoos. And somehow we’ve unrolled this treatment!’
Certainly changing your gender is a much more consequential decision than having a tattoo.
Perhaps the biggest problem with the debate around trans children and their treatment is that there are so many unanswered questions. As many critics have pointed out, there are no reliable or long-term data on follow-up care for patients who have chosen to transition. We do not know how prevalent ‘de-transitioning’ is, how many patients continue to have mental-health issues after their treatment, or the long-term effects of treatment itself. Mermaids and other trans-advocacy organisations claim that fears around puberty-blockers are unfounded, and that the treatment is reversible. But even the NHS admits that ‘little is known about the long-term side effects of hormone- or puberty-blockers in children with gender dysphoria’.
Certainly more data would be a good thing.