Mick Hartley

In a long essay in the Times today (£), Janice Turner looks into the business of medical intervention to help supposedly trans children on their way to a new alternative life. Giving puberty blocker to ‘trans’ children is a leap into the unknown:

An 11-year-old child is probably years from his or her first kiss. Yet the drug they are about to take will almost certainly lead to a medical pathway which will leave them sterile. Since their gametes will never be allowed to mature, doctors will not even be able to harvest their sperm or eggs. Can any 11-year-old understand the gravity of ruling out ever having children?

Moreover can this child, for whom sex is an unimaginable, probably rather revolting adult business, consent to a treatment which will depress their future libido to the extent they may never have an orgasm? (Imagine trying to explain the concept, let alone the desirability, of an orgasm to an 11-year-old.)

These are the ethical issues which make puberty blockers the most controversial of medications. On one side are “affirmative” clinicians and trans activists who believe that halting the onset of natal puberty is the only way to alleviate the distress of gender dysphoria, a sense of being “born in the wrong body”. On the other is a growing number of psychotherapists, doctors and endocrinologists concerned that blockers are administered too readily and, since they are prescribed “off-label” with no research into the long-term outcome for patients, amount to conducting a medical experiment on children.

As I suggested a few months back, this has all the makings of a new cult, along the lines of the "recovered memory" scandal of the 1980s and 90s. Then it was suggested to unhappy young people, by unscrupulous or over-enthusiastic psychotherapists, that all their problems could be explained by childhood sexual abuse, and could be cured by years of psychotherapy and by confronting their abusers – parents, grandparents, teachers – with their past crimes. It was nonsense, it didn't work, and lives were ruined. And here we go again. This time unhappy and troubled young people are told that they've been born into the wrong sex, and transitioning will solve their problems. And lives will be – are being – ruined.

Meanwhile the problem has increased exponentially: in 2009, only 77 children were referred to GIDS [the Tavistock Gender Identity Development Services] but a decade later it was 2,590. Whereas male referrals were once the majority, three quarters are now natal girls. In any other health sector researchers would leap to investigate such a trend. Yet GIDS remains incurious. Last year its senior consultant psychiatrist Dr Elizabeth van Horn said on Newsnight: “We do not know why the numbers have gone up so dramatically recently. Or why more of them are girls.”

Perhaps this isn’t surprising when anyone who interrogates this phenomenon is hounded by an activist lobby. Dr Lisa Littman, of Brown University, explored what is termed “rapid-onset gender dysphoria”: clusters of teenage girls, often friends, often same-sex attracted, who after long exposure to online transition forums in early puberty abruptly declare themselves trans. Her paper was denounced as bigotry and removed from her university’s website.

Yet her views are echoed by GIDS clinicians, 35 of whom have resigned in the past three years, many alarmed by the rush to medicalisation and the way Mermaids, Instagram trans influencers and the CBBC programme I Am Leo present transition as uncomplicated. They say they are seeing girls with a panoply of other issues — anxiety, depression, self-harm, undiagnosed autism, victims of homophobic bullying and sexual abuse — for whom transition to a male body was presented online as the universal panacea. Often a normal, tom-boyish disgust at their new breasts, eliciting sudden and unwanted sexual attention from men, is interpreted as a certainty that they are in the “wrong body”. Yet instead of interrogating these underlying issues, clinicians are told to “affirm” a young person’s “trans identity” and prescribe the puberty blockers that trans campaigners fiercely insist are their right. […]

Doubts about puberty blockers have come from senior clinicians, from LGBT campaigners worried that gender clinics are performing “gay conversion therapy” on future homosexual kids, and from feminists appalled that girls who do not conform to sexist gender stereotypes feel they cannot be girls. Already a growing number of “de-transitioners”, mainly young women, are coming forward, angry that doctors rushed them into irreversible treatment.

How will this play out in the next decade, as the first cohort on puberty blockers come to terms with their probable infertility? Such experimental paediatric medicine has been politicised and shrouded in secrecy for too long. It is time to ask serious questions.