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.”
“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.”
“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.”
- 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.