Currently a former GIDS clinician and the mother of a trans-identifying teenager are asking the courts to consider whether it is legal to prescribe puberty blockers to children and adolescents under the age of 18. Although the puberty blocker became 'established practice' within the NHS in 2014, the safety and efficacy of the treatment remain unknown and GIDS has not yet published any evaluation of the treatment. As fellow-parents, we welcome the additional scrutiny of evidence that this important legal action promises. Sue Evans and Mother A have been kind enough to provide us with an insight into why they are bringing this case.
Media coverage of the case can be found in here and here. Sue Evans and Mum A are raising funds to pay for this case through a crowdjustice page. Please consider donating, if you haven’t already done so.
Sue Evans' Story
Why are Mother A and I bringing this case?
I want to explain a bit more about what we are hoping for in the judicial review on the administration of hormone blockers to children under 18.
Some people have asked if this case and the outcome, will only affect the care of the child of Mother A. This is not why Mother A and I are bringing the legal action. We believe and are very much hoping that it will be deemed unlawful for children under 18 to give ‘informed consent’ to hormone blockers. If we are successful, then this legal decision will impact on all young people under the age of 18 who are currently experiencing gender dysphoria and/or ideas of feeling ‘trans'. We are focussing on puberty blockers and asking that they should only administer hormone blocking treatment to children under 18 if an application has been made to the court and the court is satisfied that such a treatment is in the Child’s best interest. The blocker is the first step treatment on the pathway to cross sex hormones and in some cases reassignment surgery so we felt it was important to focus in the first instance on the hormone blockers which are administered to children at Tanner stage 2 (possibly as young as 9/10 years old). We are aiming to provide evidence around calling into question the child or family’s ability to give informed consent and thus prevent the progression on the pathway.
We are hopeful that this change in the treatment protocol will allow for an improvement in the psychological assessment and non-medicalised support and therapeutic treatment for children presenting with distress about their body.
What is not included in the case, but what I am hoping would be an outcome of this decision, is the decentralisation of the current GID service, with improved local services where people with GD could be assessed and treated in a more holistic and multidimensional way. In other words to treat and care for the person and their family, and not just the gender dysphoria as if it is a separate thing to all the other aspects of the young person's life.
So to summarise it it mainly the legality of the informed consent to the treatment that we are challenging.
Where are we at the moment?
Our lawyer wrote on our behalf to the Tavistock GID service for children and NHS England, asking for them to desist from prescribing the hormone blocking treatment to under 18s. The Tavistock GIDS were given until the 1st November to reply. They replied by offering a meeting, but they have not desisted from the hormone treatments.
We are planning to meet with them in the near future, and in the meantime we are involved in gathering evidence and witness statements, in order to apply for the judicial review if the meeting with GIDS does not have the outcomes we have requested.
Mum A's Story
I would like to thank Bayswater Support Group, for giving us this opportunity to promote our legal case against the Tavistock and Portman NHS Trust. This is an opportunity for us to give a full explanation of why we are bringing this legal case and what we hope to gain from it.
Let me start by saying, we are not getting any financial gain from this legal action. Nor are we wishing to stop anybody from transitioning ever. We are not denying anybody’s existence and we are not promoting conversion therapy. We would like the discussion on treating children and young people with puberty blockers and cross sex hormones to be open and uncensored. We would like the current pathways reviewed and revised, to take into consideration the huge and rapid change in demographic with regard to those presenting at GIDS. We would like kids to be able to explore the reasons that may lie behind their new found identity, without the pressure (both internal and external) to start on medical intervention at the earliest opportunity.
What I would like people to know
This whole period in our lives has been traumatic. My daughter is distressed, deeply distressed. As a parent you want nothing more than to see your child growing up happy and contented. But my daughter’s belief that she should transition to a boy has torn at our family for the last few years. To being with, it was no more than requests for clothes and items typically seen of as ‘boys stuff’. I have no problem with girls wanting to climb trees, fix cars, ride motorbikes, have tattoos and become engineers. They can and should pursue these things, with my blessing and encouragement.
But when your child tells you they wish you to call them by another name, because their ‘dead name’, the one I spent months choosing for her when I was pregnant, is not theirs any more, it hurts. It hurts more than anything I have ever experienced. The body you gestated, birthed and nurtured, is a source of agitation and distress to them. That everything about them is wrong and needs to be changed. That the pronouns you use to describe them to others are offensive and harmful. That each scar they made on their arms was as a consequence of some minor remark you made, that did not validate their new reality, one that you don’t share their enthusiasm for. When a psychologist tells you that you could alleviate your child's suffering by going along with the lie that they can actually change sex, by affirming their new identity and that you are part of the problem that caused her attempt on her own life, it is heartbreaking.
My daughter had completely changed, from a quirky, opinionated, strong willed little girl with a heart of gold and a love of animals, into an aggressive violent and self centred teenager, who was intent on controlling everything we did, from what we listened to on the radio and watched on TV, to the words and pronouns that came out of our mouths. But when we still didn’t affirm her after a serious episode of self harming behaviour, she seemed to calm down, was less aggressive, and started to accept that we had our boundaries, and we were sticking to them. As with many children, the asserting of boundaries made her feel safer. We talked about a compromise over her name, maybe a nickname, a pet name that might be acceptable to her. But she no longer seemed interested in pushing so hard for us to change our ways, though her thoughts of transition have not wavered. We were suddenly able to talk to each other, to express how we felt without conflict. A barrier that had been there for a long time was suddenly removed. We agreed to disagree, and even agreed altogether on some things. We started to look outwards, at the world around us, at activities and pastimes we could do together. We found common ground, and life has started to get better now that we both can communicate more effectively. Before she wouldn’t listen to anything we said, now she listens and explains to us clearly her differing viewpoint.
Our daughter was affirmed by her friends, by her counsellor and by her school. In a room full of children and adults, I felt like I was in an alternate reality, the only one who could still see my little girl in front of me, when everyone was calling her he and a name I didn't recognise as hers. Their affirmation made our lives at home harder. Why couldn’t we just call her her chosen name and pronouns, when relative strangers at school could? It was the line we drew in the sand, and we have not stepped over it. We felt, as a family, that she could present how she liked out of home, be called whatever she liked, but at home, we used her birth name. It was what we’d always done, and what her siblings knew and understood. I was not going to turn their worlds upside down, when I didn’t know whether this would last. They had already had to try and understand why the police were at our house in the middle of the night, bringing their sister home after running out on an argument. They had to wonder why I hadn’t come home to put them to bed on the day she took an impulsive overdose because she didn’t want to follow our house rules.
I have been accused of being transphobic, mostly by my daughter, but also by many on social media, who feel it’s their duty to tell me I am an abusive, unfit mother, who deserves to have a child who takes their own life. It’s awful. I also get accused of homophobia, but I have never expressed any opinion that could be interpreted in this way, as I don’t hold these views. If my child decides, as a fully formed, clear thinking adult, that this is the only path that will alleviate her pain, then so be it. But now, when her mind is expanding and developing, in part due to her endogenous pubertal hormones, I don’t think she is even capable of seeing so far into the future that she can comprehend the enormity of changing her body to fit her current state of mind. That is my job as her parent, to see the potential obstacles that she isn’t yet capable of navigating. To help her prepare for adulthood, for being independent. But she is not there yet.
For a long time, I told my daughter that being transgender wasn’t the only reason for having such an intense dislike of her sexed body. I mentioned her autism, but this just pushed her into the reasoning that, if I used her autism to avoid allowing her to transition, she should deny that she is autistic. So she did just that. Every time I tried to tell her to slow down, to take time to let her mind develop, to get used to the changes of puberty happening to her without her consent, it only made her want to transition faster. I have never denied that she suffers from gender dysphoria, or more accurately sex dysphoria. In fact I think her case is quite severe. We disagree, however, with how it should be treated. She tells me the only way to get rid of dysphoria is to transition. If you pass as a male, you will no longer be dysphoric. If you no longer have breasts, you will not have “chest dysphoria”. But then you mention those who desist or detransition. Then she will repeat the mantra she has learnt, ‘they were not really trans in the first place.’ But the current wave of online thinking is that anyone who says they are trans must be believed and accepted. But those who detransition are not only called out as never really trans, but are actively expelled from the trans community. Their mere existence calls into question the presence of an immutable, innate gender identity. They prove that this feeling might not last. You might change your mind. Your gender dysphoria might be strong enough for you to undergo treatment with hormone blockers, followed by cross sex hormones, followed by a double mastectomy and/or a hysterectomy, but these may not alleviate your distress. But if you do change your mind, if you realise that this was not the panacea it was purported to be, if you realise no amount of hormones or surgery will actually make you the opposite sex, or cure you of your gender dysphoria, then what next? I worry that she may go through all of that, and discover that she is not actually a man, and never will be. Worse than that, she may realise she has always been female, and that gender dysphoria is an illness. That gender dysphoria needs a skilled therapist to explore the development of her identity, and to challenge her underlying thought processes that have culminated in her believing that if she is not what society views as a typical female, then she must transition to appear as a male. Her autism is a huge contributing factor to this. Having autism means she likes things in black and white, not grey. And gender expression is grey. We all have a profile of characteristics that makes up our own unique personality. There is a set of characteristics that society interprets as being mostly masculine, and another set that is more feminine. With the difficulties an autistic individuals often possess in seeing the societal rules about what is and is not acceptable for men and women, it is no wonder that they are over represented in the transgender population.
I believe my daughter when she says she hates her sexed body. I believe that this is manifested in gender dysphoria. I agree she needs help to deal with this. She thinks she needs hormones, I think she needs to first undergo extensive psychotherapy to understand whether these thoughts and feelings are attributable to other causes, but are manifesting as gender dysphoria. I want not only her, but clinicians too, to be sure that she is in that small minority of people with gender dysphoria, for whom extended psychotherapy has not worked, and for whom physical transition is the last resort to alleviate their symptoms. The trouble is, more and more often you hear of teens being put onto hormone blockers as ‘time to think’. But when nearly 100% of children on hormone blockers go on to take cross sex hormones, you have to wonder how clinicians are so accurately choosing the right kids to start on these powerful drugs. You have to wonder if it is not something to do with the drugs themselves that is causing persistence in gender dysphoria and the desire to continue with transition.
When my daughter first said she would rather be a boy (which were her words: not I am, but I want to be; only later did it become I am) I read and read every book and study I could get my hands on. Memoirs of transsexuals, current studies on hormones and blockers and surgeries, critical accounts of the trans lobby, criticisms of the feminist movement as scaremongering about ‘saving the children’. In doing so, I came to this conclusion: there is no solid evidence of who will persist and who will desist. The suicide rates in gender dysphoria are reported by the pro trans lobby to be huge, but they do not appear to be much higher than other mental health issues. Indeed, studies have shown rates of suicidal ideas to be not dissimilar to autistic individuals, but you hear from many affirming parents ‘better a live son than a dead daughter’. But the evidence from GIDS’ own statistics points to only four suicides of transgender young people since 2008. Whilst all are tragic, the numbers just don’t add up to the epidemic of trans youth suicides.
However, the consequences of getting it wrong? Of transitioning a child that may have otherwise desisted? Now that really is harrowing. Having had several family members undergo mastectomy for breast cancer, where the consequence of not going through with the procedure is almost certainly deadly, there are intense feelings of loss, of regret. It is painful, with complications that can last months or even years. Do I want to encourage the path that will ultimately lead to this operation to be one my daughter can decide to pursue at 15? No, I don’t. When talk of egg harvesting or sperm banking for teenagers begins, some parents believe their child's fertility will be restored. But it is becoming better understood, that after a few short years on testosterone, the female genital tract starts to atrophy, to waste away. This is an excruciating condition, often necessitating hysterectomy. So although there may be a possibility (we don’t really know) that my daughter would be able to harvest eggs and that the effects of testosterone might not render her infertile, even if she takes testosterone for only a few years, vaginal atrophy would mean she would be unable to bear children, as she may have had to have a hysterectomy. A hysterectomy that even grown women in their twenties, who suffer from endometriosis or chronic pelvic pain, are denied because of the possibility they may want children later. They may change their minds. But we are quite happy for adolescents to make this decision, because we believe them when they say they have been born in the wrong body?
I want a happy child. I want a child who can life her life to the full. Her struggles with her gender have overshadowed a large part of her adolescence, and she is not by any means out of the woods yet. Our local CAMHS service feel out of their depth addressing her gender dysphoria, deferring to the experts at the Tavistock. But her mental health issues will not be resolved without directly confronting her self identity, how she views herself and her body. The waiting lists are long, but my fear is that once she gets to the Tavistock, she will be of an age that they feel there is nothing they should do other than aid her transition. Historically, those who went through adolescence still holding to their gender identity would persist. But the rapidly changing demographic, from predominantly male born kids with the belief they are the opposite sex present from early childhood presentation, to the current predominantly female born adolescents with very little or no historical behaviour indicative of lifelong dissatisfaction with their natal sex, has not been investigated. The Tavistock don’t seem to have reacted to this overwhelming change in presentation. Their approach, rather than being the cautious hands off monitoring of the past, has morphed into a gender affirming, medical pathway. This frightens me. If they get it wrong, it could be catastrophic. The voices of the detransitioners around the world is growing, and I want to make sure my child doesn’t have to be one of them.
I question and doubt myself every day. What if I’ve got it terribly, terribly wrong? What if she is right and I have wrongly interpreted what I’ve read? It’s not easy, choosing to resist the pursuit of your child for transition. In Britain we used to have a policy of watchful waiting, which is what I am trying to do. I want the option of blockers off the table, so my daughter can understand that she must fully explore what it means to be her in this world. But it is painful. I am not in any way belittling the distress my daughter is in. But it is very hard for families too, whichever path you choose. I cannot condemn those parents who choose to immediately affirm and facilitate transition for their child. They are doing what they feel is best for their child. I just wish there were options, time and space, not a rush for medicalisation.
Oh, and a crystal ball to let me know this will all be worth it in the end.