Since the start of the Covid-19 crisis we have been watching transgender support groups and health services to see what advice and information is being offered to children and young people who are dependent on hormone regimes or have been unable to attend clinics for first appointments for puberty blockers. We were concerned that no information was forthcoming from GIDS and eventually we sent a tweet to them on March 21st. Among other things, we asked:
“What should young people be advised to do if they can’t get their hormones? Would it be important for ICU staff to know birth sex? Trans people have undergone specific medical interventions, where is the specific medical advice for them? Reassurance would be helpful.”
On March 27th we were pleased to see that GIDS had finally posted Covid-19 information on their website.
We were concerned because, without professional advice, young people were left with only the support being offered by activist groups, who are unqualified to offer medical advice. In the case of a child suddenly unable to get their first appointment for puberty blockers, it is hard to know what kind of ‘support’ would be appropriate from organisations who have previously spread the message that medical suppression of puberty is ‘life-saving.’ This narrative has made the current situation more difficult than it may have otherwise been for children and parents, who have been led to believe that there are only two options: medical intervention or increased suicide risk.
Perhaps this is why the GIDS Covid-19 page does not offer links to any of the transgender youth support charities such as Mermaids or Gendered Intelligence. Nor do these organisations provide links back to GIDS. It seems odd that if you campaign for earlier medicalisation for children you don’t think to link to the advice page from the clinic that provides it. A crisis can bring people together but in this case it seems to have divided support into two distinct camps, and the difference between them is perhaps most starkly illustrated by looking at who has an ‘escape’ button on their site and who doesn’t.
A child or young person searching the GIDS website or the NHS page on gender dysphoria apparently doesn’t need an escape button in case parents see what they are looking at online. But if your narrative is that some young people are ‘trans’ just like some young people are gay, then it follows that they need to be protected from ‘transphobic’ parents just as gay young people need to be protected from homophobic parents, so providing a quick escape from your site is vital. The support offered by transgender organisations is, unsurprisingly, more about affirmation and pride in being transgender than strategies to manage the symptoms of dissociation and body-hatred associated with gender dysphoria. There is even a text service available which will send you daily messages of ‘affirmation.’
It may be that in this current crisis GIDS has opted to distance themselves from the politicised support groups, but the past influence of these groups is still apparent from the lack of alternative means of support GIDS is able to offer during this unsettling time. What the current situation exposes is the lack of mental health support specifically geared to helping young people with gender dysphoria. The system has become predominantly reliant on medical solutions which have been pushed by a transgender lobby intent on reframing psychotherapeutic support as ‘conversion therapy.’
The Tavistock GIDS Covid-19 page offers some ‘psychosocial support’ to families by phone or video link but stresses that some members of staff may be diverted to Covid-19 care. For proper counselling it is therefore compelled to offer links to outside generalised mental health support services such as youngminds.org.uk. The Tavistock and Portman NHS Trust is “committed to improving mental health and wellbeing”, offering a self-referral option to the child and young people mental health service (Open Minded) on their Covid-19 page. But GIDS does not link to this mental health support service of their own NHS Foundation Trust, perhaps indicating how far they have moved away from the original aims of the Trust.
If it is concerning that during normal times there is no specialised psychotherapeutic support available for children suffering gender dysphoria, either at GIDS or within CAMHS for children on the waiting list, it is even more critical now. A system which has become dependent on medical intervention is predicated on the availability of drugs and a normally-functioning NHS. If questions are to be asked about why no psychological support pathway has been developed for gender dysphoria alone amongst the range of psychological issues a young person may face, the time is surely now.
The issue of breast binding is a case in point. This physical ‘solution’ to a psychological issue not uncommon in teenage girls is promoted as normal and necessary by transgender youth support groups. A graphic which has been shared by various groups states “Trans or non-binary people who bind their chest are at much higher risk of complications from COVID-19” and yet the only other option given is wearing ‘worn-in binders’ or other tight, restrictive garments.
There is nowhere to go to find alternative, safer strategies to manage breast dysphoria, strategies that do not put you at risk of developing complications from Covid-19. Specialised mental health care for children with gender dysphoria could have easily been transferred to an online service, a lack of service provision that is now unfortunately exposed.
The politicisation of childhood gender dysphoria may explain the mental health profession’s apparent lack of curiosity about why a young person may hate their body so much they wish to inhabit a different one. More accurately perhaps, a lack of professional confidence in dealing with this ‘specialised’ area in Tier 1 or 2 services (such as CAMHS) may be down to a fear of the consequences of providing counselling and subsequently being accused of ‘conversion therapy.’
The exponential rise in the number of referrals to GIDS has been faster than any research or knowledge base could hope to keep up with and perhaps now this gap in expertise has been exposed, more research studies into the causes and effects of gender dysphoria in young people will be urgently prioritised.
There are also specific worries a parent or a young person may have at this time which have not been addressed or even acknowledged in any Covid-19 advice we have seen. While many organisations stress the higher risk for LGBT people because of higher HIV and cancer rates, higher rates of smoking, the increased risk of homelessness, or discrimination, we have seen nothing on puberty blockers or testosterone as potential risk-factors. It may be an uncomfortable subject to bring up, but as nobody else is providing any information we have done our best to research it.
If Covid-19 has taught us anything, it is that sex matters, biology matters, and that human beings exist in physical bodies – bodies that are vulnerable. Information shows that in every country for which we have sex disaggregated data, men are more susceptible to corona virus than women. There has been much debate about why this may be so and one issue relevant to young people on hormone regimes is the possibility that female hormones are protective in some way.
Studies have already begun into the role of estrogen and progesterone in trials on men and women with symptoms of Covid-19 and we have heard that trials of the GnRH agonist (or puberty blocker) Lupron are to begin in the US on a group of men. Because of historic male bias in health research studies generally, the situation now is one of speculation rather than informed prediction. The apparent ease with which testosterone has been prescribed for females under the ‘gender neutral’ protocol of ‘cross-sex hormones for trans people’ is perhaps reflective of the wider historic problem of neglect of the female body in clinical research. We have found only one article which references trans people in this context and it speculates that transwomen may be better protected and transmen more at-risk.
Previous studies on mice suggest that estrogen may be protective, but the research is far from conclusive. As males have proved to be more vulnerable across all age-groups, it may be more likely that the main protective factor lies in the XX chromosome and not in sex hormones. As nobody knows for sure, we can only advise everyone to follow the official advice to keep themselves safe: wash hands thoroughly and keep to social-distancing rules.
We would also suggest that young people have a look at the Covid-19 page of the Sandyford Clinic, Glasgow, which is more informative than GIDS about what to do if you cannot access hormone injections. Critically it advises that stopping GnRH injections for a while will not cause any harm. The NHS Scotland National Gender Identity Clinical Network for Scotland is also more helpful and provides an information sheet for doctors about alternative preparations of hormones that don’t need injecting.
The current Covid-19 lockdown can feel as if the whole world has stopped for a while. School and University closures have meant that children and many young people are away from their peer groups and back at home with their parents. There is suddenly something bigger that unites us all and gives us the breathing-space to perhaps reconsider our priorities. The unprecedented event of Covid-19 has been a reality check and a time of reflection for many people.
While there has largely been a pause in news reporting and social media activity on the subject of gender identity, people are getting on with practical problems concerning their health and livelihoods and their families. The need to ‘question your gender identity’ perhaps for some people doesn’t seem so urgent now. Children who identify as trans or non-binary are not meeting up in real life and they are not walking into the playground every day to face their peers, or being affirmed by their teachers. What happens if you construct a social status that depends entirely on outside affirmation and validation – the importance of which is constantly reinforced by trans youth support groups – and suddenly that outside affirmation is not there?
We have been hearing about children quietly desisting and we have been watching Twitter with interest, and noticing a shift.
We welcome the very sensible advice GIDS has included on their Covid-19 page – the kind of simple pleasures that young people may rediscover when they get bored of being online, such as structured activities, exercise, gardening, arts and crafts or cooking. These are things that are very positive for mental health generally, and probably more beneficial in terms of developing the useful skills of self-acceptance and resilience than becoming immersed in an ideology that is fragile and dependent on external validation.
We hope that children and young people who are really suffering with gender dysphoria are able to access the support they need at this time. Along with the useful links to mental health support charities that GIDS recommends, free support from psychotherapists is also available from this Facebook group: https://www.facebook.com/groups/2866663836736475/
Some of the best strategies for managing gender dysphoria we have seen have come from a number of detransitioners on Twitter. Their words may be helpful because, although they have detransitioned, they do not try to persuade others to do the same, but talk about the alternative ways they manage their gender dysphoria now. Gender dysphoria does not necessarily magically disappear when someone decides to detransition, so these personal accounts of dealing with it in different ways may be relevant and helpful for young people who still identify as transgender but need ways to cope with their dysphoria while other avenues are blocked. Here are a few examples:
We wish the best to our readers in dealing with this time, in whatever situation you find yourselves. Our hope is that this has been a wake-up call to educators and health professionals who might be less willing in future to teach children that they exist in their heads and not in their bodies. We also hope that the idea of encouraging a child towards a pathway of lifelong dependence on synthetic hormones and other medical interventions will be quietly dropped and alternative psychotherapeutic pathways of support will finally be developed. We would suggest consultation with the experts: the detransitioners.
For this we need robust research. To start, please share this call for volunteers to participate in a new research study by Dr Lisa Littman, and if you have detransitioned or desisted yourself, please consider taking part.