We write in regard to the recent reports in the Sunday Times which revealed “very serious ethical concerns” expressed by a number of staff members at Tavistock GIDS, and the warning that some young patients could be exposed to “long-term damage” due to pressures from campaign groups and parents.
Subsequently, a review of recent research by Professor Carl Heneghan, revealed on BBC Panorama, exposed the lack of robust research and evidence to support the medical treatment of children with gender dysphoria, concluding: “The current evidence base does not support informed decision making and safe practice.”
We write as critical friends of Tavistock GIDS on behalf of the many parents who have contacted us over the years, from the perspective of their collective experience of daughters and sons who have suddenly adopted a transgender identity in adolescence, with no prior indication of gender dysphoria in early childhood.
The treatment of children with gender dysphoria has become a highly politicised issue.
We recognise the profound changes in background factors when a child presents with any kind of gender confusion today. These new factors are not only very recent but they are changing rapidly. They include the following:
*The role of the internet in children’s lives: this is a new social media generation.
* Political activism: the ideology-driven re-education of children and young people in schools and society which reinforces messages from social media sites such as Tumblr, Reddit and YouTube.
*Social transition: children and young people may be socially transitioned before referral to the Tavistock, and ideas about gender and self-identification as transgender may already be entrenched.
*The uncoupling of ‘gender dysphoria’ from ‘transgender’ which has recast a clinical condition as a political identity.
*The unprecedented increase in the number of teenage girls referred to gender clinics and the poorly understood new phenomenon of Rapid Onset Gender Dysphoria after puberty.
*The increasing number of children and teenagers presenting with pre-existing mental health issues, neuro-divergent conditions such as autism and troubled or traumatic backgrounds.
*The change in language from ‘transsexual’ to ‘transgender’: the rise of Queer theory as a model of understanding of transgender identities, including in children.
*A political climate of fear of challenging or disagreeing with these ideas among professionals and throughout wider society.
These factors need to be understood in relation to the care of children and young people presenting to GIDS, and mechanisms in place to take account of this rapid social change. There is little clinical understanding or established approach towards ROGD teenagers for example: how does a care pathway evolve on the basis of minimal research evidence?
The role of GIDS is becoming unclear in light of these changes. Is its function:
- To help and support the individual child or young person affected by gender dysphoria, taking into account the whole child, their developmental stage, social context and unique circumstances?
- To validate the ‘transgender child’ in service of an ideological and political rights movement?
Tavistock GIDS has to operate within a context of increasing pressure to adopt an essentialist theory of gender which is unscientific and unproven. We recognise that political pressure, hostility and accusations of ‘transphobia’ will create a particular challenge in maintaining a position of neutrality.
However, the role of clinicians should not be to validate and reinforce the ideas of one political lobby at the expense of evidence and clinical experience.
The demands of activists should not be allowed to pressure clinicians entrusted with the care of children and young people. The influence of lobby groups such as Mermaids, GIRES and Gendered Intelligence is being felt in both health and educational settings, through schools toolkits and NHS professional development resources.
Other professionals such as teachers look to the Tavistock for guidance so the Tavistock must be guided by peer-reviewed research and evidence-based practice.
We owe it to our children to ensure that best practice is not derailed by any currently popular belief system and we are concerned that the integrity of GIDS may be compromised if clinicians feel afraid to speak openly about their concerns. The culture of intimidation felt in wider society should not be extended into the arena of clinical care for children.
We call for honest and transparent investigation and review of current dilemmas at GIDS and we demand, in the service of our children and young people, that clinical practice be clearly separated from political activism in all spheres of healthcare and the care of children.