The Times newspaper published four separate articles on 8 April about the healthcare provision for trans people in the UK, but oddly, they didn’t feature a single trans perspective.
Instead, they focused on interviews with clinicians raising concerns about the Tavistock and Portman Clinic, the only NHS gender clinic which treats children.
The clinicians, all five of whom have reportedly resigned from the service, speak of rushing to treatment, ‘damaging young bodies to serve societal issues’, and a lack of evidence. The Times claims that these NHS specialists, who are all quoted anonymously, walked out of their roles because they felt pressured into treating vulnerable children and teenagers without the necessary time to assess any reasoning behind their gender variance.
And yet, speak to many trans youth who have sought medication via the NHS and there is little evidence of any ‘rush’ to treatment. If anything, the opposite is true.
Trans children aren’t ‘rushed’ onto treatment
The waiting times to a first appointment (not treatment) for adolescents is a minimum of 20 months.
This far exceeds the promised 18 weeks to treatment set out in the NHS constitution, so I ask: if this is considered too fast, exactly how long is long enough for an “expert” to be convinced that what the patient – and their family – is saying, is true?
Last week one of the global experts in the treatment of gender variant youth, Dr Johanna Olson-Kennedy, sat side by side with representatives from the Tavistock and Portman Clinic at an event organised by Bristol University’s Law Department.
The difference between the two approaches to treatment was remarkable. Where the UK promoted a policy of gatekeeping and caution, the US focused on how best to support gender variant children. Where the UK started from a position of doubt, requiring the patient and their support network to prove their gender variance, the US acknowledged that being trans was simply part of human variation, and treated accordingly.
The US approach, which focuses on how best to treat the individual, is in line with international guidelines provided by the Endocrine Society (endocrinology being the branch of medicine concerned with hormones). Interestingly enough, the UK also cites those same guidelines as a basis for their own treatment protocols, but the interpretations could not be more different – and nor, perhaps, could the outcomes for patients.
Gender affirmative care
As a doctor, listening to the two sides of the debate was fascinating. I established GenderGP – a platform which signposts trans and non binary people to a variety of services providing gender affirmative care.
Our approach has always been to believe that the patient is the expert in their own gender experience, rather than the clinician. Being trans is as inherent as homosexuality – you wouldn’t expect someone who was gay to prove themselves. Given our approach, we are naturally aligned with best practise coming out of the US.
There is no UK education programme at any level for trans healthcare. As such, in Bristol, I was expecting a room full of medical professionals hungry to learn about best practise coming out of the States. I’ll be honest, I was hugely disappointed at the lack of representation from senior decision makers and doctors keen to understand more about how to help trans patients.
If the clinical leads are not thirsty for education, what chance do we have that those who work under them might question the recommended approach? Without education, how can we ever progress?
The UK has no guidelines for the treatment of transgender youth
I know this to be the case because I put in a freedom of information request in order to get some clarity on UK protocols. This revealed that, despite the Service Specification for the care of transgender young people in the UK making reference to standards informed by NICE (National Institute for Health and Care Excellence) guidance, no such guidelines exist for the treatment of children and adolescent patients in the UK.
Furthermore, NICE themselves confirmed that they ‘do not currently have plans to develop a guideline on the topic of healthcare of transgender patients, but they have agreed with NHS England to review this decision in 12 months.’
Instead, existing protocols are based on a mixture of spurious research, which has been widely discredited and an arguably questionable interpretation of the recommendations coming from the leading body on the matter, the Endocrine Society.
This is how it works for trans kids
The media narrative paints a picture of sex change children being showered with hormones, whether they like it or not.
Let me be clear:
- No medical treatment is prescribed to any gender variant child before puberty
- Not all gender variant youth want medical intervention – often they just need to be supported along their journey
- For those who are suffering because of pubertal changes, hormone blockers can help to press pause and give them thinking time, this can help alleviate any acute distress that they are in
- In no other area of medicine would a patient have to prove themselves time and again to be able to access the treatment they need.
- All media coverage like this does is serve to perpetuate misinformation and ultimately damage young vulnerable people who are already struggling to keep their heads above water in a cis-normative society
All media coverage like this does is serve to perpetuate misinformation and ultimately damage young vulnerable people who are already struggling to keep their heads above water in a cis-normative society