Transitioning Teens - contains some upsetting scenes ...
But ends on a hopeful note - we can all agree that the current treatment for gender questioning children does not promote their best interests
On August 5th the BBC released a documentary called ‘Transitioning Teens’ where ‘trans activist’ Charlie Craggs meets trans teens waiting to be seen by the NHS, and explores the risks and costs involved in starting to transition, sometimes without medical advice.
Given that some young people are waiting up to three years for an appointment with a specialist gender clinic, what happens to the children who can’t or won’t wait? They buy hormones over the internet from unregulated services.
It begins with a scene of young people shouting that what they want are trans rights, and when they want them is right now. Jess, downing an unidentified pill comments ‘I know its dangerous, but I have no choice’ while at the same time recognising ‘there is no one overseeing this. It is all black market’.
What was good about it?
Charlie Craggs is a likeable and charismatic presenter. It was good to see a recognition at the outset that ‘this divided area of medicine is under extreme scrutiny’ and it is without doubt a scandal that so many young people in distress have to wait so long for a specialist service.
Craggs is constantly messaged by young people waiting for ‘medical support’ and meets 19 year old Jess in Brighton who has been waiting 2 years. Seeing the waiting list get longer and longer, Jess considers the only option is to go online - without transition she will just ‘disappear’. Last year she spent £100s. Forums online have ‘thousands’ of members who share their experiences with different doses and suppliers - one has 18,000 members. A conversation on one, terrfyingly, is about ‘abnormal bleeding’ - as Jess says, these kind of conversations ought to be had with medical professionals. So how do you find a ‘safe supplier’? Word of mouth.
Craggs is understandably very worried about Jess. Strangers on the internet cannot be a reliable and safe source of information about cross sex hormones.
But for under 17s there are only two clinics - in London and Leeds. There are 7 private clinics where you can jump the queue, at a cost. Alex was led by a sense of desperation to ‘feel right’ and has been on testosterone for six weeks now. Membership is £30 per month and £40 for a bottle of testosterone a month and additional blood tests at £250. 4 times a year a £50 hormone check. Alex’s mother has heard about children cutting off their own breasts and trying to kill themselves - ‘so desperately sad’ - so it was worth prioritising the medication. The idea of self medication ‘scares me senseless’. This is medication ‘to help my child be in the right body. It’s that simple’
There was an interesting discussion with a doctor who is part of a new pilot scheme - three new clinics have opened to treat children from 17, commissioned by NHS England. This pilot has an initial two year run. Doctors under the protocol will assess and make a treatment plan and send it to the child’s GP. Everyone in this field knows that the waiting times are huge and there is no other area of health care with similar waiting times. The pilot is to examine if services can be increased by offering another safe option. Only a small number of people can be seen at the moment. Most doctors just don’t get exposure to trans people and lack of training is a huge problem.
What was bad about it?
A call for medical intervention pre puberty
Sadly, the ostensibly balanced and calm presentation masked a clear starting point that transition was both positive and necessary, and thus a failure to challenge some really serious untruths. I question the advisability of choosing a presenter who had very clear views that transition had been right for her - in fact it should have started much earlier. At several points Craggs refers to the harm that she perceives going through male puberty has done - her ‘transition’ will never end. She will always be wanting to ‘fix’ things about herself. This is clearly making a case for even earlier intervention - before puberty.
Before the investigation starts we have a tour around Cragg’s office. There is no doubt that being trans is central to Craggs identity and campaigning, which involves travelling the UK with a pop up nail salon, offering free manicures in order to ‘nail’ transphobia. Craggs is rightly proud of what she has achieved. But is this really the right starting point for an investigation into what is recognised to be a divided and controversial area of treatment for children?
Fails to challenge Dr Helen Webberley
Next off to see Dr Helen Webberley - whose private clinic is currently treating Alex. She is seen by ‘some’ as controversial - reference is made to her criminal conviction and current investigation by the GMC. She hasn’t worked as a doctor since April 2017. Webberley is immediately dismissive of ‘big long assessment periods’ so a child can ‘prove’ they are trans. Six months seems too long for Dr Webberley. She doesn’t think its ‘our job to validate anyone’s gender’ - which is rather ironic given one of the charges against her is prescribing testosterone to a 12 year old. She provides counselling ‘if’ its wanted.
With regard to detransition she says ‘we never want to do harm to anyone’. She gives the example of a baby needing a heart operation. “We don’t say that if 10% of babies dies we aren’t going to operate on any. We are saying if 1 in 100 change their minds, we will say to the 99 you can’t have treatment, that just not fair.”
Craggs doesn’t challenge Webberley on any of this nonsense. The risks and benefits of heart surgery are known. The majority of children who question their gender will desist if left to go through puberty and many will end up being gay adults.
Webberley is clear about her starting point - ‘if we believe trans people exist and need help and need a bit of medical assistance to switch their hormones’. Again, this isn’t challenged by Craggs, even though only five minutes ago she read from the NHS website which made it clear that cross sex hormones are far more than ‘a bit of medical assistance’. The future of transgender health care is to be administered by a GP and the ‘slightly difficult’ stuff dealt with elsewhere. “We know that model works.”
Relying on the suicide myth
Immediately after talking to Dr Webberley, Craggs is then quite angrily dismissive about those who are concerned about the safety and side effects of treatment. We should instead be looking at the long term impacts of denying treatment and the suicide rates of young trans people - relying on the thoroughly debunked statistic that ‘48%’ of young people contemplate suicide. As has been made clear over and over again, this comes from a study involving just 27 people. It has hardened into a fact that may not be challenged. It is wrong and manipulative to use this as an argument to support medical intervention with children.
Sadly the wrongness and manipulation then continues with a short interview with our favourite QC, Jolyon Maugham. There was discussion about a legal case bought by a 14 year old against the Tavistock - currently on hold while wait for the Court of Appeal ruling in Bell.
Maugham is asking the court to ‘tell the NHS that its continued failure to allocate resources to treatment of gender dysphoric kids is unlawful’. They are being denied treatments that improve their mental health. ‘If you get these treatments you are less likely to commit suicide. That is the basic fact of the matter’.
This is of course another big lie. The research does not show this. The best studies show the worst outcomes.
A hopeful note
It’s not until 35 minutes in to a 43 minute documentary that we come to the story of Keira Bell and the key question - can children give valid consent to experimental treatment that has irreversible consequences? Up flashes the ‘estimation’ that less than 1% of people regret transition and no acknowledgment of the very shaky evidential foundations for this ‘estimation’. But Craggs doesn’t engage with the issue of regret, and is just worried that the Bell case will make it harder for children to get puberty blockers and hormones.
But at minute 37 Craggs actually meets a detransitioner. It is very heartening to see Cragg’s initial ‘fear’ at the meeting turn into something positive. She was worried that detransitioners are ‘used as a stick to beat trans people with and to take our rights away’.
The detransitioner, sadly wants to remain anonymous as she fears backlash. She found stuff on line that made her think she was trans, she hoped the NHS would give her advice on how to cope with dypshoria but she started testosterone at 17 years. At the time she was thrilled and had no doubts but after 9 months she realised something still felt ‘off’ and she realised it was the wrong choice.
Craggs initially just can’t get her head around this. But the detransitioner realised that her issues were rooted in other things and if there was better mental health provision for distressed children we would hopefully see people make less mistakes. Transition did not lessen her dysphoria - therapy did. Trying to stop children getting access to drugs won’t work - dysphoric youth need help and space to figure out what is right for them.
Craggs is relieved - they both want the same thing. More help and provision for young people. It has shifted her whole perspective. We need more help for gender non conforming people. Some people needed a bit more therapy. It shows that all children are being failed. The system needs to be changed.
On that, we can all agree. But it was depressing at the end credits to see the long list of professional medical organisations who declined to take part. However, given how the debate over what medical treatment dysphoric children need has become so weaponised by manipulative demands based on threats of suicide, I can’t really blame people for not wanting to get involved. Perhaps we can move, with the Cass Review, to a place of more calm reflection, some substantive and reliable research and treatment for children that is based on their best interests, not political zealotry or campaigning zeal.
For Craggs a late transition is clearly a source of regret for her. But for other children, the affirmation path will be a source of deep regret for them. There needs to be proper and timely exploration of what path is right and an environment where we can talk about this, without fear.
I seem to recall someone significant - maybe Dr Ray Blanchard - making the point that better to be too late into "transitioning" which just means it isn't so easy to "pass", than to be too early and subsequently realise it was a mistake.