There are many reasons why what is sometimes crudely called ‘the trans issue’ is important. One is the political failure that left the legitimate views of many women (and men) ignored by decision-making individuals and bodies, who instead prioritised the views of interest groups and campaigners. Another is the multiple failures of governance that have seen numerous public bodies fail to deal properly and responsibly with questions of real public interest, because of their enthusiasm to follow the subjective agenda of interest groups rather than amass and act on objective evidence.
Simply put, organisations that are supposed to make decisions on the basis of facts have sometimes chosen to proceed on the basis of feelings and claims. Wishful thinking has come before harsh reality. Individuals who have questioned such things have sometimes been discouraged and even punished by organisations that priortise adherence to the campaigners’ agenda above the public interest.
Nowhere is this more painful than in the area of clinical treatment for children who may be experiencing trouble relating to their gender identity. In recent years, the number of such children seen and treated by the NHS has risen sharply, and the number waiting for such treatment is up too. The main English clinic for such treatment is the Gender Identity Development Service at the Tavistock and Portman Trust in London. Or rather, was, because NHS England has just effectively shut down the GIDS.
The closure comes after the latest report from Hilary Cass, a senior paediatrician who has been reviewing NHS gender services for children. To say her findings have been damning is an understatement. GIDS is being dismantled because over several years it administered potentially life-changing treatments to often vulnerable children, sometimes involving drugs whose effects it did not understand and often without adequate record-keeping to track the welfare of those children. Not that Cass is the first to find such things. The Care Quality Commission, a series of whistleblowers and the High Court have all raised serious concerns about the service. So too have some journalists.
Compared to pioneering reporters such as Hannah Barnes at the BBC and Deb Cohen now of ITV, I am a latecomer to this story and have only dabbled in this issue. But I’ve paid enough attention to understand and argue repeatedly that GIDS and its treatments needed more scrutiny. More than three years ago, following more important reporting by Lucy Bannerman of the Times, I argued that the weight of evidence about troubling failures around GIDS was such that a parliamentary investigation was justified.
That hasn’t happened yet but Dr Cass’s review has done a good job of examining the often troubling facts around gender treatment for young children. I continue to hope that parliament will eventually play its part and provide the necessary scrutiny here.
One aspect of the latest publication from Cass today is particularly worthy of note. It’s about puberty blockers, drugs sometimes given to gender-questioning children to ‘pause’ the onset of puberty. The rationale for using these drugs has been that doing so buys time for children experiencing distress and confusion relating to their body’s sexed characteristics to reflect on their gender identity and make decisions about gender transition.
This treatment has been intensely controversial. For several years, some observers – academics, campaigners, journalists – have suggested that giving puberty blockers to children is ‘experimental’ and could have unknown harmful long-term effects. Those concerns were frequently brushed off by the GIDS and by the campaigning charities that have worked closely with the clinic over the years. They have argued that puberty-blockers are safe and reversible and deliver significant benefit to recipients’ mental health and wellbeing. Some of them have suggested that those of us who raise questions about puberty blockers are motivated by bigotry or ideology. (Perhaps one day I’ll say more about these slurs, including the ones spread by people employed by the Tavistock. But not today.) In the context of that controversy, the latest letter from Hilary Cass is worth quoting at length:
“As already highlighted in my interim report, the most significant knowledge gaps are in relation to treatment with puberty blockers, and the lack of clarity about whether the rationale for prescription is as an initial part of a transition pathway or as a ‘pause’ to allow more time for decision making...
“We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation. We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process.
My emphasis added. In other words, the NHS has been treating vulnerable children distressed and uncertain about their gender with potentially life-changing drugs, without knowing whether those drugs delivered the intended results, or actually made it harder for them to resolve their distress and uncertainty. Puberty blockers might have had precisely the opposite effect to the one that was so strenuously claimed. That’s bad enough, but Cass has more to say:
“A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgement). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences. To date, there has been very limited research on the short-, medium- or longer-term impact of puberty blockers on neurocognitive development.
Yes, an NHS review has found that the drugs that the NHS has been giving to some children may disrupt their brain development and leave them less able to make complex decisions. Those drugs might have long-term consequences for the mental functioning of the children who were given them.
Now, years after their use began, Cass proposes that the NHS undertake serious and systematic research into the use of puberty blockers. Put another way, now that the horse has left the stable and has run headlong into a brick wall, we’re starting to think about whether bolting the stable door might be a good idea.
This all raises many grim questions. Here are just two. Given the lack of evidence supporting the use of puberty blockers and the volume of concerns raised about their use, why has it taken so long for the uncertainties and risks around their use to be officially recognised? And is there any other context in which the responsible authorities – medical, governmental and political – would have been so slow to intervene over such scandalous disregard for the welfare of children?