Tavi psychologist talk from 2018

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"Working with gender difficulties in adolescence - Clinical Psychologist GID Service - Dr Aidan Kelly"

I've transcribed the whole thing in case it's useful - interesting that he says they don't have an evidence base for what they're doing, they can't tell who will benefit from PBs and who won't, that blockers are "not benign" and that people are already coming back and saying they weren't told about the fertility implications of cross sex hormones. They worry about medicalising a healthy body and about children who are socially transitioned before they even arrive at the clinic. Lots of interesting stuff.

Working with gender difficulties in adolescence
Tigala Conference 2018

It’s great to see so many people here, things have come on a lot and it’s a good sign when there are so many interested people.

I’m a clinical psychologist at the gender identity service in London. Hopefully you picked up the accent, I’m actually originally Irish and I am one of a small number of the team that come over monthly to Crumlin to run a clinic here … I was a little bit disingenuous with the original title of this presentation because I talked about adolescence but in hindsight I thought I should take about the whole of childhood really (0.48) as they kind of relate to each other quite well so the idea is today to give a brief introduction, talk about the service that I work in, consider identity but also gender identity in a wider context it’s really really complicated, it’s really really yeah complicated and there’s lots of things to think about, we won’t get to think about them all today but maybe I can plant some seeds, get you thinking and will be around after if people want to think more about what’s mentioned and obviously particularly how do we support the young people that I see and I’m sure you guys see as well who are exploring their gender identity (1.29)

So what we do to support young people and their families who are experiencing difficulties in the development of their gender identity, they don’t necessarily, it’s not an outcome specific service so you don’t have to say I know what I want when I come to the service, if I say I know there’s something I want to explore and think about, that’s what we’re really about.

The service - when I talk about the service I’m referring to the Tavistock in London. It was first established in 1989, the main bases it has are in London and Leeds, it is funded through the NHS and we see young people up to the age of 18 and we work closely with local services such as yourselves and CAMHS or these sorts of local services (2.31)

You’ll see now that the service probably from 1989 to now looks very very different and obviously now part of the service includes the Dublin outreach… we see much more mainly kind of older teens, then the primary school age kids but we do see primary school age kids, probably the youngest kids I have in my caseload are six or seven, there’s a range of … at the moment we see a lot more, I use the term assigned female at birth to refer to what people might think of as people born with an anatomically female body so we are seeing a lot more of them now, proportionately it’s about 3: 1 so about 75% of our referrals are assigned female at birth, whereas maybe 5,6,7 years ago it would have almost been a flip on that, almost the reverse, we can think about and have ideas about why that might be but the answer is actually, I don’t know, but there might be theories and ideas about what might be going on. (3.35)

There’s a range of identities and we can think a bit more about what do I mean when I say identity so for example we’re seeing a lot more of what we call non-binary individuals at the moment. Not everyone will identify as trans or non-binary for the rest of their lives, identities are such that, because they are quite complex they can develop and evolve especially for young people and we also see a small number of young people who are children of trans parents so if a parent comes out as transgender we will help and support the child around understanding that and thinking about that and the implications for the family as a whole.

99% of what we do is with young people who identify as transgender but it’s not just that. (4.25)

I’ll think a bit more about the Dublin service in a minute but just as a whole, this lovely graph
(4.42) - graph shows huge rise in referrals

if anyone has gone where someone from the Tavistock is talking before you’ll have seen this graph, we wheel it out all the time, we keep going on about it, we want your ideas - what’s it all about?

This is our referral rates, I don’t know how clear that is but basically the bottom axis there, the bottom left is the first year of referrals 89-90 basically I there were 3 referrals and you are coming up to 2015-16 and 2017 we broke 2000 referrals in a year, that’s across the UK and Ireland

You can see there around 2010 the referral rate started doubling, going up and up and up and it’s been going continually up and that’s around the same short of time that the gender, the sex flip, flipped on its head as well and it went from predominantly assigned males to predominantly assigned females being referred. And these are UK figures but this is reflected pretty much in ireland as well, pretty much the same obviously proportionwise (5.45).

In Dublin as I said it’s a similar picture to the UK but obviously much smaller numbers, at the moment we’ve got 50 what we call active cases that are open and I’ve put 17/33 there and it basically refers to assigned gender or natal sex as some people cal it so 17 are assigned males and 33 are assigned females in the caseload at the moment. (6.18)

As I said monthly clinics in Our Ladies’ Children’s Hospital and we are starting … I’m the first person within the service who is Irish, I don’t know if it means it’s a good or bad thing but I guess because it’s a HSC bought in service and it happens, to be honest because we’re an NHS service we need to focus on NHS work and until now it’s been difficult to give Dublin and Ireland all the energy and resource that it needs so I’ve taken the lead on the Irish service at the moment and I’m trying to do a lot more working alongside other agencies..

For example I was down in Tralee running a clinic down there for the first time, kind of down in Kerry doing a clinic with the local child and adolescent mental health services there, so alongside the clinicians to try to train them up so they are not just referring on to us and wondering what kind of magical and crazy stuff happens there, what do you do, so doing joint assessments with one of the psychiatrists, one of the psychologists and social workers, so I’ve got a different case with each of them and I’m supervising them as they do a bit of work and I come back over to Tralee a few months later (7.39), check in

… trying to pass o expertise around the country actually, to skill people up, so that it’s not such a ... it can feel like a scary thing to start talking about and people can feel quite deskilled when somebody says something about gender issues and they don’t really know what do I do where can I even ask what’s the first thing I should think about and it’s demystifying it because essentially these are young people, you work with them, you know how to do that anyway and it’s just giving a little more information and thinking about how do we start to talk about gender. (8.11)

Currently there are about 30 people on the waiting list and we are getting about 2 new referrals every month. How do we get those referrals, they come, it’s a funny system because it’s not an HSC service it comes through something called the treatment abroad scheme, that’s a CAMHS so you would usually have to go to CAMHS or a paediatrician to get the referral to get funding from treatment abroad to come to our service so it’s a bit of a minefield compared with the UK where a GP can just refer direct in to our service (8.51)

… in terms of Ireland in terms of the service here which is what we are trying to help and support the local HSC to do, there’s rumblings that there’s one kind of coming soon, they’ve been trying to get funding for the last 4-5 years and I don’t want to say it’s definitely there but I think we might be on the cusp of something in the next year or two ….

So that’s the service level stuff, what is that we even do?
We are - I’m a psychologist, we are predominantly (9.58) psychologists, we’ve got social workers, we’ve got family therapists, we’ve got a psychotherapist, that’s most of them, a Multi Disciplinary Team, a typical team you might find in a CAMHS. It’s very much family focused, the first stage of what we do when a young person comes to us, I guess you’d call it an assessment phase and that usually lasts 4-6 or 3-6 sessions where we meet with the family and the young person, we work in pairs, so myself and another colleague, and often we will get to know the family, doi developmental history, thinking about education, social side of things, well-being health and of course gender and how that develops and evolves over time and basically at the end of that assessment we will come up with some recommendations which might mean more talking (11.05) and thinking and family stuff, might mean medical and physical interventions, age dependent, or it might mean the process itself has been helpful and they might just go on their way and get back on normal lives. We do lots of group and family days usually in London but we are trying to get something going in Dublin soon and we really want to link with local services to support young people to think about gender.

We do what we call a stepped care approach, these are young people in developing bodies and developing minds and maturity so we do things in a quite cautious… people get annoyed with us because we move too slowly but given it’s young people we think it’s appropriate that we move slowly. (11.55)

It’s not just a physical intervention service though that’s part of what we offer with an endocrine team, and actually Irish people, we do have, the endocrinologists, the hormone doctors are in Crumlin, it used to be that they used to have to travel across to London to UCLH to get the endocrinology there but actually that’s changed, we’ve been able to support the local consultants to offer that service instead but we also do psycho social and therapeutic support which is a bit more difficult in Ireland as we come less regularly but that’s the idea…(12.29)

In terms of what we offer in terms of the world’s, there’s a world agreed kind of criteria or protocol for child services. I should have pointed out that the GIDS, the gender identity service, I work in is the largest child gender service in the world, propbably because we are national whereas in the US and Canada you get more regional based services, so we see those numbers, they are the largest you’ll get in terms of service size (13.02)

In terms of physical interventions which people, especially young people are really keen to know more about, “what can I get, how can I get it?” we start off with something that is physically reversible, the hypothalmic blocker which basically pauses puberty, it stops your body producing its naturally occurring sex hormones so for assigned males that’s testosterone and assigned females oestrogen, it doesn’t further masculinise or feminise your body, it just stops things from progressing.

That won’t be offered until you’re at least half way through puberty and that’s for different people that’s different ages but that is because for lots of young people beginning puberty is a really important thing and how you integrate your identity, your idea about yourself in terms of not just gender but sexuality and other things, it’s really important that a certain amount of puberty is allowed to occur, you’re allowed to develop an idea of who you might be attracted to. (14.13)

And also we know from the limited evidence that we do have in this area - which this is a massively under-researched and really quite an experimental area especially in terms of young people - the limited evidence that we do have is that young people before coming into puberty who express gender-related difficulties, it’s not clear whether that will sustain throughout puberty.

It’s probably… the numbers... people argue over numbers but it’s certainly a 50:50 sort of split in terms of what we expect. There are some people who will go through puberty and continue on to express a wish or identity with the gender they weren’t assigned at birth, but then there are also children who experiment and play (15.08) and for them once they hit puberty, by experiment and play I mean with things that are stereotypically viewed as the other gender or a different gender and once they come to puberty they find a way of incorporating that identity within the body in which they inhabit and so puberty is pivotal, it’s really really important, it’s a scary thing but it’s also a really important thing too. (15.31)

So once we’ve got to a point where we think this is the right thing to do with the family and really often we are putting responsibility back on the family because we don’t have the evidence base to say it’s these kids and not these kids and how we can pick out which kids should go forward and which kids shouldn’t. It’s really a holistic piece of work to make sure that the young person - well as much as they can the young person - but really their family and we’re thinking about everything that needs to be thought about and engaging in conversations and being open and honest about any difficulties and things that have gone on in the past just so that we know that if they come back to us in 10 or 15 years - not that they come back to us - but they think back themselves in 10 or 15 years and they think: “You know what, I made the right decision for me at that time” and that’s really what our holistic assessment is all about.
(16.23)

In terms of the medical side it’s the hypothalmic blocker, which if you stop taking it your body will just kick back in and continue on, reproduce the naturally occurring sex hormone and your puberty will basically kick back in, finish off if it’s not already finished. People often young people say why don’t you just give me the blocker really quickly, it’s totally reversible just give it to me quickly, my body’s changing and it’s distressing me.

The blocker is not a benign thing, it comes with downsides, especially around energy if the young person has mood difficulties the blocker can sometimes make that worse, it also takes away those sex hormones so that whole thing I was talking about in terms of being attracted to, developing crushes, when all your teens and peers are getting into relationships and developing social connections in that sense that’ll be gone, not totally gone but that drive, that interest in the opposite or same sex or whatever is greatly reduced and we do worry because we don’t have long term evidence for this, what impact that might have on their identity because sexuality is such an important part of your identity, who you are attracted to (17.46)

So the hypothalmic blocker is available dependent on puberty so the youngest you can get ...depending on how far into puberty you are you could in theory get the blocker as young as I’ve never given it to someone who’s 10 - 11 or 12. So it’s really quite young, it’s very much the exception, it’s not quite precocious puberty but early puberty but often we are thinking about 13, 14 or 15, and once you’re on the blocker for a minimum of a year we would continue, meeting, thinking, it’s not quite therapy but it’s a therapeutic piece of work, assessment, cross ex hormones which are definitely not fully reversible they are available from 16 and up, OK.

And once you start taking them, then it’s not an instant thing overnight, but slowly changes will start to happen where even if you stop taking that medication it won’t … it won’t undo itself so it’s quite a serious thing to be thinking about and that’s as far as we go with the child and adolescent service any surgeries and things like that are only available over 18 (19.10)

So that’s the physical side of things, there might be questions, a lot of information to take in there. I always separate out the physical side and the identity and sometimes they get merged together into one and people think well if I’m trans or if I identify as male and female I need to do X , Y and Z and that’s almost like a fixed pathway I need to follow through and often adults - well meaning adults - can fall into the same trap and actually the more and more work we do we realise that’s not the case, everyone is different and whether they identify as male or female or non binary or gender queer or all these different sorts of terms that you might become more familiar with, how they become comfortable in their body might be different for each person.

And so somebody telling me they identify as trans male or trans female or non binary doesn’t necessarily mean that medical and physical intervention is the right thing for them. In the assessment that we do, diagnosis is a part but a small part, the diagnosis is called gender dysphoria in case you don’t know that, but I could probably diagnose someone in one session but we meet for four to six, there’s many young people who will meet that criteria and experience that dysphoria in their teenage years who will with time no longer experience that and with time will be able to integrate how they feel about their body with their identity and come to terms, come to accept themselves and some won’t and that’s the tricky part, it’s not the diagnosis, isn’t necessarily the hard part it’s the assessment of whether this is the right ithing for this person at this time and incorporating that so when we’re doing that we often thinking about identity as a whole of which gender is a part and I guess the thing I’m all for thinking about is this venn diagram (21.38)

Biological sex is your anatomy which is an important part and sexuality and sexual identity is there and gender identity and how…. that’s a personal individual thing which young people will often take time to come to ,some will tell you straight away from a very young age and will stick to that, this is my identity and that’s fine too, but some will take time to explore that and form that.

Gender expression is a thing that can confuse people sometimes, how I... I guess if I identify as a male and my idea of masculinity might be difficult to someone else’s and how I express myself as a man might be different from someone else, people often talk about a traditional sort of man and he’s a metrosexual type of guy so even within masculinity and femininity there’s different ways that i would let you know, not let you know but I would maybe dress or even might use my hands, or dress of if I sit I might cross my legs in a particular way, such as S shape that is seen as a more feminine way of sitting but how you express that gender is a complicated thing and it’s something you have to think about it a little bit. (23.04)

Then there’s gender roles and what do men do what do women do, what does it mean to pick up the dustpan and brush or hoover and do things and what does it mean to be really into football or ...all these things often we talk about gender stereotypes and that’s a boy thing and that’s a girl thing well actually why, why is it?

o a lot of it is deconstructing and critiquing, with the family and the young person, how is that you’ve come to this identity and how do you incorporate that into your world I suppose, because the last thing we want is a young person changing their body to fit in with what they think society’s rules are there is a level of that in society, we can’t change society, I’d love to be able to change society and take gender out of it all together because then what does it matter, you just express and be what you want to be, or how you identify but there’s a reality to some of society but we also want to just help young people teel that they can carve out a place for themselves to be and express themselves how they identify really. To do this sort of work we often use things like the gender unicorn which introduces the idea of continuums for these different sorts of parts of identity or gender identity and helps with children, to think about not so much for themselves but maybe their parents or their friends and family Uncle John, where does he fit in terms of how he expresses his gender, is he more or less manly than so and so and it’s just kind of shaking it up a bit, it’s a nice tool that I use to talk to young people (25.09)

What are your worries so far, it’s a big group so I am not going to field questions but I guess in terms of what often comes out when I do this sort of talk, the common worries that we get are - are we intervening too young, these young people and their bodies, they’re young, they’re haven’t fully formed, mentally as well as physically, and what about sexuality, how do we we know that for a young person it’s not more about sexuality than gender identity and what happens if there’s a traumatic history and that’s particularly relevant to this group here and you guys, does that influence, or not and how do we know if it did and I always come back to in a way to say that it’s really important that we know about history and trauma and thinking about that but at the same time we are here because we’re here and I’m not going to say it doesn’t matter how we got here because it does but it’s also not everything as well. (26.15)

How can they know, especially young children, what does gender mean to an eight year old compared with a 38 year old is probably quite a different thing, especially if it’s an adult asking them, they’re saying mum I’m a boy or mum I’m a girl and what do they actually mean by that?

There are often worries about a difficult life ahead and what it might mean in terms of physical interventions, it can often mean you are signing up to be a patient for the rest of your life, in a way you are taking what is essentially a physically healthy body, it’s not got medical, internally it’s not already and but physically it’s a healthy body and you are introducing medication and making it dependent on medication so it’s really quite ethically it’s quite a complicated area and again specially for children

Physical intervention some people say get in there help them, puberty is too distressing, get in there before it gets too far down the line some people say given them more time, how can they know until it’s over 18 and these sorts of things and the big concern is fertility because once you block puberty you are not producing .. once you go on either oestrogen or testosterone everyone’s different but you will certainly not be producing your naturally occurring hormone (27.43) and after a period of time there will be fertility issues if you ever did decide to come off I suppose and we are starting a child down this path and what 14 year old can think about whether I want to have kids, most of them say they don’t but when they get to 28, 30 or whatever that might change and often does actually. (28.07)

We’ve only just started talking about fertility in the last 4 or 5 years and before that we were putting people down this pathway and they were coming back to us 15 years later and saying “Wah you never really said” or you know and that’s what I mean about this being such a new area because we weren’t even doing hypothalmic blockers under the age of 16 until 5 years ago, we don’t have people who are 40 or 50 to see how’s your life been, were we right to intervene so early, we don’t know. (44.35)

So how do we support children presenting with gender identity difficulties, it’s a developmental approach so that means in terms of how they can grasp and hold onto concepts - obviously a six year old is different from a 16 and how you can engage in these conversations it totally varies across age (29.05)

I’ll go into a bit more of the development stuff but what we also see is what we term associated difficulties so other things that go alongside, often, so this is taken from our clinic and it’s self report and not diagnostic so I’m not saying so for example low mood about 42% of young people will report low mood or lack of concentration - it’s not a formal depression diagnosis, but they’ll report that.

We have a very high rate of it’s not again diagnostic, it’s ASC traits, we do a screener which is a self report questionnaire that the young person family and teacher will fill in and around 30% of the young people who get referred to us in the clinic report autistic traits in the clinical range so would be highly indicative of a diagnosis though not a formal diagnosis. What’s that about? I mean, why is there such a high number of people with autism or autism like presentation coming to our service? I”ve got some ideas about it and I think quickly I can share that often people who have that condition will find social interactions difficult and will often feel a gap, engaging with friends and peer group can be difficult and is … gender isn’t just a physical thing it’s a social thing as well and we do wonder if that’s why it might relate in some way. That doesn’t mean they are any less able to go forward, it just means we need to think about that in terms of the whys and how they got to this point. (30.58)

Unfortunately self harm is becoming increasingly common, we do have …suicides we are unfortunate in that we do get some but it’s not much more than we would get in CAMHS population obviously there are people who feel down and do attempt to end their lives which is very unfortunate but at the same time in terms of the child population that we see it’s not usually higher than CAMHS but CAMHS is still quite high so I don’t know if that’s a win or whatever but we do try to support the young people as best we can with everything not just gender .

obviously the rest of them, anxiety, feelings of confusion and shame, bullying is there quite a lot and we get a lot more of the internalising - anxiety - rather than anger where people are getting angry or running around causing conflict it’s more of an internalised difficulty. (32.14)

So in terms of development, I’m aware I’m flying through this so hopefully it’s not too much, in terms of development, we kind of break it into three groups, pre puberty, peri puberty which is just on the cusp of puberty and pubertal young people.

So you are born, you got no idea of what boy and girl is and that binary idea of things, you are still an infant, exploring the world and quite egocentric. A newborn infant does not have a self concept of male or female kind of identities that is something that comes from the social world over time. (33.08) What can they grasp and what can they hold on to? I suppose we’ve got some research to show that coming to the age of about two, children learn to label others as boys or girls but that’s based on external things, rather than … I mean they are usually told whether they are a boy or girl but how they pick it up from other people is usually around things like clothes, hair and nothing else really, to them, to a 2 year old that’s what gender is - if you’ve got long hair and a dress you’re a girl, if you’re dressed in shorts and short hair you’re a boy and that’s it. (33.45)

The notion is usually ...with time they will learn about anatomy, if they have siblings, maybe bath time they might see a brother with a penis and sister with a vagina and get to realise that boys have this and girls have that but again it’s very physical. Between the ages of 3 to 5 you are becoming more curious about the physical side of things, that idea of the bathtime when you’re curious, why does my brother have a willy and my sister has a vagina? (34.26)

Primary school years things start to develop a bit more, you start developing relationships with caregivers, becoming aware of your father as a man and he does certain sorts of things and the mother is a woman and she does certain sorts of things, you start to differentiate a little bit about what roles might be and … yes, but still it’s all kind of, sometimes children will play mum or play dad but they don’t realise that I have a penis, so I”m a boy and I can play whatever role I want because it’s all about the imagination.

In pre-pubertal children they say this and that but it’s more about where they are developmentally I suppose because sometimes we get referrals of 4 and 5 year olds and you’re thinking well we’re not going to intervene just yet we’ll see how this one plays out I suppose. But parents can get really anxious and worried because they’re son or whatever is playing with dresses and heels at 5 or 6 and actually that’s normal, that’s OK. We move away from pathologising cross-gendered behaviour really. That’s not a problem, that’s OK, it’s exploration, imagination, we want to allow them to be curious, we want to allow them to express themselves, we want to help, if a young person is feeling a bit confused we try to usually support parents to demonstrate a varied gender expression (36.19)

So if ...I should be clear, this isn’t us trying to lead, we are totally neutral in outcome and if this is what the right thing for a young person is we’ll go with that but if a young boy or someone ASMAB is playing with dresses and playing with dolls and if it’s not a problem it’s fine but if they’re getting very distressed or it’s causing a problem we will often encourage dad to do it with them so they know it’s OK, hopefully if there’s a dad around or a male carer or whatever, so that they know it’s OK that men if they want can play with these sorts of things and it’s OK. They might be getting different messages at school but we would just encourage breaking down those stereotypes, that’s how we’re approaching things with the young people. (37.05)

One of the dilemmas that we are coming across increasingly, we used not to get this until about three years ago but all of the young people - not all - 90% of the young people under the age of 8 or even 7, the pre-pubertal kids, they used n’t to be what we call socially transitioned. It used to be that they might want to, it might be that at home they’d dress up in Mum’s high heels and the girl, the assigned female, might present as more masculine but now we’re seeing that lots and lots of parents (37.36) are transitioning their child, cutting their hair short, changing their name, even deed polls and then changing schools and sometimes living in what we call stealth, in secrecy and .. we don’t know what that does, it’s kind of a big social experiment, we’re a bit worried about we don’t know how that’s going to impact pathways for these young people. That never used to happen until a few years ago and part of the problem for us I think with the waiting time, we are back to about a year’s wait so by the time they are waiting a year, they come in and all of these changes have already happened. And it’s not that they shouldn’t happen, it’s just that they can happen quite quickly and we want to be thoughtful about it really.

Peri and post puberty to go through. Peri is when you’re coming to the cusp of puberty and that can be different ages and that’s quite a critical time, it’s when your relationship to your body starts to change and coming into puberty is quite a traumatic time anyway but you’re still very much a binary, there’s men and women and that’s it, You are quite rigid usually, you are about 9 maybe, you are quite rigid about what a boy and a girl is, and your social role, say you’re an assigned female and you love playing football and you love playing with cars or playing, doing stereotypically boy things, it makes sense for you to say that I love that, all my friends are boys, I see myself as a boy and that given developmentally that makes sense, I guess that developmentally you might be able to process that differently as you get older but that makes sense. A lot of the work around this point is around managing parents’ anxieties because they think “Oh my god, I’ve got a transgender child, I want to support them as much as possible, do everything that’s right” and often it’s not the child it’s the parents running around going: “When do I get the hormones, when can I get blockers, when can I do this, when can I do that” and actually it’s just about helping them to manage their anxieties and saying we still don’t actually know, they’re not far enough into puberty to really know yet - OK?

It’s also the time that they are starting to develop crushes and things like that and it’s really important to think about especially if they are (40.05) saying, same sex, same as their assigned gender, assigned male attracted to male, is there homophobic messages around, if there’s that around we want to knock that on the head as much as possible (40.23) if possible.

And then puberty and this is the bulk of our work and this is the hard part because this is when identity sexual, gender , are starting to crystallise and starting to become a bit more constant. I would say that you don’t fully really form your identity until you are 24 or 25, but you’re coming into 16, 17, 18 and things are starting to crystallise a bit more there and that’s when we feel a bit more comfortable intervening in terms of medical intervention (40.54) at around that point.

The only exception to that I guess is where things are complicated and that’s when we might be thinking about traumas in the past, previous difficulties within the family, what does it mean to be male or female, and if they are coming to us at that point, age 16, we really want to spend a lot of time going back, thinking about family (41.21) experiences they’ve had, sometimes around violence, especially if it’s an assigned male and what it means to be a man if there’s been a violent father or violent man in the house or what it might mean to be a woman if there is a (41.32) woman who is perceived as weak or vulnerable, people can have quite toxic views on what it means to be a man or a woman and if that’s your assigned gender, not that it’s causing it but we just want to be sure of these things first of all (41.51)

That’s kind of when we get to the puberty stage and that’s also when medical interventions start happening. Umm right, that’s when we support social transition much more, coming into that first as a way of testing out and doing it in a staged way and yeah… ok… we work a lot with local agencies to support that… I’ve got 2 minutes maybe … just takeaway messages:

Puberty is a really challenging time for all young people, irrespective of gender, and can be very distressing, so all young people will question things around sexuality, they might not overtly question gender and give it that label, but they will be thinking about things around, they are coming from young boy to man and young girl to woman, you know it’s quite a scary thing, we are all through the other side and it’s hard to think back to, and actually society is different now, hard to think back to all those really challenging things actually.
It’s really helpful when a local assessment happens and an exploration and we try to support that from the Tavi and also coming across to Dublin.
The system you guys are really important in terms of keeping outcomes open because often it can be “That’s what I am, either support me or leave”. You can be supportive but also questioning and curious and supporting them to think about what that means for them.
I guess some of the tensions, there might be external dominant affirmative discourse being present or the other side as well - really doubting and questioning - but questioning as in an anti-argument. We try to straddle ourselves in the middle and be quite neutral.
Yeah and I won’t get you to answer this but it would be helpful for you to think about where you stand, because everyone has different positions with regards to gender non conforming children and how you kind of support them, I’m more than happy to speak to people separately in the break and as I said if you do need to get in touch you are more than welcome to call up.

(From final slide)
Initial local assessment and exploration of gender isseus can be helpful and ongoing local support is crucial.

The importance of support in the system around the child/young person

Keeping possibilities open

Tensions: external dominant affirmative discourse being present in the room whether explicit or implicit - a pull to action

What is your position regarding gender non-conforming children?

Lotsof information - not necessarily well presented but if you have all this well-researched scientific evidence why did the Tavistock not use it?

Thanks for posting Sadly.
I dont see evidence to back up his statements.
I would expect that a health based CPD training in a specific area such as this, would include lots of references to journal articles.

The possible excuse, that this is a new phenomenon, and the research hasn't come through yet, doesn't bear up when you look at the response to Covid.
Every Covid-related CPD that I've done in the pst 6 months, has referenced papers on experiences around the world.

So, why none here?
They have numbers passing through their service- but no outcome measures. Why not?
It's healthcare 101.
What are the outcomes?
Where is the evidence?

If I should be encouraging gender questioning children to take PB's and if I should start having those conversations with parents- fine. Let me see the evidence to support that.

He makes it very clear there is very limited evidence