Woman's hour today (29 October) 10 am

Italiangreyhound
When you're looking at the data, compare the numbers across one row rather than column by column. Each row represents a specific group of children. So for 2013, for example, 22 children were referred, 19 of those 22 went forward to the clinic, 19 out of the 22 (i.e. all those going forward to the clinic) were on blockers, and 4 were on hormones as of 2016. Any children who were only 11 or 12 at the time of referral (2013) would have been under 16 in 2016 when the table was compiled, so still too young for hormones. Some of the older children may not have been prescribed hormones as soon as they turned 16. Without more recent data we don't know whether or not the remaining 15 were given hormones at a later date.

Micke
Yes, that's exactly what I meant. Except I think the cross-sex hormones can be prescribed at 16.

It would be interesting to know given Dr Helen Webberley's conviction, if investigation into her prescribing for under 18's will be investigated.

Children and young people may of course have sought private treatment instead of NHS GIDS.

Meaningful data to analyse children and young people receiving puberty blockers / cross-sex hormones would need to include those prescribed privately.

since less time has elapsed since referral." I don't really know what that means. How can you tell that?

I think it's because the people in the later years are still younger - ie if everyone was referred at 15, then those referred in 2012 will now be 21, but those referred in 2015 will only be 18 this year - and cross sex hormones are only proscribed past 18 I believe, so the 2012 cohort can all be on hormones, but some of the 2015 cohort won't be old enough yet.

OldCrone

Exactly, why are the numbers given cross sex hormones going down? I've added the letters because I am not sure how to display it otherwise.

The chart says
A) Year refereed to earl intervention
B) Number of referels
C)Actual number of refereells going forward from clinic
D) Number of people who started the hypothalamic hormone blocker
E) Number of people who strated cross sex hormones

A B C D E
2011 14 13 12 13
2012 14 11 11 7
2013 22 19 19 4
2014 49 46 41 5
2015 52 52 32 x

So to me it looks like the number of people who started cross sex hormones went down from 2011 to 2012 to 2013, up in 2014 by one and then not sure what 'x' means.

"The decreasing numbers in the cross-sex hormones column is presumably because for each years figures, the cohort is younger, since less time has elapsed since referral." I don't really know what that means. How can you tell that?

As you can see I am not very good at graphs so am struggling to understand this one.

Dr Helen Webberley is being sentenced tomorrow.

Still listed on Mermaids recommended links page with comment:
www.mermaidsuk.org.uk/resources-for-professionals.html

"GenderGp - Helen Webberly
Provider of private health care for transgender patients based in Abergavenny, but also working through video conferencing. Prospective patients may want to know that, in Oct 2018, Health Inspectorate Wales successfully proceeded with criminal action. Both Online GP Services Ltd and Dr Webberley were found guilty at Merthyr Magistrates court. Sentencing will take place on 2 November 2018.
hiw.org.uk/news/onlinegpprosecution?lang=en
To review Helen's response: gendergp.co.uk/update-health-inspectorate-wales-decision/ "

"Healthcare Inspectorate Wales prosecutes online GP
Published 5 Oct 2018
HIW has today successfully prosecuted Online GP Services Ltd and Dr Helen Webberley for illegally providing online healthcare services which require registration under the Care Standards Act 2000

The prosecution follows a period in which Dr Webberley had refused to stop providing services to patients. As a result, HIW proceeded with criminal action against Online GP Services Ltd and Dr Webberley for operating a service without being registered under Section 11 of the Care Standards Act 2000.

Both Online GP Services Ltd and Dr Webberley were found guilty at Merthyr Magistrates court today. Sentencing will take place on 2 November 2018." (continues)
hiw.org.uk/news/onlinegpprosecution?lang=en
thread:
www.mumsnet.com/Talk/womens_rights/3385789-Helen-Webberley-found-guilty

I also don't see why the numbers are going down when referrals are up exponentially.

Italiangreyhound Where do you see the numbers going down? The referrals have gone up (from 13 in 2011 to 52 in 2015). The numbers on hormone blockers have also gone up. The lower number in 2015 (52 referrals vs 32 on blockers) might just be because the other 20 had not yet started on blockers, since the referral would have been quite recent when the table was compiled in 2016. This means that the Tavistock is doing what they say they do, and going slowly, which is positive.

The decreasing numbers in the cross-sex hormones column is presumably because for each years figures, the cohort is younger, since less time has elapsed since referral. Until we get to the 2015 cohort, where all of those who were under 15 in 2015 were still under 16 in 2016. So still below the minimum age for hormone treatment.

It would be useful to see how the same table would look in 2018 - and how many of those children were eventually treated with blockers and hormones. Also the figures for early intervention referrals and treatment for 2016-2018 since there has been quite a jump in the number of children referred to the Tavistock.

@SonicVersusGynaephobia sorry I couldn't see the grid on my phone.

To be honest I don't understand the grid. I also don't see why the numbers are going down when referrals are up exponentially.

I'm assuming that each line of the table is for one group of children, and 'under 15' refers to the age they were at referral. In 2016 when the table was published, the children who were referred in 2011 were 5 years older than they were when they were referred. All those who were 11 or over at referral were 16 or over in 2016. So all old enough for hormones.

For the group who were referred in 2012, if some of them were only 11 at the point of referral, they would have been only 15 in 2016, so too young to have started on cross-sex hormones. There were 11 children in 2012 who started on blockers, but as of 2016 only 7 of them were on hormones. If we could get the 2018 figures, we would be able to see whether the other 4 children started on hormones later or stopped treatment.

For the group who were referred in 2015, only one year has elapsed since referral, so since they were under 15 at referral, they are all still under 16 one year later. So still too young for hormones.

I hope that is clearer. If my interpretation is correct, then it's not saying that children under 15 are being given hormones, it's saying what happens over the next few years to the children who are under 15 when they are referred for 'early intervention'.

Your interpretation sounds better then Old, though I'm not sure I follow - if the numbers on X-Sex H are decreasing, could that mean that some stopped blockers?

There's not enough information in those tables to really know what the figures mean. If 'under 15' means the age at referral, then by 2016 all those children who were 11 or older when they were referred in 2011 would be 16 or older. Going forward, fewer of the referred children will be 16 or over, since less time has elapsed, so those who were referred in 2015 would all still be under 16. That would explain why the cross-sex hormone numbers are decreasing, and it is zero for those who were referred in 2015.

It would be useful to see some more recent figures, and see if 100% still end up on cross-sex hormones.

That is the table for the under 15s referred for "early intervention".

Very grim reading.

@SonicVersusGynaephobia that is very scary!

"But in 2011 they gave cross-sex hormones to every child under 15 that walked through their doors."

Under 15? I thought you had to be 16 to get those!

It is not true that Tavistock don't give cross-sex hormones to under 16s.

Here is a table from the Tavistock's own report from 2 years ago, showing the number of children aged 14 and under given cross-sex hormones.

It has been decreasing. But in 2011 they gave cross-sex hormones to every child under 15 that walked through their doors.

The fact its decreasing suggests they've realised that they were wrong. Maybe they aren't so good at identifying the correct children as they think.

There's increasing focus in USA on the damage done by Lupron to women who were prescribed it.
www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/

I suppose it would more comparable to a nurse specialist in oncology who as you say would be always be working under the supervision of a consultant? There will be prescribing there which is fairly routine for specific circumstances with medication that would be seen very differently outside that specific circumstance.

I'm just speculating but I do have a friend who is a nurse prescriber in a different acute specialist area. I'll ask her if she has a comparable situation.

Dr Carmichael no doubt represented the view of GIDS that some chidren's gender identity distress is appropriately treated with blockers.

I’m not sure about the regulations R0wan. I’m a GP and we have no nurse prescribers where I work. We have a pharmacist who has done some minor ailments training and prescribing for that. He will prescribe for e.g. ear infections but wouldn’t do outside of his competence so for example doesn’t prescribe antidepressants because he’s not trained to. Certainly there are specialist nurses locally for certain services e.f. Rheumatology who will initiate and prescribe drugs for patients under the direct supervision of a consultant and when the consultant has made the decision to start that treatment. As you say, they would then follow a set protocol regarding dose changes, blood tests etc. It may be the same at GIDS but I would think it risky medicolegally given the complexity of caring and prescribing in this area and the potential for litigation. While as doctors we often prescribe drugs off label where this is accepted practice I have not come across a nurse who would do and in such potentially problematic cases. As I GP I would be wary of continuing prescribing in this area, even under the supervision of a Consultant and would want a robust shared care agreement in place and potentially would run it past my defence organisation.

Some clinical nurse specialists are allowed to prescribe in certain circumstances. I have no experience of the GIDS service to know if they are nurse prescribers but I would be surprised if they are given that these drugs are being used off label.

(I am not a medic)

Presumably it is possible / likely that within a speciific setting a protocol will have been established by consultants and approved there which then enables others eg clinical nurse specialists etc to prescribe?

The principle of prescribing off-label medication described as 'blockers' to children & young people is obviously accepted by GIDs as it is internationally by other clinics.

A quick look at the members of staff page on the GIDS website lists 7 people who are medically trained, 5 of who, are Consultant Endocrinologists and 2 who are Consultant Psychaitrists. There are a couple of Clinical Nurse Specialists too. So that’s 7 people who have undertaken undergraduate and postgraduate training in medicine. Some clinical nurse specialists are allowed to prescribe in certain circumstances. I have no experience of the GIDS service to know if they are nurse prescribers but I would be surprised if they are given that these drugs are being used off label.

current thread:
www.mumsnet.com/Talk/womens_rights/3410239-Being-The-Dad-Of-A-Boy-Who-Identifies-As-Transgender-article

The giggling was very off-putting, but didn't sound as if she found things funny iyswim? (I was once told by a training manager that I did little giggles when I was presenting information in a sales pitch, which I was unaware of, and which I put down to nerves form being 'observed')

Someone mentioned upthread that Polly is under a lot of pressure from TRAs and that could perhaps go some way to explaining her odd behaviour

I think what she was trying to hide was Stephanie knew more and understood more than her, fidgetspinner555.

Lewis came across well. I remember him from a previous TV programme I think.

One thing that really annoyed me, was the question was put by Jane to Polly (Paraphrasing) "Are children too young to know, too young to understand, being given drugs at the Tavistock on the NHS that may have life-changing effects on them?"

Polly replied Yeh, and then said "No" and then said something like "Well I would say no because it is something that we do."

Jane asked "What do you mean about something you do?"

More laughter and then Polly said they were not doing that.

Polly said that the first not fully reversable drugs would not be given until 16.

But possibly over 90% of children (at the Tavistock) who use puberty blockers go on to use cross sex hormones. So in one sense this seems the medical pathway begins quite young and goes on. Polly said the blockers stage started in the early stages of puberty 12-14 (but a handful have started earlier).

I just was not convinced by the way Polly spoke.

The way she said 'Stephanie's name at (35;38 minutes in) sounded condescending and more laughing. No real insight from Polly.

Completely agree with fidgetspinner555 " ...Polly Carmichael cannot look at the bigger picture if her life depended on it! What a load of drivel she spoke. Very dodgy IMO. I personally felt she was hiding something."

Very interesting.

Jane Garvey was very good.

Stephanie Davies-Arai got some good points in.

Not comfortable at all with Polly Carmichael's constant laughs in the background. Hugely unprofessional. This is all fucking serious stuff that massively affects some children, young people and families.

Her light-hearted (to my mind) way of discussing this really put my back up.

Her constant laughter suggested she was not taking this discussion seriously.

Jane asked Stephanie about the 'debate' around this. I think she prefixed it with something like 'people who are not overly involved in this discussion'.

But I think this is itself overly simplistic.

Lots of women are concerned about this because of the issues for women's rights and lots of parents are now affected by this because their own children or their children's friends are directly affected by this.

Listened to this earlier today and was heartened by the interview overall. I liked how JG asked for evidence and that they were happy to find areas of agreement.

It is odd that whilst polly notes a lack of data, that she did not then push the need for data. Especially as a doctor and one with a PhD!

The thought of a 4 yr old being able to talk in the terms of having the wrong body just doesn’t sit right with me. Most 4 yr olds are struggling with getting their coats on and getting to the toilet on time... it sounds like a very adult assessment of a situation.

Interestingly I’ve had a very limited amount of shit on Twitter about my tweet that was read out at the start .

One misogynist who didn’t have a point to make, one butch lesbian (her words), one person who was cross but still entered into a conversation.