Isn't Helen Webberley still prevented from providing services in UK?

Why wouldn’t it be ethical? If it’s a sexual health condition and not a mental health condition we should be working towards defining it.

People keep telling us about brain scans - why not pursue that avenue?

DuLANG

Gate keeping is a method i am familiar with and see no great problem with it although, I am aware that I say that from the position of only having had to wait around six months to see a specialist. If I'd had to wait three or four years my opinions may differ. What diagnostic testing would you like to see? In the current absence of a genetic marker or particular blood profile that stance if it were medically accepted could lead to no treatment. It's okay to want that to be the position but, I'm not sure it would be ethical.

PaleBlue

As far as I am aware you can not access state funded gender surgery in the UK without a diagnosis of gender dysphoria.

As for treatment of last resort, in the main it is. But, many years of trying different treatments from electric shocks to counselling patients out of it did not seem to work in the main. At some stage they arrived at a point where aligning the body as best as they could with the mind is what seemed to work best for the majority of the patient cohort. But, you are right to say that surgery is just one option, I am led to believe that some don't need it to reduce the dysphoria although i personally haven't yet met a TS who has not had or doesn't desperately want surgery.

As for the surgery itself, it isn't without risk but it isn't high risk in the grand scheme of surgeries. I'll speak candidly seeing as you can't see me and say that after care (I can only speak for M to F) is mainly limited to keeping yourself clean and dilation which reduces with time particularly after the first twelve weeks but will always be required unless you are lucky enough to be engaging in regular sex. As for risk of complications they are there however, to think that the person considering surgery would be a normal healthy adult without it is not correct. Further to that, developments with techniques of surgery will always take into account previous problems to drive improvement.

Proper diagnostic tests rather than informed consent is the best way to avoid mistakes.

But that’s ‘gatekeeping’.

Quentin

My feeling that the UK is still a mildly socially conservative society comes mainly from my experiences. I'm gay and I'm trans. Same sex public displays of affection even such as holding hands are still something that risk running the gauntlet of those who can't hide their bigotry in public. San Francisco is socially progressive, certain areas of our large cities are socially progressive, in my opinion the UK as a whole certainly isn't. It's just my experience though, perhaps yours is different?

As for the second question. You are right it is a tiny minority that present with symptoms of GD in childhood. Many that do, hide it well away knowing that to bring it into the open is going to cause all sorts of problems. Perhaps even worse than the ones that are already causing you so much distress. A minority do speak up, over the last 5 years GIDS figures suggest they had just short of 9000 referrals. That is an increase, particularly among girls which is interesting (although the rate of increase did start to slow again in 2016-17). That said 9000 referrals is a tiny proportion of the children under 18 in the UK(circa 12.5 million). In 2017 the DM did an expose to report that 800 had been prescribed blockers. Is that 800 of 9000, i don't know really, actual figures are hard to come by but, if so it would suggest just under 10 per cent of those referred go on to be treated suggesting a high desistence rate/ not diagnosed rate during the evaluation phase. From that I would suspect those that do eventually go on to blockers are those that present with the most persistent symptoms during the evaluation phase. Currently the most common age range for referral is 13 - 16. The wait to see a clinician currently stands at around 27 months so I suspect most 14 year olds and above will never see GIDS and instead be referred on for a further three or more year wait with adult services. Of those that are treated though there are likely to be a a very small number of that group that go on to de transtion. Those cases should provide valuable evidence for them to improve both evaluation and subsequent care. I know that is no recompense for the false positive but, if we were to pretend that trans health care is the only field that suffers from a minority of false positives then we wouldn't be being honest. What I can't bring myself to do is advocate withdrawing treatment from a very small number of 18's based on the experiences of a very small number of that particular group within a group. To do nothing as far as those who are suffering are concerned really isn't a neutral act. That said, it is now the subject of judicial review so whatever we think is likely not to matter.

I meant Webberley not Waverley

I suppose whether or not they have actually continued to work whilst suspended will come out when their case is heard. It's not really about the UK stopping people from accessing medical treatment abroad. it's about keeping patients safe and ensuring that Doctors work within their regulators guidelines. Regulation is all about keeping patients safe and HW has been convicted of illegally providing healthcare services so she was clearly not acting in the best interests of her patients.

With all the emotion involved in all this, it just highlights the importance of evidence based medicine and informed consent...

Even with known medical scandals, there would always be a large cohort of happy patients who were happy with their breast implants/vaginal mesh/surgeon who cauterised his name on their liver etc etc...

It’s only through ongoing clinical audit, rigorous research and accurate case follow up (plus sadly sometimes the need for courageous whistle blowing) that the truth comes to light.

I can’t see how informed consent can be given when patients are children and the information isn’t there.

Ignore double negative.

NHS cardiologists who are doing private consultations on the weekend that aren't motivated by profit so, I don't think the W's are unique here.

Those cardiologists would not be continuing to practice after GMC suspension though. That is the unique point.

www.theguardian.com/society/2016/jul/11/transgender-nhs-doctor-prescribing-sex-hormones-children-uk

Psychologists, psychiatrists and surgeons don’t avoid employment at GICS due to ‘GPs not liking transpeople’ but because of a variety of professional reasons, including a handful of angry service users. Check out the whatdotheyknow website for FOI’s including the words ‘transgender’ or ‘gender reassignment’ for some alarming examples.

Look at the way transactivists have behaved towards Zucker, Blanchard, Cantor and Reid. The ‘politics’ is coming from inside the genderhouse

With regards to the sucide, it's absolutely tragic that it happened full stop and I can't even imagine how the parents must feel. It fills me with sorrow. To think that cases like this would then be weaponised for political capital is really disappointing. Reading about it though, I am yet to find any direct blame for the suicide accredited to the W's

There is no 'weaponisation' here. That's a gross false accusation.
There is a recognition & concern for the multiple Safeguarding framework failings which did not adequately protect a vulnerable young female who tragically died by suicide.
Jayden's parents have called for a second inquest/inquiry.

"[Jayden] was buying the £360-a-year treatment from Helen and Mike Webberley, who have since moved their clinic Online GP Services Ltd from Wales to Spain after being refused a licence from the NHS.

The couple have also been suspended by the GMC having been told their care 'fell below the standards expected' in the treatment of three transgender patients prescribed puberty blockers and hormones. They have treated children as young as 12, it has emerged."
www.dailymail.co.uk/news/article-7200189/Mothers-agony-transgender-son-18-took-life-months-paying-hormone-therapy.html

RTFT
www.mumsnet.com/Talk/womens_rights/3625515-Patient-of-webberlys-commits-suicide

Medical transition is just one option for treating gender dysphoria (which has multiple causes). Some of the medical interventions are cosmetic, but still drastic and often irreversible. Many of them might seriously compromise the health of the patient and have to be actively managed. Medical intervention was previously a treatment of last resort. Why would medical transition be considered if the cause of the dysphoria has not been identified and other treatments (or ways of managing/living with the dysphoria) have not been explored and rejected. It has little to do with whether you are transgender and everything to do with whether medical transition is the best/only treatment for the symptom of gender dysphoria being experienced by that person.

For those without gender dysphoria I do not think that medical transition should not be on the table (unless the person wishes to access cosmetic treatments privately to the extent it is ethical to provide that treatment).

mement

Although I am not 100 pr cent sure I think that you will find they refer adults to a network of gender specialists and endocrinologists from other countries so patients can be treated privately. As far as I am aware the UK has not yet stopped its citizens seeking private treatment abroad although with the ever so increasingly authoritarian regime in number 10 it may be coming. Any hope that would refer to only trans people though is I expect a long one.

duLANG

I do understand that trans healthcare is fraught with politics. But, it needn't be, especially for adults. It's quite simple, there is a diagnostic criteria (currently ICD 10 soon to change to 11 I believe). Once diagnosed there is a standard treatment pathway. Normally psychiatric/counseling, medical and then for every trans person I know surgical. The only politics that arise in a medical sense (and I only refer to a medical sense here) is that some people even in 2020 are uncomfortable with trans people. That can include Gp's. But, that is their problem, they need help.

Of course the W's were partially motivated by profit but, as far as adults are concerned they are also providing a great help. I'm not sure you'll find many NHS cardiologists who are doing private consultations on the weekend that aren't motivated by profit so, I don't think the W's are unique here.

Did they provide cross sex hormones or did they provide blockers to the twelve year old? I honestly don't know but, they are not the same thing and as far as I am aware in the UK it would be highly unusual to provide cross sex hormones to an under 16. That said I'm led to believe with respect to blockers by 2017 around 800 under 18's had been prescribed blockers for trans related healthcare. I suppose around about 0.0064% of the under 18 population.

With regards to the sucide, it's absolutely tragic that it happened full stop and I can't even imagine how the parents must feel. It fills me with sorrow. To think that cases like this would then be weaponised for political capital is really disappointing. Reading about it though, I am yet to find any direct blame for the suicide accredited to the W's. I don't know if it's the same case or not but, one adolescent died as a result of suicide shortly after receiving a letter from GIDS advising that despite waiting a few years to be seen, they were now being transferred to adult services where the wait would be another three years.

Of course many Dr's both medical and psychiatric are involved in the care of those who end their own lives, it's always sad for everyone involved but, it doesn't necessarily follow that blame is aportioned to the practitioner who has been treating them.

The other thing is, the large majority of the adults presenting for care will often have agonised over it for years, in many cases since they were children. Trying to make it go away is a common theme in a mildly socially conservative society like the UK.

1. what leads you to characterise the UK as socially conservative? I think we are a progressive country compared to most, I'm interested why your views differ

2. That makes sense from the perspective where you are a transitioned adult who suffered gender confusion as a child. But it seems likely you are in the minority. Most children with gender dysphoria desist after puberty. How do you suggest we protect those children from the permanent effects of puberty blockers and cross sex hormones? Apparently it isnt possible to know which children will desist.

As for adults, the W's have stepped in to provide a service where the NHS was failing miserably and as far as I understand, the vast majority of adults under their care are happy with their treatment. The GMC has likely recognised that and realises that to take that away would leave a group of patients at the mercy of an unregulated supplier

But the GMC have taken 'that' away as the Waverley's are suspended. I wonder if they are even indemnified? If reports of them setting up abroad are true, they also they are working whilst suspended which means they are ignoring their regulator's rules. I can't really see this going well for the Waverley's when their case is heard. Working (as a doctor) whilst suspended is a big no no.

Many of the NHS GICs are unable to recruit and/or retains staff because gender medicine is so fraught with politics.

The Webberley’s stepped into a vacuum (that in an ideal world, shouldn’t have been allowed to occur), motivated by profit.

They prescribed cross sex hormones to a 12 YEAR OLD and a young patient of theirs recently committed suicide.

None of the other private providers accept patients under the age of 18. The Webberleys are irresponsible.

In my opinion, the W's have been a much needed source of support for adult trans people over the last few years. I can't really speak for children other than to say, I'm very confident a tiny minority have GD and believe the tiny minority that do should have access to appropriate treatment provided in a peadiatric sphere with appropriate support and full engagement of the parents. To not offer that tiny minority help or treatment would not be a neutral act.

As for adults, the W's have stepped in to provide a service where the NHS was failing miserably and as far as I understand, the vast majority of adults under their care are happy with their treatment. The GMC has likely recognised that and realises that to take that away would leave a group of patients at the mercy of an unregulated supplier. To leave those who have started treatment without it for a few years until the NHS can get its act into order would again not be a neutral act.

I also think to infer that they are villains rushing vulnerable adults into unregulated care with untested medicines would be quite wide of the mark and stems from an attitude that positions being trans as always the undesirable outcome. They follow well established pathways common to other developed countries.

Even a number of post operative patients will use them after discharge from the GIC/surgical teams because many Gp's just don't seem to have a clue or want to be involved in what is essentially a very basic treatment regime. Some trans patients will often find that the only way to be treated like a human being in the medical system is to seek help from people who deal with the issue day in day out and that help is often in the private sector. There are GPs out there who will claim one minute to know nothing so they can't help but a week later be so expert on the condition that they decline to act as requested by a consultant involved in the specialist care. A bit odd really.

The other thing is, the large majority of the adults presenting for care will often have agonised over it for years, in many cases since they were children. Trying to make it go away is a common theme in a mildly socially conservative society like the UK. Despite assertions, being trans isn't the fashionable option, it will likely mean loss of family, loss of many friends and being the subject of bullying from people who should know better. That's not to say I don't think other demographics suffer the same fate, they do and it's always wrong. For these people to then present and find out they are stuck on a 3 year waiting list to see a GIC is hard. They will likely wait another year to 18 months on top of that to commence any treatment and by the time they see a surgeon most being referred today if they haven't got thousands of pounds to throw at it will probably be looking at a timescale of 6-7 years. Again, I'm not going to say there aren't other agonizingly slow areas of medical treatment but, it's always wrong.

In my opinion, what the W's stepping in to did was help to shine a huge light onto what a mess NHS gender services were in. I don't think either the NHS or the GIC's were over the moon about this and even less so when politicians started asking questions about it back in 2016. The sad thing is what could have been used to progress and improve access to trans healthcare got bogged down in discussions and consultations about GRA reform, something which in my opinion wasn't ever very high on the list of priorities for most of those suffering from the symptoms of GD.

Cw, read the responses. No one is insulting you. We are disagreeing, and some of us have even been courteous enough to provide you with evidenced reasons why.

I was pretty harsh! I’m just not that into people who advocate for paediatric transition at the hands of disgraced doctors on Mumsnet. Sorry/notsorry 🤗

I wasn’t nearly as harsh as a typical AIBU poster or a bad day in Style and Beauty, mind you.

Cw please point to anything that anyone has said which is as "nasty" as:

bitching
whining
mean girls
vile
hateful
bints
full of spite

Only one person here is throwing around "nasty" comments.

The fact that you see fairly measured disagreement, backed up with evidence, as "hateful" is interesting. It suggests that you can't bear any possible divergence from your personal worldview and that you have to attack others in order to defend it. What are you afraid of by acknowledging that your repeated defences of the Webberleys and GenderGP may be flawed, at the very least in part? Is this part of a dependence on the external validation of others to prop up your gender identity, which becomes more precarious if you are told 'no, reality is something different'? Such a quickness to be stirred to throw unpleasant (mostly) gendered insults suggests that perhaps transitioning has not entirely resolved your internalised misogyny and has not given you the security of self you were seeking.

Don't be mad though. It's a waste. If you want a convo, I'd suggest not insulting those you're trying to reach.

This is very true (always).

I havent heard anyone calling women/girls 'bints' for years.

Imagine doing so on a feminist chat board

And apropos of wateves cw the women here, they're fking amazing and they'll listen, and kick your arse, and make you a cuppa.

They are not weak, or weak minded, or 'old', or behind the times. They will make sure you're ok. If you want that.

Peace x

CW, honestly, maybe you would be best taking a wee bit of time to reflect on things? You seem to be getting really upset, and as far as I can tell it's because people here aren't agreeing with you.

Again, you are the only one flinging insults about. Can you really not see that?

What started as me providing a (very civil) different point of view to you all turned in to an attack on me

Cw, disagreement is not an attack. Honestly, I can't see anyone being rude here, apart from one person calling people bitches, bints, mean, vile, etc.

Like I said, though, I am always happy to hear other viewpoints.

I'd mostly appreciate solid information - not anecdote. Peer reviewed research would be best.