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By Jane Galloway

Jane is an autistic woman and parent. She campaigns to highlight not only the under diagnosis and support of autistic women and girls, but the lack of research into the rapid rise in autistic youth identifying away from their birth sex.

On June 18^th, BBC Newsnight reported on the Tavistock and Portman Gender Identity Service for Children and Young People, and concerns expressed by clinicians that young people were entering medical pathways to treat gender dysphoria, without due care.

I watched it with interest, as I was aware of the ongoing controversy, but in the weeks surrounding its broadcast, high profile women including author JK Rowling, journalist Suzanne Moore and The Baroness Nicholson of Winterbourne, had been castigated on social media and in the mainstream press, for expressing their opinions.

The investigation into the workings of the Tavistock by Deborah Cohen and Hannah Barnes, highlighted worry that young people prescribed medical treatments for gender dysphoria, may in fact be masking latent gay or lesbian identities, or undiagnosed Autism Spectrum Disorder. In addition, it revealed that safeguarding concerns, which should have been referred to safeguarding lead Sonia Appleby, were blocked or discouraged by clinic director, Dr Polly Carmichael.

This follows an earlier report by them, investigating claims that parents were not fully informed about the possible long term effects of puberty blockers, and that vital information was left out of the information leaflet given to families as part of the consent process, More detail on that can be found in this paper by Professor Michael Biggs, Assistant Professor of Sociology and Fellow of St Cross College, Oxford.

Transgender Trend has been at the forefront of reporting concerns about the medical pathway for gender variant children and young people for some time, and this is further evidence that the service may not counselling their young referees with enough rigour. It is clear that in the absence of NICE guidelines, pressure from lobbyists in both the UK and the United States may be shaping the terms of the debate around appropriate gender health care, as only the WPATH guidelines (World  Professional Association for Trans Health) are currently available.

If you look at the position statement released by WPATH on Rapid Onset Gender Dysphoria, something which has overwhelmingly affected adolescent girls, a large number of whom report autistic traits, it makes clear that WPATH do not recognise it as a valid term, due to lack of clinical research. Having asked Tavistock Director Polly Carmichael, myself, at the Next Steps for Trans Equality conference in July 2018, whether there was any research planned into the sudden and unexpected 4400% rise in referrals  from adolescent girls, she acknowledged that there was not; ironically the very cohort that matches the study by Lisa Littman, in the journal Plos One.

With regard to the large number of autistic young people reporting symptons of gender dysphoria,  Polly Carmichael, and Dr James Barrett, head of the Charing Cross Gender Identity Service for Adults, have both acknowledged that they have no idea why this is the case. This has been echoed by Dr Wenn Lawson as well as Prof Tony Attwood, both acknowledged experts in autism in females, and it seems to me, that this is a vital question to ask.

Adolescents are growing up in a world that is arguably more homophobic than ever before, where girls are bullied and ostracised for being Lesbian and where the effect of online porn has created a landscape where girls are expected to engage in oral sex before they have even kissed, and where Teen Vogue refer to them as ‘non-prostate owners’ and teaches them how to have less painful anal sex. This toxic landscape isn’t considered when querying why this exponential rise has taken place.  For a new cohort of autistic and LGB youth, disenfranchisement is being met with instant, social justice mandated acceptance via the medium of trans identities, in particular non-binary.

However, while The Newsnight report confirmed that the findings of the GIDS review ‘did not identify any immediate issues in relation to patient safety’, transcripts make clear that ‘there is wide variation in practice’ with staff citing the case of Sarah Davidson, a lead GIDS clinician, who referred young people to the medical pathway within one or two appointments, and on one occasion, within an hour of meeting them. The response to concerns raised was that the young person was experiencing ‘very intense gender dysphoria’ but given that we know that issues such as Autism, sexuality, pre-existing mental health issues and even a history of sexual abuse, can be at the root of such feelings, this response is at best, strange. I am both late diagnosed autistic and a survivor of abuse, and it took me three years of therapy before I was ready to acknowledge my history and how it had impacted on me, so the idea that these complex issues can be broached and resolved in one hour, beggars belief.

I believe that medics hold some responsibility for this. Dr Carmichael stated on the CBBC programme ‘I am Leo’, about a young trans boy who was transitioning,  that puberty blockers are safe and reversible. She knew at that point that this may not be true, but she said it anyway, because when you are trying to explain something as complex as Gender Dysphoria and its treatment pathways, to a child, for a child audience, you have no option but to simplify it considerably.

And so a dishonesty was created. And it has persisted in the continual promotion of the idea that this is a minor drug that causes no harm. For precocious puberty, these were only ever intended to be used for at most, two years. They have never been licensed to be used for this long in adolescents, as part of a pathway for gender dysphoria. When the Tavistock started using them in 2011, it was part of a study, the outcomes of which have never been made public.

The problem with simplifying the effect of puberty blockers, or GnRH agonists, is that they don’t just halt the development of secondary sex characteristics. Puberty is a whole body process that effects the entire developing system; skeletal growth, brain development, height, genital development, and the hormone release that regulates emotional and psychological growth.

These children will watch as the bodies of their friends change dramatically before them, while theirs stay in a state of arrested development. Their friends will develop an active sense of emerging sexuality, start dating, develop more sophisticated emotional landscapes to match their growing bodies, while they remain in a semi-permanent stasis.  Even if they then take cross sex hormones, (and we know that almost 100% of them will) many of those physical and mental growth points will never be fully caught up, because the developmental window of opportunity for them to take place has been missed.

I don’t blame parents for believing what they are told, but I do think that the clinicians at the Tavistock absolutely bear responsibility for telling parents and young people something that they knew might not be true.

The transcripts also mention homophobia, with staff complaining that the issue was never properly addressed. As one former clinician told Newsnight, “We did have a lot of families and parents who would actively tell us ‘Oh, I’m so glad, at least my child is not Gay or Lesbian’, implying that a Trans outcome would be better for their children”, something that was referenced by JK Rowling in her recent open essay.

Following this, Mermaids asked their parents to make statements supporting their children and denying they were homophobic, which seemed terribly sad to me, as the leaked report didn’t specify a number or particular cohort of parents. I’m genuinely sorry that so many parents felt attacked and so felt the need to clarify their support for gay and lesbian children, but the divisive and vicious battle that is being encouraged on social media has left parents in highly defensive mode.

We know that Mermaids have already lobbied the UK Government for an affirmation-only healthcare model and a removal of the lower age limit for medical transition, describing it thus:

‘Arbitrary age-based restrictions are not in place in Canada, US, New Zealand, Australia, Spain. Leading endocrinologists in those countries are now proposing no more than 2 years on puberty blockers, and certainly never the 4+ years on blockers, which we see as common practice here’.

In the same submission, to the LGBT Healthcare Review, they made the startling request that GIDS staff should be screened for problematic views around transition of children:

‘Mermaids asks that a thorough audit of staff and their views on transgender issues and identities is carried out to ensure every TNB child is dealt with in a respectful and supportive way. Training to ensure awareness and a correct approach to gender issues should be carried out to ensure this’.

It’s worth looking at where Mermaids are getting their information. Despite them frequently denying the promotion of a medical pathway, they invited Dr Johanna Olson-Kennedy to be the keynote speaker at the conference Re-thinking Trans Healthcare, a conference hosted by The University of Bristol Law School.

The purpose of this conference, in partnership with the Trans Equality Legal Initiative (TELI) and Mermaids was stated to include ‘gender affirmative care for young people, trans healthcare inequalities, non-binary treatment protocols, male pregnancy, trans ageing, and medico-legal reforms.’ During the panel discussion, Susie Green, CEO of Mermaids suggested of young people, that ‘the assessment model doesn’t work for them; they have the right to autonomy over what happens to their body’. This was echoed by Dr Jay Stewart, founder of trans lobby group Gendered Intelligence, who added ‘So if we choose at 13 to take testosterone and 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’.

As unbelievable as it may seem to encourage children to make changes to their bodies with powerful cross sex hormones, so that they can ‘feel a little bit more non-binary’, this is now a reality, as evidenced by a very recent series of tweets by Dr Adrian Harrop, a GP registrar and trans-ally.

Gendered Intelligence is one of the largest providers of training for staff in schools, colleges, universities and youth services, and one of the largest groups providing educational materials to schools in the UK around trans inclusion, alongside Stonewall, the Allsorts Youth Project,and GIRES. Mermaids, as we know, provide training to the NHS, Police and uniformed services, Social Services, schools and CAMHS as well as other charity, corporate and public sector clients’.

The idea of Gillick and Fraser competencies is usually raised as evidence that young people can give consent to these treatments, however, it was never intended for use in complex, life altering situations, where robust investigations are not being routinely held before treatment is commenced. Even more concerning is whether survivors of abuse, or autistic young people with a differentiated theory of mind, can consent to medical interventions for which there is not yet an agreed evidence base and no known long term outcomes.

We are also seeing more detransitioners emerging, mostly young women, in their twenties, who have realised that they are autistic or lesbian or both, but who are finding it impossible to get help with this, because the possibility of detransition simply hasn’t been built into the medical model.

The young people treated at the Tavistock have, until now, been moved to adult services with no system in place to track them and their progress. This is quite extraordinary, since the cohort that they are treating is markedly different to any that had come before and, being comprised of 75% girls, doesn’t fit into any of the previously recognised groups of transsexual patients, as outlined by J. Michael Bailey, Ph.D  and Ray Blanchard, Ph.D, in this piece based on their extensive research. This cohort, presenting with sudden gender dysphoria, often as part of a small group of pupils in the same school year group, is something new. However, instead of giving the service pause, it has actually caused the process to speed up in order to keep up with demand. They are now embarking on a research project with Imperial College to track the progress and outcomes of any future patients, which, after prescribing puberty blockers to children and young people for nine years, is a welcome development.

Journalist Abigail Shrier, interviewed here about her new book Irreversible Damage: the transgender craze seducing our daughters, has dated the rise in the ROGD cohort back to 2007 – the year the first smartphone came into circulation, and by 2017, the vast majority of teens had one, allowing them unfettered access to YouTube, Reddit, Tumblr; the spaces most cited as influencing their experience of gender dysphoria.

But this completes a potentially dangerous circular feed. Children and adolescents find online a name for their feelings of bodily and/or psychological otherness, whether it’s caused by confusion over sexual orientation, puberty, autism, toxic expectations around what it is to be a young man or a woman, responses to porn, or already co-existing mental health issues. There is no medical model for ROGD as it has been such a fast moving phenomenon. While this makes it easy to dismiss, it is also the case that no other convincing explanation for the phenomenon has been forthcoming.

Young people talk online with their peers, or watch videos, and find the concept of gender dysphoria fits their feelings, and this then leads them to identify as trans. The prevailing culture, in which lobby groups like Stonewall, GIRES, Mermaids, Gendered Intelligence and the No Outsiders programme are training schools to teach gender ideology as part of their diversity syllabus, leads to schools frequently affirming the young person’s new identity either with or without the parents’ support.

Many detransitioners have spoken about how it was easier to be trans than a lesbian, or to feel accepted as trans than autistic, so for many of these young people they have found their niche and the die is cast. This is the point at which these children will find themselves referred to the Tavistock, sometimes directly from Mermaids. But I wonder how much pressure the Tavistock are under to prescribe blockers and hormones, given the suicide narrative that is fed to parents?

Official Samaritans guidelines on the reporting of suicide, are clear that attributing a single cause to suicidal ideation is dangerous. Nevertheless, statistics suggesting that 48% of trans youth will attempt suicide, are brandished in both mainstream and social media as evidence that they are being literally murdered or hurt by a refusal to affirm, so I was relieved to discover that the actual statistics show nothing of the sort. The Tavistock, are equally clear that this is inaccurate.

Dr Aiden Kelly, who works at the Tavisvtock as well as at their outreach clinic in Ireland,  talks about this, in his presentation working with gender difficulties in adolescence, saying:

‘Self harm is becoming increasingly common, not just with our population but as you would know, working with teens, with any sorts of difficulties, we do have thoughts of suicide. We’re fortunate that suicides are rare, at least in the teenage group, but we do get some, but I don’t think it’s more than you would get in a normal CAMHS population. Obviously there are people who feel down and do attempt to end their lives which is very unfortunate, but in terms of the child population we see, it’s not usually higher than CAMHS’.

However, the fear engendered has a powerful hold over families, particularly when they are used in Police training via Mermaids, in schools via Stonewall, and even referred to on Question Time by activist Paris Lees.

When we add in information from clinicians in the United States, with a private health model that encourages the medical transition of children without question, as well as the private practice GenderGP, (run by ex GP Helen Webberley), all promoting private blocker and hormone treatment for children, it may be that the Tavistock feel that the young people are safer being treated under their NHS care.

Certainly, Dr Aiden Kelly is very clear that not only is puberty an incredibly important process to go through, but that they have no idea of future outcomes for the children they are treating, as there have never before been such a number of youngsters with potentially affected fertility.

‘So once we’ve gotton to a  point where we think this is the right thing to do, with the family, and really, often we are putting responsibility back on the family because we don’t have the evidence base to say it’s these kids and not these kids, or how we can pick out which kids should go forward and which shouldn’t’ (my highlight).

Despite this surprising admission, Dr Kelly seems genuine in his care for the young people he works with, but also in his openness about the knowledge gaps. He clearly acknowledges that not only do puberty blockers have some very unpleasant side effects, but also that their use in younger children at the Tavistock has only been in the last 9 years.

‘One of the dilemmas we’re coming across increasingly is that …We usen’t to get this until about 3 years ago, but all of the young people, 90% of the young people under the age of 8 or 7, the pre-pubertal kids? They usen’t to be what we call socially transitioned… now we’re seeing that lots and lots of parents are transitioning their child by cutting their hair short, changing their names, deed polls, changing  schools  and some are doing what we call stealth, living in secrecy so we don’t know what that does, in a way, it’s a bit of a big social experiment that we’re worried about and we don’t know how that’s going to impact pathways and young people’ (my highlight).

What is clear is that when Kelly talks about the sea change in presentation since 2013, it becomes more difficult to divorce demands for blockers and hormones and the risk of suicide, from the concerted push by Stonewall, Gendered Intelligence and Mermaids to educate schools and public bodies, and by extension parents, that this is not only a desirable route, but necessary.

The affirmation-only approach favoured by Mermaids, is mirrored by Dr Diane Ehrensaft, Developmental & Clinical Psychologist & Director of Child & Adolescent Gender Centre in San Francisco, who says of her colleague  

“I have a colleague who’s transgender and there is a video of him as a toddler – he was assigned female at birth – there is a video of him as a toddler tearing Barrettes out of then, her hair and throwing them on the ground and sobbing. That’s a gender message”.

She continues:

“So you look for those kinds of actions. There was one… where a child wore a little onesie with snap ups in between the legs, at age one would unsnap to make a dress. Have the dress flow. The child was assigned male… That’s my sense about the one to two year olds. And children will know as early as the second year of life. They probably knew before but they’re pre-pre-verbal”.

While parents may be baffled to learn that an infant displaying discomfort at having a clip in her hair is actually evidence of a latent male identity, Dr Kelly is clear that at such a young age, babies have no such understanding of either sex or gender.

‘As they approach two years of age, children learn to label others as a boy or a girl using external factors such as hair length or dress. However the notion that gender itself is stable and sex constant as children grow to adulthood, does not usually take root until a child is five or six years old’.

Dr Kelly is equally circumspect about the number of autistic children presenting.

“what’s that about? I mean why is there such a high number of people with autism…or autism like presentation coming to our service?“

I have some ideas about it. Often people who have that condition will find social interactions difficult and will often feel a gap engaging with friends or a peer group, because, gender isn’t just a physical thing, it’s a social thing as well and we do wonder if that’s why it might relate in some way? That doesn’t mean they’re any less able to or should be any less able to go forward, it just means that we need to think about that in terms of the whys and the hows they got to this point“.

Surely discovering how all of the children got to this point is the key to deciding how to proceed? A more in depth analysis of Dr Kelly’s presentation, as well as some excellent investigative work on the Tavistock and pathways used to support trans identified young people can be found on this excellent blog.

Alarmingly, as an autistic woman, there is, from the US, the idea that transitioning can somehow ‘cure’ autism spectrum conditions. As Johanna Olson Kennedy commented in her Facebook Live video discussion with Dr Helen Webberley: ‘

“I think it’s exciting to write about this, there are people who see symptoms of autism go away when they are affirmed in their gender”.

Dr Webberley agrees, asking:

“Well who put them on the spectrum, I’d like to ask, in the first place? Again it’s down to that label, that diagnosis, isn’t it? How do we diagnose someone as being on the autistic spectrum? And one way that somebody might be showing signs of being on the autistic spectrum, is through social difficulty and so children who have social difficulty might be labelled as being autistic“.

The lack of understanding of the rigorous and elongated pathway to an autism diagnosis is astonishing given that Dr Webberley was a GP, albeit with an additional certificate in Gender Care from the Royal College of General Practitioners. (the training module no longer exists, but suffice it to say, it was woolly enough that I, as a non-medic, was able to complete the course and am the proud recipient of a certificate in Gender Care from the RCGP).

Dr Webberley is also keen to place responsibility for suicide on caregivers, including the Tavistock, who refuse to affirm. 

“I’ve seen scars, I’ve seen overdoses, I’ve seen nooses round necks, these children are really shouting loudly that I’m hurting…and that child has been to lots of doctors and lots of caregivers while waiting for the Tavi and each one of those has been able to say I can’t help you”.

She continues:

“Everyone in contact with that child needs to be accountable. I was listening to a BBC podcast about Female Genital Mutilation and they were saying that every single person that saw that child have that procedure done, who noted it but had not done anything about it; all of those people need to be answerable for not taking any action on that young person“.

This conflation of the Tavistock ‘Watchful Waiting’ approach with FGM, is as egregious as it is nonsensical. and her approach to trans youth healthcare is interesting, to say the least.

GenderGP now operates remotely from an address in Hong Kong, having been taken into the Harland International Limited group, since the Webberleys lost their licence to practice in the UK. Harland International Limited is described as

‘a global organisation, based in Hong Kong, which supports the rights of lesbian, gay, bisexual, transgender, queer and intersex individuals across the world. GenderGP was acquired by Harland International in April 2019 in order to support its long term-future and enable it to confidently continue with its mission to improve gender-related healthcare throughout the world’.

There doesn’t seem to be much information about Harland International on the internet, however the Companies House website does link the new director for all the GenderGP related companies, being registered to the same Hong Kong address as well as an address in Belize. Perhaps most pertinently, the GenderGP Terms and Conditions contain this disclaimer: ‘GenderGP is the organisational name, a business name, a trading name, it is not a legal entity and has no physical location in England. Harland International is the legal entity which is based in Hong Kong, and therefore has no requirement to be registered with any of the UK regulators’.

They were previously linked to the Mermaids website (they have since taken the link down).  It is important to note that organisations whose purpose is to support trans identified young people will all connect and at times work together, but we need to look at what they are promoting, how it fits in with both our healthcare system in the UK, and with private healthcare providers who are moving in to fill delays in the pathway.

This is partially due to long waiting lists, but also the process of Watchful Waiting, which necessitates creating space for therapists to work with young people to deconstruct the root of their desire to transition. However, the providers with the approach favoured by Mermaids and Gendered Intelligence, promote affirmation-only care, which doesn’t sit well within the framework provided by the NHS.

They consider it entirely appropriate for young teenagers to have permanent changes made to their bodies, via a new model of cosmetic surgery. They make it sound easy and it is being normalised via a series of YouTube videos made by young FtM transitioners, talking about their experiences of medical transition.

These young people are vulnerable, so I’m reluctant to link to them. However, they are enthusiastically promoting to their followers, the GenderGP clinic as well as the Harley Street Gender Clinic, run by Dr Vicki Paterski, which provides services to under 18s. This particular clinic, recommended by a young youtuber, Ash, started them on Testosterone at 16, and now, at 22, they are having a hysterectomy. Another young person, Max, describes the timeline of their Testosterone treatment: not wishing to delay, they were seen in America, where they were given a diagnosis of Gender Dysphoria, then came back to the UK, and contacted the Gender GP clinic. The length of time from first contact to receiving their Testosterone by delivery, was 24 days.

The NHS website has now updated the guidelines about the treatment pathway for young people with gender dysphoria as part of the standard 3 year review, to reflect the fact that they know that puberty blockers may not be reversible. Dr Webberley’s response to this has been to publish a blogpost, entitled ‘Puberty Blockers are reversible’ which gives no evidence for this claim, but is a call to emotion, stating that children will kill themselves, despite the risk being hugely overinflated.

She held a roadshow in the UK in 2019, promoting her services, and much of the information shared was alarming. The transcript of the roadshow can be found here but Dr Webberley alongside counsellor Marianne Oakes, made it clear that she considers that there should be no age restrictions on the medical treatment given to children. When asked when would the right time to commence cross-sex hormones, Oakes observed:

“When the time is right, we will arrive there, whether it’s age six or sixty or beyond. That really is the right time to start HRT; when our lives are in the right place”.

Taking cross sex hormones, which can have very serious side effects, is simplified by Dr Webberley:  

“What I want to say to you is that we are switching your hormone profile from one that your birth-assigned body would have given you, to the one that the birth-assigned body of your neighbour, who happened to be born in that gender identity. Switching your hormones, there’s no problem“.

Even if you believe in innate gender identity, and even if that extends to giving hormones to six year olds, this is an extraordinary way to frame taking hormones designed for the opposite sex, which can have serious side effects. But all of this is discussed as if it is no consequence at all.

They are equally disingenuous when discussing protocols for children. As Webberley observes:

“The Tavistock—we think they go too slowly. The children aren’t getting access to puberty blockers and hormones in time to spare their mental health…and the reason why Tavistock can’t retain their staff; who could possibly work in an environment where all you see is distressed children coming through, waiting for their medication to help them stop this terrible puberty, and they are told “maybe next time you come in six months’ time.” Who could work in that environment? I could not work there”.

This is a clear misrepresentation of the concerns noted in the Newsnight report, but even the RCGP comes in for criticism, with Webberley stating:

“The Royal College of General Practitioners has recently released some guidance, and it’s ridiculous. And I wrote to them and said ‘this is ridiculous’“.

Perhaps most concerning of all is the information that Webberley is giving to children under 18. When asked by an adolescent, ‘As a minor, how can I fight for the right to pressure GPs to be able to sort out blockers and hormones?’, she responded:

“You are the future of tomorrow. We really believe that. We’re very lucky in this country. Even if you are a minor, you have the right to get the healthcare you need. I don’t know if your guardians are here, or even if you don’t have parental support, you are allowed to get healthcare for yourself if you have enough brains, which I am sure you have and are competent”.

The ‘future of tomorrow’ not withstanding, the suggestion that under eighteens have ‘enough brains’ (by which I presume Dr Webberley is referring to Fraser competence), ignores everything about child and adolescent development that Dr Kelly refers to in his presentation, including the fact that the adolescent brain doesn’t finish developing until age 25. But the GenderGP patient advocate at the roadshow, continues to minimise the risks.

“I’m a bit of a tiger mother; I pushed to get the treatment at the right time. She doesn’t suffer from gender dysphoria. She’s just a 13-year-old girl”.

Webberley is at least partially honest about the risks to the cohort of adolescent girls who are starting to make up their patient base:

“Whether you were assigned female at birth or whether you were assigned male, men tend to live less than women, and that includes trans men. Trans men who have a testosterone-rich environment will probably have a shorter lifespan than they would have if they stayed as their birth-assigned female”.

But of course, and this is one of the things I find the most questionable about the push for medical pathways for children, the adults are happy resisting the pressure to transition. As Oakes says:

“I’ll be honest with you, if I can avoid the NHS having surgery, I will. However, they’re insisting that I change my name legally. And for different reasons, I don’t want to change my name legally. I don’t have any dysphoria regarding my old name. And I don’t want somebody telling me that I need to do that to be female“.

Gender GP currently have a petition on their webpage, signed by most of the notable names in the trans community, urging the Government to reform trans healthcare. They are absolutely right to lobby for improved healthcare, as for many trans adults, it isn’t currently fit for purpose. However with Dr Webberley, as well as Mermaids and Gendered Intelligence, making clear their support for no age restrictions on medical treatment, I fear that what they are asking for will not serve young people well in the long run.

It is also worth reminding ourselves of the findings of the tribunal that removed Webberley’s GMC certification, http://phl.decisions.tribunals.gov.uk/  (the findings can be found by following the search instructions and typing Webberley into the search results).

“We have found that her reasons for refusing access to her practice on 5 October were disingenuous and manipulative. She wanted to prevent access or investigation. The respondent has satisfied us that she lacks the essential attributes of integrity and candour which are essential to suitability. She also lacks insight. We do not consider that the attributes of suitability are divisible as between private and NHS practice because suitability is a concept that goes to the very core of a practitioner’s true character and attitude. Dr Webberley’s attitude is one of entrenched resistance to regulation and is highly coloured by her lack of integrity and candour“.

There is currently a review of the UK NHS pathway for gender dysphoric youth, led by Dr Hilary Cass OBE, former Consultant in Paediatric Disability at Evelina London Children’s Hospital, and former President of the Royal College of Paediatrics and Child Health. This is welcome news, as it will lead to much needed NICE guidelines for care. However, CCGs tender for all NHS services to the most cost effective provider, whether that is within the NHS or private companies like Alliance and VirginCare. One of the biggest donators of funds to the LGBT community in the US is the Arcus Foundation, the philanthropic arm of Stryker Medical; one of the biggest medical corporations in the world.

The normalisation of cosmetic surgery that took root in the 1990s is complete and it can’t be divorced from the push to introduce affirmative gender healthcare for children in this country. Dr Olson-Kennedy has herself published a study into her double mastectomies on adolescents as young as 13. She can also be seen suggesting that this cohort, if they express regret, can simply get implants. This approach is shared by US healthcare company Kaiser Permanante, discussing here performing mastectomies on 12 year old girls.

We are constantly told that we can buy our way to happiness, so why would these companies and clinicians hesitate to sell us the means to create the perfect ‘us’. If it is impossible to prove nor disprove the existence of innate gender identity, it is then it is difficult to prevent cosmetic surgery taking centre stage as the treatment of choice.

This is entirely logical, as consumerist organisations already demonstrate utter disregard for female self-image, seeing it as something to exploit; in order to sell a ‘solution’, one must first create a problem. Thus the treatment of gender identity allows the commercialisation of plastic surgery to come full circle back to it’s medical roots.

Dr Helen Webberley wrote a blog for her GenderGP website on 3^rd July this year, in which she tried to conflate the genuinely harmful conversion therapy practised on the LBG community, with clinicians taking care not to make irreversible changes to a young body without investigating whether this is the right pathway for them. As the Government plans to enshrine the Memorandum of Understanding on Conversion Therapy in UK law, this was presented through the locus of what is possible, as opposed to what is right – presumably on the basis that a child, or even a baby, can ‘know’ their intrinsic gender identity (as opposed to their sex) and that this will never change. She also rejects clear evidence that the GMC don’t regard behavioral or psychological management of gender dysphoria, in order to explore other explanations, (such as ASD, or an LGB orientation) as conversion therapy.

This is happening as we await a judicial review into The Tavistock NHS GIDS, led by ex-patient Keira Bell, who claims that she was encouraged too quickly down a medicalised pathway and has been left with irreversible changes to her body that she now deeply regrets. With more and more detransitioners emerging, this is a subject that was sensitively explored in a recent Sunday Times piece by photographer Laura Dodsworth.

Dr Kelly is clear when he says in his presentation:

“The last thing we want is a young person changing their body to fit in with what they think societies rules are…we can’t change society; I’d love to be able to change it and take gender out of it altogether, because then, what’s it matter? And you just express and be who you want to be or how you identify”.

He comes perilously close here to the position shared by so many parents; that gender is imposed by society and is not innate and does not require transition. However, this is the opposite of the medico-consumer model promoted by Mermaids, GenderGP and other lobby groups. There needs to be research, as a matter of urgency, to understand what has caused these young people to detransition, the effects on their mental health and physical bodies, and crucially, to deconstruct what made them believe they were trans in the first place. The results of research must then be fed back into robust, evidence-based NHS pathways and this is something that I would strongly urge Dr Cass to take into account.

It is negligent in the extreme for the medical community to treat these young people, then cross their fingers and hope for the best. Our children deserve better.

With Brexit complete at the end of this year, and Boris Johnson eager to negotiate trade deals with countries outside Europe, I’m fearful that US healthcare companies, who have enormous resources, will be all too eager to tender for contracts to supply gender affirmative care in the UK, particularly if plans to expand the number of regional healthcare centres supporting the trans population come to fruition. The companies are already circling as this Twitter advert shows.

Mermaids and Gendered Intelligence, along with GIRES and Stonewall, not only have huge influence over trans youth and their families, but they have enormous influence in schools, especially in light of the new mandatory RSE syllabus which includes the teaching of gender identity as fact. Mermaids’ legal department has already worked with the EHRC in its challenge to the NHS regarding providing fertility treatment to young people undergoing medical transition, as noted in the latest Mermaids financial report, and their plans also include working with the LGBT consortium to appoint a post to act as liaison between all the lobby organisations to ‘facilitate data and knowledge sharing’.

Given that these organisations have made their support for a no-age-restriction, affirmation-only medical model clear, and given what we know about what this means in practice, it is vital that those in both the NHS and Government, thoroughly investigate the current landscape of both NHS and private healthcare provision to gender dysphoric children and adolescents. They need to ensure that this young cohort of patients are subject to robust safeguarding and therapy, to avoid, as far as possible, placement on a medical pathway they may grow up to regret.

The six BBC Newsnight investigations into the Tavistock & Portman NHS Gender Development Service, can be viewed here.