Second Section:
A Culture of Silencing Dissent or Questions in Medicine
Experts in GIDs
Several experts working in Gender Identity Services have raised serious concerns about the treatment given to young people with dysphoria. They have spoken about a culture in which it is difficult to discuss these concerns and in which evidence is lacking, and political lobbying seems to have undue influence.
Marcus Evans, one of the governors of The Tavistock and Portman NHS Foundation Trust has resigned last year. In his resignation email he wrote
“I do not believe we understand what is going on in this complex area and the need to adopt an attitude which examines things from different points of view is essential. This is difficult in the current environment as the debate and discussion required is continually being closed down or effectively described as ‘transphobic’ or in some way prejudicial.”
www.theguardian.com/society/2019/feb/23/child-transgender-service-governor-quits-chaos
Susan Evans, a psychoanalytic psychotherapist, and wife of Mr Evans, resigned from the Tavistock Clinic in 2004 over similar concerns. She is currently bringing a case to see if current treatment guidelines are lawful.
^“I fear that in 10 years time, there will be a lot of people in their mid-20s whose lives have been wrecked by poor assessment and poor evidence based treatment, who will have been rushed down a path which they should never have been taken down so swiftly.
“We have a situation where clinical sense has been overridden by political lobbying and activism. And I am not ashamed to say that.
“I fear that some of these young transgender patients will have grounds to sue the NHS in years to come.”^
www.telegraph.co.uk/news/2020/01/11/fear-young-trans-patients-could-sue-nhs-negligence-former-tavistock/
Kirsty Entwhistle, former clinician at Leeds GIDS:
“I think it is a problem that GIDS clinicians are making decisions that will have a major impact on children and young people’s bodies and on their lives, potentially the rest of their lives, without a robust evidence base. GIDS clinicians tell children and families that puberty blockers/hormone blocks are “fully reversible” but the reality is no one knows what the impacts are on children’s brains so how is it possible to make this claim? It is also a problem that GIDS clinicians are afraid of raising their concerns for fear of being labelled transphobic by colleagues.”
medium.com/@kirstyentwistle/an-open-letter-to-dr-polly-carmichael-from-a-former-gids-clinician-53c541276b8d
In Ireland, experts have expressed concern at the proposals of a HSE steering committee on transgender services.
Paul Moran, consultant psychiatrist at St Columcille’s, says this proposal is “unsound and unsafe” because it “does not enable adequate assessment of patients and does not require proper qualification of professionals”.
“Thankfully there is in place a sound and safe service which, unlike this [proposal], has qualified, highly trained people working in a well-governed service,” Moran said.
Donal O’Shea, a consultant endocrinologist, said the St Columcille model was approved by the Royal College of Physicians of Ireland and was in line with best international practice, so doctors would continue to implement it.
“My concern is that they’re almost encouraging self-declaration to equal ‘you should start treatment’ and that there is no need for a full assessment prior to that decision.
“A person’s gender is their own decision but where that should lead you — should it lead you to hormone treatment and surgery or not — is a really complex decision.”
www.thetimes.co.uk/edition/ireland/simon-harris-pushed-hse-to-review-need-for-psychiatric-assessment-for-gender-switches-pzw7mnrsx?region=ie&t=ie
James Cantor is a clinical psychologist and sexual behavior scientist. He is Director of the Toronto Sexuality Centre and Associate Professor of Psychiatry at the University of Toronto. He has written an article criticising the policy of treating gender dysphoria with affirmation only:
“every follow-up study of GD children, without exception, found the same thing: By puberty, the majority of GD children ceased to want to transition.”
www.sexologytoday.org/2018/10/american-academy-of-pediatrics-policy.html
Trans People
Some trans people and others with gender dysphoria are voicing dissatisfaction with current treatment, and, again, the need for open discussion. GCCAN - Gender Care Consumer Advocacy Network - campaigns for more research, better information and a standard of care that provides alternatives to medical transition, as well as more complete information on side effects of medical transition and support for those who do opt for medical transition.
“Our experience as gender care consumers has shown the lack of professional advice before committing to body-altering therapies, and we have a right to this information before making decisions.” [...]
“We have the right to access peer-run support networks for gender dysphoria, including as a possible alternative to professional care. We have the right for peer-run spaces to allow for questioning and exploration of causes for our gender dysphoria without favoring transition or detransition.”
www.gccan.org/bill-of-rights
Detransitioners - people who have undergone medical transition but who then regret it - are also finding it difficult to be heard.
“Dr David Bell, consultant psychiatrist at the Tavistock, described why it’s so difficult for those services which deal with trans identity to accept the detransition movement. “Detransitioners are a threat to an ideology that has acquired an almost totalitarian quality and cannot be challenged,” he says. “It is extraordinary the way in which, without any evidence at all, trans ideology has had the ears of politicians up to the highest level.””
unherd.com/2019/12/the-nhs-is-failing-trans-kids/
The taboo on discussing detransition is evident in the treatment of journalists like Katie Herzog, who, for an innocuous article interviewing several detransitioners, was ostracized as a transphobe.
Her article: www.thestranger.com/features/2017/06/28/25252342/the-detransitioners-they-were-transgender-until-they-werent
An article on her ostracism: www.nytimes.com/2019/11/02/style/what-is-cancel-culture.html
Detransitioners do exist, however, and their needs are as valid as those of transitioners. Some have set up websites and groups to share their stories and offer support. eg . post-trans.com/
GCCAN also supports detransitioners & campaigns for recognition & support of detrans people.