UK: Evidence From Medical Organisations

We had a look through all the written evidence submitted by medical organisations to the government transgender inquiry to see how the recommendations for the care and treatment of children and adolescents were reached by the inquiry. Here we’ve pulled out the most relevant quotes, with our synopsis at the end:

Written evidence submitted by Polly Carmichael of the Tavistock and Portman Clinic

“Typically, these young people are unhappy about their biological sex and wish to belong to the other one.

Clinicians in the service accept that gender non-conformity cannot be explained adequately within any monolithic theoretical model, and that explanations are probably multi-factorial.

The Service has seen large increase in the number of referrals received, by an average of 50% per annum since April 2009. In 2014/2015 the service received 697 referrals.

Along with the increase in referrals, the number of complex cases has increased. Many of the young people referred to the service have significant associated difficulties, features of ASD and challenging social circumstances. Self-harm is not unusual in adolescent service users

The appropriate care of Gender Dysphoria in children and adolescents is contentious and debated in the absence of an adequate evidence base. It is not possible with any certainty to predict the outcome of gender identity development and the evidence available suggests that for the majority of pre-pubertal children their gender dysphoria does not persist into adult hood.

It is important to establish the competence of any of the young people for whom physical intervention is recommended. This evaluation must be done with special care for those under the age of 16. ‘Competence’ requires young people to understand fully what is proposed, retain an understanding, appreciate the importance of information and see how it applies to themselves, and weigh the information in the balance. The level of understanding that is sufficient will vary with the complexity and gravity of the decision. Greater understanding is expected if the burdens are heavy, the risks high, or the benefits uncertain.

We offer assessment and treatment not just to those young people who are identifiably resilient and for whom there is an evidence base for a likely ‘successful’ outcome. We have carefully extended our programme to offer physical intervention to those who have a range of psychosocial and psychiatric difficulties, including young people with autism and learning disabilities, and young people who are looked after. We have felt that these young people have a right to be considered for these potentially life-enhancing treatments

Some young people back off from physical treatment at an early stage, but the majority who choose to undertake physical interventions stay on the programme and continue through to adult gender services where surgery becomes an option.”

Written evidence submitted by NHS England

“Gender Identity is the individual’s personal sense of their own gender. It includes both binary and non-binary experiences of gender. Binary experience implies that an individual identifies either exclusively as a man or exclusively as a woman. However, there is growing recognition that many people do not regard themselves as conforming to the binary man/woman divide and that this will impact on their treatment.

“Although we do not have recent data on prevalence in England, a primary care population study of transsexual people conducted in Scotland reported of an incidence of 1:12,225 (0.00818%), and a prevalence of 1:7,500 in assigned male at birth and 1:31,000 in assigned female at birth. The trend in epidemiological research appears to be towards higher prevalence rates in the more recent studies.”

Written evidence submitted by Royal College of General Practitioners

“Another potential barrier for GPs is a fear of litigation. The majority of hormones prescribed to transgender patients are unlicensed for this usage. This means GPs fear ramifications if they prescribe them and something goes wrong.”

 

Summing-up:

  • Acknowledgment that children want to change sex, not gender
  • ‘Gender non-conformity’ framed as a condition requiring explanation
  • Acknowledgment of absence of a theoretical model of understanding
  • Acknowledgment of prevalence of associated difficulties, ASD, challenging social circumstances, self-harm
  • Huge steady increase in children presenting to gender clinics (why?)
  • Appropriate care and treatment protocols not yet established (and contentious)
  • No means of predicting outcome of gender identity development
  • Absence of adequate evidence base
  • For the majority of children, ‘gender dysphoria’ does not persist into adolescence
  • Competence of children and adolescents to understand treatment implications?
  • Nevertheless, treatments being extended to children with serious co-morbid conditions
  • The majority of children who start treatment progress to adult services (blockers > hormones > surgery path)
  • Not conforming to either the 100% male or 100% female gender stereotype is not considered normal
  • 0.008% prevalence of transsexuals (the trans inquiry inflated the figure to 1% by including ‘non-binary’ etc)
  • Acknowledgment that hormone treatments for children are off-label

 

All of these issues raise many questions and serious concerns and should indicate that great caution is needed in the diagnosis and treatment of children for this very new ‘disorder’ of gender-non-conformity.  Despite all this, the government’s recommendation is to speed up treatment processes and reduce the age at which a child can legally ‘change gender’ (not sex?) from 18 to 16.

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This Post Has 7 Comments

  1. PetuniaCat

    OMG! My eyes are bulging out of my head! I only read the Polly Carmichael Portland clinic section and your concluding bulleted points. But good gravy. Polly Carmichael’s submission isn’t a submission it’s a confession!

    “Greater understanding is expected if the burdens are heavy, the risks high, or the benefits uncertain.” says Polly.

    She’s referring to the child patient’s understanding. But these of the criteria in standard pervasive medical ethics for when you DON’T provide the treatment. If the burdens are heavy, the risks are high and the benefits are either very small, or if they’re not known they might be small. This is why Johns Hopkins stopped doing sex change procedures in 1979. And that was on adults. The benefits from it were two little relative to the “radical” in medicalese, meaning invasiveness, destructiveness of the treatment.

    The question is why is the British government manipulating information in its own Transgender Inquiry in order to evade the limitations medical ethics would put on this thing.? Why would they do that? Regardless of the reason, and it might just be cupidity, that is what they have done. The British government has manipulated medical information in order to engage in extreme medical practices on children. This is horrific. And will certainly come back to haunt MP Miller and others.

    Let us remember the rate of desistance is very high. They’re advocating for mass misdiagnosis. Followed by irreversible medical interventions. It’s like giving people who don’t have cancer chemotherapy.

  2. E

    So, all indications are that trans kids frequently desist, so the answer is to lower the age of transition. Seriously?!

  3. atranswidow

    Meanwhile, a teenage boy under the care of the Tavistock and Portman cuts off all contact with his adoptive parents with the full backing of the High Court.

    http://www.theguardian.com/law/2016/mar/10/high-court-transgender-teenager-cut-off-contact-adoptive-parents

    ”The judge said the situation was extremely difficult for everyone. PD struggled to understand the lack of support and understanding shown by his parents, and they struggled with his feelings and decision about his gender.”

    “The upshot is that he, at 16 years of age, has decided to completely disengage from family life with them.” He said it was a decision that PD was perfectly entitled to reach and that the court must respect.”

    So the parents are described as having a lack of understanding and support and that they struggled with the child’s feelings. Not only that but the child, at the age of 16, has the right to cut himself off from them completely to the point that they are not even entitled to know anything about what happens to him in the future. Their only hope of appeasing the court is to be re-trained by the Tavistock in the error of their ways regarding continuing to use his old name.

    This is so unbelievably sad for all the family. It also sets a worrying precedent. In this case the parents were adoptive. I would dearly like to see a full copy of the judgement. This government’s understanding and descision making on trans policy and law has been wholly influenced by trans focused and activist groups.

    1. atranswidow

      Just to clarify, it appears that the child in this case was born a female and is transitioning to male.

  4. Not a happy bunny

    I wish they would find out what causes Gender Dysphoria.
    I have battled with it since I was about 4 years old keeping it secret from loved ones for forty years, saying that I think it is a big mistake to consider changing a persons gender before they have reached the age where they can seriously appreciate the ramifications of what the process involves and the effect such actions will have on them and their loved ones.
    I am over fifty years old and I still don’t know what to do about it, it has made my life a living hell and I have not transitioned and still live in a male role and I wish the whole damn thing would go away

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