What you all said was coming

If he has commenced legal action, surely that information is in the public domain and journalists have the right to report on it. Similarly, his Twitter thread is publicly available.

I have every sympathy with his predicament, but I'm not sure what the Times has done wrong here.

@SamphirethePogoingStickerist yes! Yes, this exactly!

@OvaHere yes, I thought about referencing the vaginal mesh issue, but realised I didn't know enough about it. I think it's a really good analogy - no doubt at all those women had capacity and consented, but the surgery was a disaster for them as a group because it was bad surgery and, as such, is I think no longer offered.

I think we will in the future realise that offering these surgeries to distressed young people to manage their distress is similarly bad care. Not because of capacity, but because it's bad care. Unfortunately it's those young people who will end up suffering for it.

I think the fact that there are people who had whatever counselling is available, then, as adults, consented to getting this surgery, and now regret their decision should be a warning to the NHS and all other healthcare systems.

It just goes to show that even adult patients who appear absolutely sure that this is what they want don't necessarily understand the consequences of their decision.

Doctors should have these cases at the forefront of their minds every single time they are weighing up whether to prescribe hormones or approve irreversible surgery to someone. How can they be sure that the person in front of them isn't the next Tullip or Keira Bell?

@EggRollsForever I don't know him. But I do have more than a passing knowledge of the procedures he went through. And they are not adequate.

In the 30+ years I have been involved in supporting individuals having such operations that has always been the case and in recent years the lack of time taken, the deliberate slowing down and in depth discussion of all issues has been even further reduced.

I know enough to know that he has a point that needs to be made, out loud and very publicly. Trans surgery comes with a price that many are not equipped to pay.

Thanks @Motorina that explains it a bit further and I agree with you. I also don't think this surgery is a good idea full stop, in a similar way to the vaginal mesh surgery that everyone though was a miracle fix but turned out to be a bad idea.

What is happening with vulnerable adults and GI treatments does feed into the wider legislation and conversations about capacity. It's not as standalone as it first seems.

the trans surgeries subreddits are full of young people posting their despair and frustration that transition has worked out badly for them. Their posts are either removed, acuused of transphobia or they are gaslit that there's nothing wrong with their surgical results and that their pain isn't real.

Until the denail stops, nothing will change. However - if the NHS is henceforth less cavalier about using my taxes to transition mentally ill young people, then that's a win imho.

This.

@Motorina and @OvaHere yep!

It isn't 'capacity' that is the issue here. It's the lack of adequate pre-surgery intervention: counselling, density of information passed to the individual, time given for discussion, debate, thought processes, support to fully engage with the dysphoria and the realities of surgical intervention, and then the surgery itself.

All of which Stonewall etc want to make illegal, labelled as 'conversion therapy'

yes but you have read HIS version of it - you know lots of stuff but still not the actual facts as to dates of consults, doctors seen etc etc ....

He has used valuable time and resources and now isn't happy.

Then maybe this isn't the best use of the NHS's valuable time and resources. Care in this country is supposed to be evidence based, there is no evidence that this treatment measurably improves peoples mental health, any suggestion that it does is cherry picked propaganda.

@EggRollsForever I have read his own words, blog/Twitter.

I know what dysphoria is, how it affects perceived reality and thought processes

I know the parlous state of pre-surgery counselling

I know the lack of consistency in available operations

I know the variation in outcomes of the various operations.

I know people who have had all of the operations available to them and their outcomes, good and bad

I know that it is not unusual for anyone with any kind of dysphoria to demand a form of self harm - but only in gender dysphoria does medical science oblige!

He's taken up the services of a 'no win, no fee' lawyer who I imagine has got their eyes on a big payday.

It's the only way many people can challenge medical malpractice.

@OvaHere I think you're right, and there's been a lot of misunderstanding on this thread about capacity. I'm sure you know all this from your training, so in a sense I'm speaking to everyone else here, but...

The bar for having capacity to make medical decisions is a low one. The presumption is that someone has capacity unless it is established that they don't, and that adults with capacity are entitled to make really stupid decisions.

To not have capacity the individual has to have:

1. A disorder of the mind and brain


2. Which prevents them from absorbing information, weighing up that information to make a decision, and communicating that decision

Capacity is decision specific (you may have capacity to decide if you want the
cheese or the ham sandwich for lunch, but not where to live, for example) and I'd say that consenting to surgery of this nature needs a relatively high level of capacity. But Tulip, from the podcasts I've heard, is intelligent and articulate, and, had I been the clinician, I don't think I would have questioned capacity.

I know the information we have is very limited, but that's my take on it right now. As someone who occassionally does capacity assessments, I have 'passed' people with far far less decision making ability than Tulip has.

That's different, of course, from saying Tulip should have been offered this surgery. I don't think he should have been. In the same way someone with a broken toe should be offered painkillers and crutches, not amputation of the foot. But that's a seperate reason from lack of capacity.

Do you have a factual idea? Do you know in detail exactly what has gone on- what counselling etc was gone through? Have you read his medical notes? You haven't and are only going on what everyone else is reading on a Twitter feed and newspaper articles. None of us really know. Some people are quick to point out that he has a mental health problem and it was wrong to do the surgery but then it is OK somehow now to accept that someone with a mental health problem ( if so) is giving an accurate account of what happened? Doesn't make a lot of sense to me.

A lot of people are saying that this is also about consent. Surely it is also about whether this surgery should actually ever be offered in the first place - where is the evidence of benefit to the patient?

I work in MH and we have quite a few patients presenting as Trans which is a relatively new thing. It didn't used to happen until the trans lobby whipped up a media frenzy. If I was mentally ill and asked a doctor to chop off my perfectly healthy leg because I had dysphoria, they would refuse and get me psychiatric help.

There definitely needs to be a long period of evaluation and therapy before agreeing to remove healthy body parts that isn't conversion therapy that's putting your patient first.

Care to elaborate? Not sure what you object to…

This kind of legal action isn't just about compensation. It's about preventing the same thing happening to other people.

Exactly.

but obviously the man said he did understand, he consented to surgery

I have waited 4 years for a knee replacement
I am in severe pain and cannot walk
But he gets this nonessential op

Oh God that poor man! Bloody journalists!

I read that leaflet and it very clearly lays out the likelihood of what can happen:

Vaginoplasty surgery related complications:
• Loss of sensation
• Loss of sexual function
• Dissatisfaction with visual appearance of the vagina, clitoris and/or labia
• Inability to orgasm
• Urinary incontinence (unable to control the need to urinate)
• Necrosis to skin or clitoris (tissue dying resulting in blackening of the skin or Clitoris)
• Vaginal prolapse
• Fistula: (an unwanted connection between the vagina and urethra or bowel)
• Urethral stenosis: (narrowing of the urethra, making it difficult to urinate)

In fact it is almost the list that this man is complaining about. Did he not read this bit and think it was all not going to apply to him? The media is too full of people like Jessica Alves and other Hollywood stars touting their lifestyles.

But his decision making was based on, probably, convincing, believable info on the net.
He was convinced he was making the correct decisions. I don't see how you counteract that.

Desperately sorry for the poor man. And yes, the NHS should be sued. This man is owed compensation, not least for the awful future ahead of him and how difficult and expensive it is going to be due to their intervention.

No one should be able to have extreme, permanent, very high risk of complication surgery that involves the removal of healthy tissue and body parts and permanent loss of function based on nothing more than an emotional decision, without very, very in depth psychological exploration first. It should be an absolute last resort. It should not ever be experimental, it should not ever be carried out by a unit or base in hock to a political lobby pushing their own agenda, and it needs to be with eyes wide open to the fact that there is a whole lot of pressure, politics and marketing being put on patients as a magic bullet to their distress.

You have no idea. And are showing your ignorance quite clearly!

OMG! It seems nobody spoke to TullipR before publishing that!

twitter.com/TullipR/status/1540157638016647170