Article in The Times today about Dr Helen Webberley.
www.thetimes.co.uk/edition/times2/the-doctor-who-helps-kids-to-change-gender-xsw6dxc7n?CMP=Sprkr--Editorial--TheTimesandTheSundayTimes--Magazine--Imageandlink--Statement--Unspecified-_-FBPAGE&linkId=42465208
When I arrive at Dr Helen Webberley’s door it is hard to believe I am at the home of the woman who says she is Britain’s only private doctor to treat transgender children — and who is being investigated by the General Medical Council (GMC) for giving sex-change hormones to a child of 12. I mean, I’m in Abergavenny! This isn’t San Francisco or Bangkok. Inside her comfy cottage Webberley, 48, bustles about making us a nice cup of tea and I admire the photos of her three teenage children.
It’s not what I expected when I read the glowing headlines in a gay newspaper: “Hormones for 12-year-olds. Puberty-blockers without the wait. Trans healthcare available in every town — Helen Webberley has torn up the rule book and started a revolution!” or the less glowing ones in tabloids about a lone doctor offering “sex changes for tweens”.
However, it gives me a moment to say a quiet prayer of thanks that my children have not hated the sex they were born with. To see any of the recent documentaries on transgender children is to see a world of pain. Uniquely, this is a pain on which everyone seems to have an opinion. It aggravates feminists and traditionalists alike, escalating into rage about prisons, toilets and school uniform. It is like Brexit, but with genitals. Maybe in these circumstances I too would be bringing my weeping son or daughter to Abergavenny to circumvent the slowness — in the form of waiting lists and caution — of the NHS. Who knows?
“Who knows?” is the battle here. Webberley is unrepentant. In fact she attacks what she regards as the outmoded treatment that transgender kids experience on the NHS. Out of the 850 transgender people she has treated, about fifty have been under 16. For some she prescribes “puberty-blockers”. However, for a “handful” she has prescribed the sex-change hormones that can compromise future fertility. Her critics are just as sure that they know what’s best for transgender children as she is. Do people ever say to you: “First, do no harm”?
“Yes. Definitely,” she says. “First, do no harm. And doing nothing is doing harm. That’s what people find difficult to get their head around. Doing nothing seems safe — it’s not, because psychologically, suicidally, it causes a lot of harm.”
However, the fact that there are sex-change regretters around is surely enough to introduce doubts, I say. We are living in a period of experimentation, giving a generation of children the option to “switch puberties”. Dr Polly Carmichael, the lead consultant of the Tavistock Clinic in London, the only NHS treatment centre for transgender children, has said: “We don’t, and can’t, know the longer-term outcomes of these decisions.” As a result the Tavistock advocates no sex-change hormones until the age of 16. When you helped this 12-year-old genetic female to go through a male puberty, were there any doubts in your mind?
“That was a very unusual case,” Webberley says. “People reading this may think, ‘Oh my God, she must be giving all 12-year-olds this, how does a 12 year-old-know?’ And for the majority of 12-year-olds it’s completely the wrong thing to do. They’re not ready. For that family and child it was definitely the right time, 99.9 per cent the right time.”
In a way I’m jealous of her conviction, which has made her the hero of the transgender community. There is nothing zany about her. This makes her unlike Dr Norman Spack, an American paediatric endocrinologist at the Boston Children’s Hospital, who is way ahead of Webberley when it comes to confidently prescribing cross-sex hormones for children. Spack wrote in The New York Times that “mastectomies could be done at 14”. When he visited the annual conference of the British charity Mermaids, which supports transgender youths, last year he led the audience in a rendition of “The times, they are a-changin’ . . . there’s a battle outside and it is raging.”
Webberley was for most of her career a normal NHS GP, until in 2014 she set up a private practice website offering, among other things, transgender care. It was an interest of hers after ten years working in sexual health. The next morning her “inbox was full” of heartrending pleas. “I was like, ‘Woah.’ I thought this was a really rare thing.”
No one can be sure of the incidence of childhood gender dysphoria — estimates vary from 1 in 500 children to 1 in 10,000. It’s certainly disproportionate to the headlines it gathers, but still, the Tavistock had 1,400 referrals in 2015, double the number of referrals that it received the previous year, and the numbers are still rising. In 1989, when it first opened its doors to children, there were only two.
“It’s always been there, it’s just now it’s more acceptable,” Webberley says. “The adults will tell you very clearly that this is not a new thing. They knew from the first day they can remember . . . they may self-medicate as so many people do, just buy pills on the internet from Hong Kong, Thailand, India.”
You’ve got to wait until you’re 16. However much it’s killing you
Within six months of setting up her transgender practice — charging £75 to £150 an hour — parents found Webberley.
“I suppose I’ve pushed as many boundaries as a doctor would ever push,” she says. “So, transgender care, unusual, attracts attention. Children, unusual, attracts attention . . . when I started this I didn’t think, ‘Goodness, I’m going to be treating children’ . . . but I suppose it was inevitable.”
The first was a 16-year-old, and Webberley’s reaction was: “Oh God, 16, this is going to challenge me.” Now she says, “16-year-olds are easy-peasy”, but 18 months ago a desperate family contacted her about their 12-year-old. “I thought, ‘Oh, Jesus.’ I just knew it was going to cause controversy.” She was right. This year two consultants complained about her to the GMC. While it investigates she has been told that she should not treat transgender patients without a supervisor. Webberley’s practice has been paused while she finds one.
The child in question had already been prescribed what are known as “puberty-blockers” on the NHS. This is a holding treatment to delay a child’s puberty until the age of 16, when they are deemed better able to make a decision. To many, this is a compromise too far, to others, including the child’s family, it is not nearly enough.
“The thought that anybody at the school might ever find out that he was actually born a girl was hideous for them,” Webberley says. “When they came to see me in the clinic I’d never seen a child struggle so badly. “Mum was saying, ‘He won’t last, my child will not survive to 16.’ ”
Doesn’t she think the Tavistock protocol to wait until 16 for sex-change hormones is reasonable?
“If they asked me tomorrow, ‘Would you come and work in my NHS clinic with this protocol?’ I couldn’t . . . Where does 16 come from? Healthcare is not like that. If you’re 15 and you’re pregnant, you don’t have to wait until 16 to have an abortion. And the doctors won’t go, ‘Come on in, have an abortion!’ They’ll listen to you and they’ll say, ‘Are you sure this is what you want to do because you could have these other options?’ If it’s the safest thing for that young person to have an abortion, she’s allowed it. Not if you’re trans. You’ve got to wait until you’re 16. However much it’s killing you.”
Transgender teenagers often present as a mental-health emergency. In the case of transgender children, time is an enemy. Puberty changes the body in ways that are hard to reverse in adulthood. Webberley has heard several stories of children attempting to cut off penises and breasts. She once saw a 17-year-old female-to-male transgender patient who had spent years unsuccessfully waiting for puberty-blocking treatment — “they didn’t do it in time.” When he undressed “it was just awful, he was covered in self-abuse scars all over his breasts. They upset me, these images . . . going through the wrong puberty is hideous.”
Sure, I say, but for a lot of children puberty itself is hideous.
“It’s tricky. Some people say to me, ‘Teenagers hate puberty’, but they don’t want to turn it off, they just want to get through it. But these children, where it’s the right thing to pause, are the ones where the changes are causing them deep distress because they’re the wrong changes and they want them to stop.”
At present, there are more male to female transgender patients in the adult population. However, that will change — in the child population the ratio is reversed. At the Tavistock their referrals are predominantly female to male, which is also Webberley’s experience among her young patients. Why would there be a different sex ratio in teenagers? She speculates that male-to-female transgender children feel more pressure to hide.
“I’m guessing, but I imagine if you were to look at any school, it’s easier to stand up and say, ‘I feel more like a boy, I’m going to wear trousers’ than it is to say, ‘I feel like a girl and I’ll wear a skirt.’ ”
By contrast, some believe that our society hitting “peak trans” is in fact teenage girls reacting against the expectations of modern womanhood in the age of selfies and online porn.
“But we would hear that,” Webberley says. “The amount of listening we do — we have girls who have been abused by their uncle and then reject every single part of their femininity that’s been abused all those years and say, ‘I want to be a boy instead.’ That’s not gender identity. And girls who don’t feel comfortable with all the fluffy stuff, they carry on as girls, but they don’t wear skirts.
“If it’s like, ‘I got into a new crowd, got a couple of trans friends and so I think I’m going to identify as male,’ it’s no chance [of treatment]. Absolutely no chance, matey. Then you hear the story of somebody who from a really young age has identified as the opposite gender and it’s never changed, the whole family have known it was coming. Those are the people that we would consider. Not the teenager who’s having a fad with a tattoo and a piercing.”
I’ve pushed as many boundaries as a doctor would ever push
What about a future society where gender roles are more fluid, won’t that lessen the need for a medical intervention?
“Gender is a spectrum, but most of us don’t fluctuate very far. Sometimes I might feel a bit more masculine, but I don’t want to take hormones to grow a hairy chin.”
What about if it was easier for men to wear skirts and women to grow a moustache?
“We see people like that anyway. They don’t want hormones, that’s just how they express themselves. These other people . . . they want a massive swap, which feels right. And if it didn’t feel right then they wouldn’t carry on with it, but they do for the rest of their lives. And they will never forget to take their pill.”
But aren’t these children just too young to make life-changing decisions? How do you know that a child who is sure at 12 won’t become unsure at 21? It has happened before.
“Ask these people going through it and for them it’s just as serious as cancer. And by doing nothing, we’re not just saying, ‘Let’s wait.’ Their cancer for them is their puberty and it’s progressing in the wrong way and making changes to their body that they’ll never get back.”
Isn’t she haunted by the idea they may return to her in adulthood and say: “I wish I hadn’t”?
“Nobody wants to do anything as a doctor that makes changes to somebody that they’ll regret later. That’s for anything — breast reductions, sterilisations, lumps that you thought were cancerous, but they weren’t. You never want to make a mistake. So, boy, am I careful. I choose my patients really carefully. And maybe one or two will come back in the future and say, ‘I wish I hadn’t done it.’ Be cautious, but don’t harm 99 just so the cautiousness was OK for the one.”
But, I say, you don’t know that is the proportion, do you? We’re back to what we don’t know.
“I think it is.”