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We have heard recent revelations in the press of ex-Tavistock clinicians’ concerns about the treatment of children with gender dysphoria and the pressure exerted on them by transgender lobby groups such as Mermaids and GIRES.

To understand what kind of pressure the Tavistock is under we need to know what it is that these groups believe in and promote. What they want, quite openly, is for the UK to adopt the same system of care as in the United States. Over the past two weeks we have had the chance to see exactly what that looks like through the visit of one of the most influential people in the area of gender care in the US, Dr Johanna Olson-Kennedy of the Centre for Transgender Health and Development Children’s Hospital, Los Angeles.

Olson-Kennedy is currently in receipt of a $5.7million NIH grant to study the effects of early medical interventions for adolescents with gender dysphoria. Mid-way through the study, the minimum age for cross-sex hormone treatment was decreased from 13 to 8. (This means that an 8 year-old girl with precocious puberty may be given testosterone.) The lack of a control group and a short-term follow-up virtually ensures that Olson-Kennedy will get the results she is after and testosterone use will be declared ‘best practice’ for girls in early puberty. Olson-Kennedy is an enthusiastic advocate for testosterone for 12 and 13 year-old girls (see below).

The University of Bristol Law School has invited Olson-Kennedy to the UK as a Benjamin Meaker visiting professor. The main purpose of the Benjamin Meaker Visiting Professorship is “to bring distinguished researchers from abroad” according to their website. In late March and early April Olson-Kennedy was a keynote speaker at the Re-Thinking Trans Healthcare conference, organised by Peter Dunne and Mermaids, and gave a public lecture, both events at the University of Bristol. She also took part in a live Facebook event with Dr Helen Webberley and was a speaker at the recent European Professional Association for Transgender Health (EPATH) conference in Rome.

Johanna Olson-Kennedy speaks

The Centre for Transgender Health in Los Angeles had its beginnings in the Division of Adolescent and Young Adult Medicine HIV clinic, when according to Olson-Kennedy, transwomen (a high-risk group) began to say “can you do my hormones too?” Following an expansion of services in 2000, Olson-Kennedy joined the team in 2006. In 2012 the gender clinic became a recognised centre separate from the HIV clinic. As Olson-Kennedy says:

“If you build it they will come”

Younger and younger children began to come. The team of Health Educators, all trans adults, go out into the community, to schools and places of worship “where the youth are.” Five new young people attend the clinic every week, and there is a similar trajectory as with the Tavistock in London, in terms of the male/female ratio: a huge rise in teenage girls and a rise in non-binary identities. Services include provision of blockers and hormones, mental health and psychiatric care, financial advice and support to change documents and various support groups for young people and family members, including a play-group for “little kids who are gender diverse.” 1,400 3 – 25 year-olds are currently using the service.

Listening to Olson-Kennedy speak about her practice gives us a clear picture of what NHS gender identity services would look like if based on the beliefs and demands of support groups such as Mermaids, GIRES and Gendered Intelligence. Olson-Kennedy is perhaps the most influential ‘gender doctor’ out of many who are already putting into practice a gender-affirmative and informed consent model across the United States. The dominant themes that emerge about her work originate from her seemingly evangelical belief in the presence of an ‘innate gender’ inside of all of us; a gender stereotyped soul (see image above: guns or glitter? Wheels or heels?) which demands expression not just through clothes and pronouns but physically through the body with blockers and hormones.  

At the Bristol conference Olson-Kennedy described her clinic as providing “young person-centred care” but it is clearly not: it would be more accurate to say that what the clinic offers is “gender-centred care.” Listening to Olson-Kennedy’s impassioned speeches, it is obvious that a mystical notion of gender is elevated so high and looms so large it obliterates everything else until the clinician cannot see beyond it to the real, individual child in front of them. In a child’s behaviour and words, the gender-centred clinician can only see validation of their own dearly-held faith; everything a child does and says is interpreted through its lens. Gender is everywhere, within us and without, although those within the faith must try to exist in a “cisgender-normative world” of non-believers.

Olson-Kennedy talks of children having their “trans epiphany,” an apt term and a revealing one for someone who appears to hold a quasi-religious veneration of “gender.” It is into this gender temple that little children come, ready to put together their “gender puzzle” from the age of three. This is achieved through conversation, by finding out what children need and “doing everything we can to meet those needs.” To enable the child to disclose information the child is asked in the presence of the family, “tell me about your gender noise,” a clarification of the lens through which the child is expected to view themselves and form their understanding.

This may be contrasted with the example offered by consultant clinical psychologist at the Tavistock, Bernadette Wren, of a question she might ask: “How curious are you about yourself?” This is a neutral question with no adult agenda behind it, no underlying expectation of how the child might frame their understanding of themselves. Because children strive to give adults the “correct” answer to their questions – to please the adult by giving them what they want – it is crucial to rid ourselves of our own inherent biases and pre-conceived ideas and beliefs when we question and listen to children. Through Olson-Kennedy’s leading question, the child immediately perceives that their answer must have to do with “gender,” the adult has decided that for them and in the child’s eyes the adult knows best. Any therapist – and most parents – would be able to see here that the child is being actively influenced into the adult’s pre-determined agenda.

Olson-Kennedy seems to think experimentation with a child’s mind is fine. She is quite open in her view that a neutral approach of ‘watchful waiting’ amounts to neglect.

“Parents use the watchful waiting model in the context of their own home – that model should be renamed “do nothing and wait” right, as opposed to, like, okay, let’s figure out how to support these people across all these stages…let’s do some stuff and see how that looks!”

A child is not a test subject for our pet theories. As adults we may bend reality into any theoretical shape we please but children’s lives and bodies are not there to participate as subjects in our academic theorising. Any work with children starts with the child, from a basis of understanding of child psychology, child development and the child’s level of understanding which is shaped by the significant adults in the child’s life. A child is not an abstract component in a theoretical equation for adults to play around with.

It is interesting to note that Polly Carmichael, Director of the Tavistock GIDS, also expressed a need to move away from the idea of ‘watchful waiting’ – but for the opposite reason:

“In the past we used to talk about watchful waiting and I think watchful waiting is now less something we do because there are significant difficulties with some of these young people.”

If ‘watchful waiting’ has begun to be seen as a form of negligence, for Olson-Kennedy it is because the child needs to be ‘supported’ with overt influence towards a self-perception as transgender, whereas at the UK clinic even the more cautious and neutral approach has led to concerns that some young people are being pushed towards medical intervention without enough therapeutic support to explore underlying issues.

During the panel debate at Bristol Polly Carmichael stated: “There is a lack of an evidence base. We’re a little bit more cautious. Rightly or wrongly, that’s where we are.” But there was a clear consensus between Olson-Kennedy and two other panel members, Susie Green of Mermaids and Jay Stewart of Gendered Intelligence, that ‘watchful waiting,’ ‘caution’ and an assessment-based approach all translate as “doing nothing.”

Susie Green stated that children don’t feel heard and that “the assessment model doesn’t work for them, they have the right to autonomy over what happens to their body” and Jay Stewart concurred: “Who gets to say who we are? We get to say who we are.”

Things have clearly moved so far ahead in the US that Olson-Kennedy interpreted the term ‘cautious approach’ to mean the physical intervention of puberty blockers. Because blockers create a medically-induced menopause for adolescent girls, leading to hot flashes, memory problems, insomnia and “all the lovely things about menopause which turns out to suck when you’re in your forties but it’s really bad when you’re 15” Olson-Kennedy’s solution is to use blockers plus testosterone.

“I don’t know that that’s cautious, to put a 14 year-old into menopause” she says, “maybe that feels more cautious,” and “it looks like caution because we’re not giving them testosterone.” Olson-Kennedy gives testosterone to 13 and 14 year-old girls “frequently” and to 12 year-olds “sometimes.” She has absolutely no concern if a girl later regrets the permanent change of voice and male-pattern body and facial hair, along with potentially compromised fertility and sexual function.

“If it’s okay at 13 but understanding of gender changes when they get older it’s not going to be the right thing for them anymore and they’ll navigate that.”

Jay Stewart agreed:

“So if we choose at 13 to take testosterone and then at 19 we think ‘I feel a little bit more non-binary now’ – that’s all okay. We need to be a bit more progressive.”

When Bernadette Wren points out that “people come back and say “I’m not sure about that decision” Jay Stewart bats back with “It’s their decision, not yours.”

We are talking about girls in early puberty who are being given irreversible medical interventions, but Olson-Kennedy is able to side-step the issue of children’s malleability, vulnerability to adult suggestion and capacity to consent by the simple decision to make no distinction at all between children and adults.

“…talk about it when you’re three, when you’re 15, when you’re 21, it’s absurd, we really have to understand that people know their gender – they’re not making a decision about their gender, they’re making a decision about what to do with it if it doesn’t match their assigned sex at birth.”

Polly Carmichael urged: “It’s incumbent on all of us to think about child development, how children’s thinking develops…” Professor Carl Heneghan points out that “children are not small adults” and that we must differentiate between adult and child bodies because there will be different effects from medical interventions. Children are not mini-adults either physically or developmentally and to make no differentiation between adults and children in gender identity services is a gross failure to recognise the status of childhood. It is noticeable that Olson-Kennedy very rarely uses the word ‘child’ but mainly refers to ‘people’:

“People come in, they already know their gender…I think it’s weird that a stranger would know your gender better than you. I just think that’s odd.”

Along with the choice to ignore a child’s developmental stage and capacity to understand, Olson-Kennedy also has little faith in the diagnostic skills of other clinical professionals working with children; to her, gender is at the root of everything. This is Olson-Kennedy again having the conversation with a child:

“…tell me about the things you are navigating every day and let’s understand how much bandwidth that is taking and then understand why you got your ADHD diagnosis, and then understand why you got this diagnosis, that diagnosis.”

This contempt for fellow clinical professionals is echoed by Dr Helen Webberley in the live Facebook event when asked about children on the autistic spectrum:

“Who put them on the spectrum, I’d like to ask, in the first place? How do we diagnose somebody as being on the spectrum? One of the ways somebody who might be showing signs of being on the autistic spectrum is through social difficulty…trans youth find it difficult to socially interact…”

The concern about referrals of ASD children to the Tavistock is overturned: these are actually transgender children who are just being mis-diagnosed as autistic. Olson-Kennedy’s partner Aydin, in a presentation at the EPATH conference, suggests that a whole host of diagnosable conditions are in fact just different presentations of gender dysphoria.

Johanna Olson-Kennedy makes the unevidenced claim that underlying mental health disgnoses are not the cause of gender dysphoria, although it’s not clear how we find this out if we don’t explore these issues in connection with the gender dysphoria, in order to eliminate them.

This slide could be labelled ‘The Teenage Brain.’ All teenagers are vulnerable, but some much more so than others. The normal teenage impulsivity, lack of ability to plan ahead and inability to regulate mood, is reason enough for caution in the treatment of teenagers who are certain they know what they want, let alone for those with more serious mental health problems.

The belief in innate gender erases the male/female sex binary and instead divides the world up into a new binary of transgender and cisgender people. This compels young people who are not trans but reject gender stereotypes to identify as ‘non-binary,’ as this model provides no other place for them. It is not surprising that 11% of young people referred to the Tavistock now identify as ‘non-binary’ because they have been taught to believe that to be a ‘cisgender girl’ is to be a stereotype. If you are neither ‘cis’ nor ‘trans’ you are literally neither male nor female, so children are led to believe, and you can order a designer body to match.

As Olson-Kennedy puts it, your ‘gender’ is something that you ‘wear’ not just in the clothes you choose but through your physical body: “In the US hormones are available for non-binary identities, how they want to wear that particular iteration of their gender and what hormones can or can’t do around that.”

It’s worth looking at Olson-Kennedy’s full statement in the Facebook live event for Gender GP Helen Webberley:

“Gender expression is incredibly fluid for all humans including cisgender people and so having these conversations about what elements of your physical body do you want to impact or might even want to change.. I’ve had non-binary folks assigned female at birth who take testosterone for a year and they know they’re going to take it for a year and  they stop after their voice goes down or some other element of their physicality changes and they’re feeling  comfortable in that presentation. A lot of non-binary young people assigned female at birth really only want chest surgery and that’s a critical piece for them in order to express their gender in a way that feels most authentic for them.”

“Gender” is not just a mysterious innate essence but a cosmetic consumer choice, with the body as the product. At the Bristol conference Olson-Kennedy stressed the importance of a double mastectomy to solve the problem of harms caused by binding the breasts. “If you want breasts at a later point in your life you can go and get them” she told her audience at a Gender Spectrum event last Summer.

(Note in the statement above that a “girl” – an ordinary girl, who doesn’t see herself as fitting the stereotypes which would define her as “cisgender” – has been renamed as “a non-binary young person assigned female at birth.”)

The overarching impression from listening to Olson-Kennedy talk is that the belief in a disconnected gendered soul enables contempt for the physical body and its limitations; that the protection of an idea replaces protection for the body. The callous disregard for children’s bodies, especially female bodies, is quite breath-taking. Would this contempt for the human body be acceptable in any other area of healthcare? The spread of gender as a new religion seems to be blinding people to what is really going on here: the sexual mutilation of young girls’ bodies.

Conversion therapy and affirmative therapy are really just two sides of the same coin of enforced conformity to rigid sex stereotypes: one side says the personality is wrong, the other says the body is wrong. Children are either encouraged to feel ashamed of their personalities and interests or to feel shame and contempt for their own bodies. A compassionate approach which supports a child to reject neither their ‘true self’ nor their body seems to be beyond the imaginative capabilities of Olson- Kennedy.

Could we ever have such a system of biological sex denial in the UK, based on an extreme essentialist theory of gender with no scientific basis? And teach children that it’s real?

We already have highly-funded lobby groups who are pressuring the Tavistock and the NHS, who are invited into schools to re-educate children, and who have succeeded in getting ‘gender identity’ added to the Memorandum of Understanding on Conversion Therapy, which effectively mandates the gender affirmative approach. The NHS is already working towards the commissioning of ‘alternative’ gender services for adults, which will include 17 year-olds. The ground has been prepared in incremental steps so that the award of a Visiting Professorship from the University of Bristol to Olson-Kennedy has passed by with little notice or concern.

Those within the faith appear to be quite confident. From the Facebook Live Gender GP event, here is the last word from disgraced GP Helen Webberley:

“We have a blank canvas, we have no training in the UK we have no specialist register in the UK so we have a blank canvas that we could make, we could start this ball rolling. With the influence we’re learning from our US colleagues, I think this is a really exciting time for the future.”

For more information about Johanna Olson-Kennedy, the website 4thWaveNow has been writing articles about her for years. For more on Olson-Kennedy’s technique of asking children leading questions (“I just gave him the language”) this post is a must-read. And see the following articles on the designer non-binary body, on coercing parents to “affirm” their child’s gender identity, on campaigning to lower the age for genital surgery, on the promotion of under-18 medical transition in the absence of evidence, on the confirmation bias in Olson-Kennedy’s research studies, and on the impact of early medical transition on adult sexual function.