We very much welcome the considered and authoritative views expressed by Professor Robert Winston that children who question their gender identity are potentially being put at risk by doctors intervening too early.
In an interview on the Today programme on BBC Radio 4 (and also reported in the Telegraph) Professor Winston expressed his concerns that we do not yet know enough about what happens in the cognitive development of children to cause their gender discomfort. This makes it very difficult to know how best to support them. He spoke about how the brain is reassigning itself in a major way during puberty and how we don’t really know the long-term effects of intervening in that process for young children who present with gender issues.
Professor Gary Butler from the specialist Gender Identity Development Service (GIDS) for children at the Tavistock and Portman clinic in London was also interviewed alongside Professor Winston. He agreed that we don’t know enough about the cognitive development of gender identity in children yet but said that it must be remembered it is ‘incredibly rare’. He quoted a figure of only 1 in every 20,000 children who question their gender.
FACT CHECK: Although it was not challenged in the interview this figure of 1 in 20,000 of children having gender issues seemed dramatically low. We know from the GIDS own published figures that over 5000 children have been referred to them since they started in 2009. This represents 1 in every 2500 UK children having had serious gender issues at some point. We know that just over 2000 children were referred in the latest annual figures alone (in the 12 months up to April 2017) and since then rates have risen to 50 children referred every week in the past six months. That’s equivalent to 1 in every 4000 children having been referred in the last 18 months and most likely still experiencing these gender issues today. 1 in 7 of all referrals have gone onto puberty blockers (800 since 2009). If that rate is the same today that means 1 child goes onto medical treatment for gender issues every single day. There are claims that rate is now much higher and that 40% of all referrals go onto puberty blockers. That’s an amazing 20 children every day. We dispute the claim that this is ‘incredibly rare’.
What are the long term consequences of pausing puberty?
Professor Butler went on to talk about how only 20% of the children referred to the GIDS are pre-pubescent and that only 1 in 20 of these go onto pause their puberty using puberty blockers. Nevertheless this still represents a sizeable number of children (32 in the last 18 months) having their puberty paused because of gender issues. Although pausing puberty may feel like a relief for these 32 children and their parents this is a completely experimental area. There is no evidence whatsoever that pausing puberty like this will be beneficial in the long run. As Professor Winston alluded to, it is perfectly possible that by intervening in the normal cognitive processes that happen during puberty we are actually preventing the resolution of the gender dysphoria that would have occurred naturally.
Puberty blockers are commonly referred to as ‘harmless and fully reversible’ despite being strong anti-cancer drugs being used off-label in children. This means there have been no efficacy or safety studies in young children for this indication and so their use has not been approved by NICE (National Institute for Health and Care Excellence). Moreover, despite being theoretically reversible we already know that once on these blockers virtually ALL children continue onto cross-sex hormones. So it is highly likely that these 32 children will NEVER experience puberty. Going onto cross-sex hormones does not trigger puberty of the opposite sex it can only induce some secondary sex characteristics.
In the case of any natal boys in that group of 32 they will grow breast tissue but their penis and testicles will remain sexually immature and the size of a pre-pubescent child. This will adversely impact their sexual responsiveness and reproductive capacity. There is a well documented case of a young boy in the US who was socially transitioned at age 3 and then later put onto estrogen. Jazz Jennings is the star of a reality show documenting the transition. Jazz is currently 17 years old with a 2 inch penis, has never experienced an orgasm and is struggling to find a surgeon to perform a vaginoplasty. Jazz’s small genitals will not give them enough ‘material’ to work with during the procedure.
In the case of any natal girls in that group of 32 they are likely to never menstruate and so will be infertile. Long-term use of testosterone is known to cause serious side effects like vaginal atrophy and high cancer risks which means that early hysterectomies are often advised. Testosterone will also cause beard growth, male pattern baldness and their voices to break, These are all permanent effects even if they later choose to stop taking testosterone. If they one day want to have genital surgery to create a pseudo penis there is a high rate of complications; something else Professor Winston referred to in his interview.
Can these 32 young children really understand the consequences of infertility and life-long dependence on medication before they’ve even had a chance to go through puberty? Professor Winston spoke of how he was seeing the long-term consequences of gender affirmation treatments in his fertility clinics. It is increasingly common for young people to have their eggs or sperm frozen before progressing onto cross-sex treatments that are known to cause infertility. Professor Winston emphasised that this is not the totally reversible step some people believe. Despite advances in fertility treatments it is well known that freezing eggs is ‘extremely unsuccessful’ and the chances of leading to a future pregnancy very low. Likewise, freezing sperm is known to cause damage and lowers the fertility rate.
He said ‘there are lots of very unhappy people who feel quite badly damaged’.