There is a mental health crisis in the UK. The symptoms are often body related, and the causes are complex, but a new orthodoxy now labels some of these people as transgender. This means that instead of getting psychological care, increasing numbers are encouraged to take potentially dangerous hormones on their way to transitioning gender. The World Health Organisation's recent ruling that it will no longer classify being transgender as a mental illness is hailed by some as a progressive step forward. But could this shift in thinking actually compound matters and mean that transgender patients' other medical issues are ignored?
There has undoubtedly been a cultural change on the issue of gender in the last few years. What started as a fringe view that being a boy or a girl is just an idea is moving into the mainstream; today, even the government wants to help three year olds 'explore' and question their gender identity. This shift in thinking is helped along by the savvy marketing of transgender charities who tell emotional and powerful stories of how transitioning gender can be both simple and satisfying. It is no surprise, then, that since 2010 there has been an almost 1,000 per cent rise in young people attending gender clinics in the UK. But is this a cause for celebration? Or should we be worried that the speed of change on the subject of gender is not allowing the new emerging orthodoxy to be properly challenged?
Doctors based at the specialist Tavistock clinic in London are concerned:
“If a school just gets a whisper of a child who may be querying their gender and within minutes they are doing everything to make sure that child is regarded as a member of the opposite sex right from the word go — that may not be the best for that child.”
A high court hearing from 2016 also illustrates how some parents – and the authorities – are failing to put a child's wellbeing first. The judge in the case ruled that a mother had ‘pressed’ her son to identify as a girl causing “significant emotional harm”; the judge also said that the authorities “did not wish to appear to be challenging an emerging orthodoxy in such a high profile issue”. Instead of confronting the boy's mother, the judge said that those tasked with protecting the child instead accepted “wholesale” that the boy should be regarded as a girl. It is easy to criticise the authorities here – and we undoubtedly should. But their reluctance to speak out and challenge the mother is at least partly understandable. After all, the consequences of questioning the new orthodoxy on gender can be disastrous. For doing just that, academics have had their research proposals rejected; one teacher, who made the mistake of wading into the issue of gender – even inadvertently – found himself suspended for referring to a transgender pupil as a 'girl'.
Others who question the wisdom of changing gender are often told in no uncertain terms that trans youngsters are vulnerable and that they should choose their words carefully. They're right: campaigners point to statistics showing that 59 per cent of trans youngsters in the UK are bullied or have self-harmed. But just because this is a sensitive issue, it shouldn't mean that any debate on gender becomes impossible. The risks of silencing the discussion here are too great.
After all, it's arguable that trans youngsters are helped on their path to transitioning gender at the cost of receiving treatment for other issues they may have. One study revealed that over half of teens with gender dysphoria (the medical term for those who feel they are in the wrong body) also had other serious mental health issues; another study put the figure for those with gender dysphoria who have other psychiatric problems as high as 75 per cent. Those transitioning gender are also likely to have suffered abuse, according to another study which revealed that half of those transitioning had experienced some form of sexual violence in their lives; in one instance, a trans male was the only one from his group of 30 who had not experienced such abuse. Are we sure that gender reassignment treatment is really the best way of helping such people?
The speed with which referrals can be made is another reason to be wary of thinking that gender reassignment is the right choice. In one instance, a teenager was given an appointment at a specialist transgender clinic after a consultation lasting less than an hour. It goes without saying that gender reassignment is a big procedure. But instances of wrongly diagnosed people who are now de-transitioning suggests some procedures are undoubtedly being carried out too quickly. There are cases, too, of those who claim to have had deeper issues ignored or brushed aside on their way to changing gender. This survey of 211 people who de-transitioned reveals that many had other mental disorders that were left untreated. It seems all too clear that gender reassignment treatment is, at times, being prioritised. But at what price?
The cocktail of hormones given to those who transition can make matters worse for those suffering from mental illness. Leuprorelin, which is used to reduce testosterone, can make those who take it feel ‘depressed’, according to Macmillan (the drug is also taken to treat cancer); yet this possible symptom appears to be a curious omission from this NHS guide to hormone therapy for trans people. This guidance also doesn't mention that Cyproterone, a feminising hormone, can cause depression. Testosterone, which is used for female to male transition, is also linked to depression; while long term studies on athletic steroids, similar to some transition hormones, show 'prolonged psychiatric effects' and 'toxicity'.
Yet despite doctors warning of a lack of research in this area, thousands of young people around the world receive doses of these hormones, not for months but in some cases for years. Make no mistake: these people have become guinea pigs in an experiment in which those who are sceptical are hounded into silence.
Of course, any decent society should support consenting adults on their journey to contentment. But what about the welfare of those labelled as transgender who may well end up changing their mind? Transition is presented at times as a miracle cure or a fix to a person's problem. For some, this may well turn out to be the case and changing gender can, it appears, lead to lasting happiness. But it is far from obvious that this applies to all who make the transition.
Simon Marcus is a former advisor to the coalition government