Why Liz Truss’s trans promise matters

It seems odd to be writing about the transgender debate amid the coronavirus crisis, but in some ways, it’s important that normal life, where possible, goes on amid that crisis. That is one good reason for parliament returning to business this week.

That business includes Commons select committee hearings on things other than coronavirus. Today, Liz Truss was at the Women and Equalities Select Committee in her role as minister for equalities, overseeing the Government Equalities Office. That brief includes the trans issue and the – postponed, possibly forever – reform of the Gender Recognition Act.

Truss’s opening remarks to the committee were interesting and worthy of attention because she chose to enter the most contentious aspect of this debate: children.

It is now widely understood that there has been a significant rise in the number of children presenting at NHS clinics dealing with gender issues. Some – not all – of those children will end up on a path that includes puberty-blocking drugs then, later in life, cross-sex hormone treatment and surgery.

This worries a lot of people who question whether children are capable of giving proper, informed consent for medical interventions that can have lasting and sometimes unknown effects. For instance, puberty-blocking medications (not designed for such use) given to children might reduce fertility in adulthood. Among some of the feminist campaigners and worried parents who have sought to raise public awareness of these issues, there is a grim truism: 'A transgender child is like a vegetarian cat. You know who’s really making the decisions.'

This, it should be said, is a view hotly disputed by campaigners for trans youth and some doctors, who say that people under 16 are perfectly capable of informed consent. Indeed, there is legal backing for that position, in the form of 'Gillick competence', a standard based on a 1985 House of Lords ruling. 

Anyway, this is a fraught, complex and sometimes alarming topic. Some people involved in the trans debate have been screaming for years now about this. They say that the result of successful lobbying by trans campaigners, groupthink among clinicians and lack of oversight by politicians intent on staying out of the trans minefield is that a significant number of children are being subjected to serious, possibly irreversible and possibly harmful, medical treatment – a situation that will one day be recognised as a national scandal.

I mention all this here to explain the context of what Liz Truss said to MPs today:

“Finally, which is not a direct issue concerning the Gender Recognition Act, but is relevant, making sure that the under 18s are protected from decisions that they could make, that are irreversible in the future. I believe strongly that adults should have the freedom to lead their lives as they see fit, but I think it’s very important that while people are still developing their decision-making capabilities that we protect them from making those irreversible decisions.

It’s worth unpacking the language here a bit (emphasis added). When Truss speaks of 'protecting' children from their decisions, that suggests a worldview far removed from the one that informs a great deal of policy and practice around children and gender.

For some advocates and practitioners in the field, an 'affirmative' approach – where a child’s expressed or imputed views on gender are not challenged but supported – is, in fact, the 'protective' approach. For them, it’s vital to support children who might be trans in their gender transition because failing to do so would expose those children to unusually high risks of self-harm and suicide.

There are books to be written about the issue of gender non-conformity and self-harm among children, but I’ll offer some very brief thoughts here.

First, a lot of the 'facts' thrown around the trans debate about juvenile self-harm are zombie stats generated by campaign groups, not objective experts. Second, the narrative that trans kids are at greater risk of self-harm generally ignores co-morbidity: a lot of the people concerned also suffer mental health problems; self-harm rates among gender-variant children may well be in line with those in the wider population of all children and adolescents with mental health problems – still too high and still something that should be addressed, but not something unique to the 'trans' group. Third, and probably most important, the 'if you’re a trans kid you’re going to kill yourself' narrative is irresponsible and potentially harmful in itself. It flies in the face of guidance from the Samaritans and is at odds with the accounts given by some clinicians working with trans children, who say that many such children are happy and robust.

Nonetheless, in the view of the people who promote that narrative, the issue of 'protecting' trans children is not, as Truss suggests, about the need to shield them from the harm that medical intervention could do. For campaigners, trans children need to be 'protected' from the harm that might befall them if those medical interventions are not carried out.

Liz Truss isn’t daft. She’s an experienced minister and policy wonk (she used to run a think tank…) who can master a brief. She knows this area well. She has not wandered into the debate about trans children by accident: those words were from her opening, scripted speech to the committee, not an off-the-cuff comment.

In other words, the cabinet minister responsible for trans policy has decided to enter the debate about trans children, and to take a side, by questioning the prevailing orthodoxy that has been constructed by campaign groups and some clinicians.

Some people will be angry about that. Some people will be happy. I will say only that I am pleased that these questions are being discussed properly in parliament, even in these unusual days.

Update:

Since this was published, I’ve been contacted by Chris Kane, a thoughtful doctor. He suggests that my reference to that 'truism' about trans kids and vegetarian cats was insensitive and might cause upset. I think he’s got a point.

My intention with that bit of writing was to offer a catchy, shorthand way of describing a view of this issue that is held by some people. That phrase is indeed one that some people use, to express the idea that in at least some cases, it is parents, not children who are the key decision-makers when young people present at gender clinics for treatment. And there is a bit of anecdotal evidence, some of it from NHS clinicians, to support that view: one of the grimmest aspects of this issue is the suggestion that some homophobic parents encourage or pressure gay or bisexual youngsters to identify themselves as transgender instead. This awful prospect deserves more attention than I can give it here, but I mention it to provide some context for that 'vegetarian cat' quote.

To be clear, my purpose in using that quote was to describe the views held by some people in this debate, and to highlight those concerns about parental pressure. I did so because is necessary to describe the various views in this debate in order to comment on this topic.

But to be clear, it is not my phrase and I am reporting, not adopting, it. The word 'truism' was probably not the best choice and I should perhaps have described it as a 'saying' instead.

On reflection, I took insufficient care in reporting that saying and the exposition of the issue, and I’m sorry for that.