Good Law project have succeeded...

[Wandawomble]

goodlawproject.org/news/tavistock-success/

I see my post was deleted.

RobinMoiraWhite

The level of paranoia displayed here is quite remarkable. I don’t deny this may occur, but in the 20 or so families with trans children I know, this isn’t a feature, so it’s either very rare or I have had a remarkable strike rate.

I agree with you that the overwhelming majority of parents have the best interests of their trans and GNC children at heart.

However, it's very important that all processes are robust enough to protect the minority of children who are being abused and manipulated. The clinicians in e.g. the Newsnight report are not saying at all that all children who are assessed at the Tavistock are being abused, but they are saying that they have assessed children where they felt very uncomfortable about something and were reluctant to make a recommendation for prescribing blockers. That reluctance could be:

• evidence of familial bullying or homophobia
• indicators of abuse or neglect

-evidence of historic abuse and trauma that may influence feelings of dysphoria

• indicators that a child is being coached in what to say (by parents or peers)

Other concerns, less related to possible abuse might include:

• finding it difficult to assess the child because they do not communicate verbally
• evidence of co-morbid autism or mental health difficulties that are not well addressed, making it hard to identify the origins of psychological distress

None of those things mean that a child should never, ever be prescribed blockers if there is evidence that blockers are effective at alleviating distress caused by gender dysphoria, but they do mean that a decision to prescribe blockers has to be taken very carefully, and cannot just be because the child says they want them and the parents say that it is ok.

Thank you Rowantrees, that's really interesting.

The Sunday Times recently ran a book review of 'The Road to my Daughter' by a woman whose son became her daughter. She clearly felt this was the right thing for him/her after many years of mental unhappiness.

But it makes interesting reading. She was married to an abusive man, her sons father, whom she divorced when her children were young. Home life was tense and her son unhappy. After some years as a single parent she remarried. Her son seemed drawn to stereotypically girl toys but she said this wasn't an issue. He was a talented singer and she looked at sending him to a choir school however:-

I liked what I saw of the first choir school I visited, until the moment my tour took me to the school hall, where senior boys were in rehearsal for their end-of-term play. Thirteen-year-olds were running around dressed as fairies and damsels, wearing make-up, sparkly wings and long-haired wigs. If I’m honest, I wasn’t comfortable with it

She sent him instead to a tough boarding school where he was extremely unhappy and suffered homophobic bullying:-

When he was given detention, the school failed to tell Spencer why. It was only years later, after Miles came out, that Spencer discovered it was for wearing make-up to class, that her son had been sent out of the classroom and that later, “that same housemaster had unleashed a withering homophobic diatribe upon her at lunch, in front of the assembled house

Her son initially came out as gay and then as trans which she felt was the problem all along.

But this is a complex story of a bullied child who witnessed his father being abusive to his mother from an early age.As Dr David Bell said - these children often have complex backgrounds of abuse, many struggling to come to terms with being same sex attraction in a homophobic culture.

because that's the role of medical science, not the law

This is something I've been mulling over. The medical establishment have created an almighty mess, the courts were dragged in to sort things out and their response has been mostly to try to remind the medical establishment about what they were supposed to have been doing.

The overall message to the medical establishment of the two cases is: sort out your evidence base, decide what you're aiming to achieve with the treatment, be very careful in who you select to undergo the treatment, and follow up to make sure you're doing things right.

But I still can't figure out what happens when a new child patient arrives at GIDS and they and their parents are insistent on getting puberty blockers, with GIDS deciding what to do within the framework of the child being unable to give consent (Bell) and the parents giving consent on the child's behalf. The courts have tossed the hand grenade back to the medical establishment: doctors have to decide what to do but they must do this on the basis of sound medical practice.

But I still can't figure out what happens when a new child patient arrives at GIDS and they and their parents are insistent on getting puberty blockers, with GIDS deciding what to do within the framework of the child being unable to give consent (Bell) and the parents giving consent on the child's behalf. The courts have tossed the hand grenade back to the medical establishment: doctors have to decide what to do but they must do this on the basis of sound medical practice.

Is this relevant to the case we're discussing? I think the case is about a child already on medication and in Family Courts (someone correct me if I'm wrong) the Judge could rule this way in this case but could rule differently in another. There was acknowledgement that there is little in the way of standard because there is little in the way of evidence?

This is why JM, in his rush to try and find a route to overturn the Bell case (rather an odd thing to do before its conclusion) has taken a route that he thinks will give some traction at some point in the future. The case has not done this, in fact in may well have done the opposite., hence the way our erstwhile lawyer crept away because he knew fanfare would highlight the lack in his strategy.

One other thing that needs a bit of a mention. There was a massive gasp of incredulity by the nation when the Bell case broke into the media and no amount of trying to put the lid on has been able to stem the way many view medication and surgery on health bodies as a real issue. Judges often make decisions on 'what would a reasonable person do , the child in this case was already on medication and did not interfere with the Bell case. The parents in this case could easily have used the Bell case and gone to the high court and it is highly likely that the court would have approved the continuation of the medication. JM did not want to do this, he wanted to try and find a loophole and exploit. This didn't happen and may well mean that any loopholes get closed by the Cass review.

@LangClegsInSpace

Up until Keira Bell's case GIDS were relying on the child's consent.

Today's case confirms the Bell decision that children are unable to consent to this treatment and also confirms that GIDS could instead use parental consent.

The implications are that in order to get proper informed consent from parents GIDS have to provide all the relevant information necessary for parents to evaluate all of the above 8 points and they can't dismiss parents' follow up questions as transphobic or unsupportive.

But the way they said it, that they wouldn't prescribe on the parents say so, if the children didn't consent, makes it sound as though it's a case where the children don't actually want it

Yes it's very disingenuous.

I can imagine cases where a child is extremely dysphoric but also doesn't want to consent to puberty blockers because they are worried about future fertility, ability to experience sexual pleasure, ability to form relationships, bone density, brain development, social development, ...

But if PBs were a truly necessary treatment then it would be fine for the parent to weigh up and make decisions on all of those points on behalf of their child, just as we would for any other medical treatment, even if our child was not at all keen.

The thing is that PBs are not a necessary treatment which is why GIDS are suggesting the same consent framework as cosmetic surgeons use when working with children.

I dunno, it's late. Maybe I'll make more sense in the morning.

Thank you!

And of course Sonia Appleby, Safeguarding Lead at the Tavistock us taking them to court:-

My case rests on being vilified for raising safeguarding concerns with my line managers about the safety of children and young people receiving GID services

Why are we pretending that parents putting their kids onto puberty blockers for their own desires rather than the child’s, or that concerns about abuse being ignored are just a “hypothetical” when there are transcripts from the Tavistock staff advising these things have already happened?

@happydappy2

The big elephant in the room, is still, WHY are so many more young girls thinking they would prefer to live their life as a male? Historically it was young men who suffered dysphoria and a small amount might transition in later life....there are many reasons young girls are running away from womanhood (sexual abuse, sexual trauma, not wanting to be a lesbian etc etc.) The fact is we KNOW young autistic girls are being caught up in this mess & their bodies are being irreversibly harmed-for that reason alone society should halt this insanity until people are aged over 25 at least (imho)

Yes, I have teenage daughters. We know a girl who suddenly identified as trans at 16, was quickly put on cross sex hormones , and at 17 had her breasts removed ( not in the UK). My elder dd is 16 and four or five of her friends have gone through identifying as boys, using binders etc. She says that the older ones seem to be moving on from that to identifying as non binary. A couple of these girls have ASD, possibly more. When you read the reports on the sexual harassment and abuse girls are facing in schools, the effect of porn culture on boys in particular and the way girls are viewed, then it is completely understandable that girls want to opt out of womanhood. These are girls who need radical feminism, but are instead being fed sexism, and unknowingly enforcing their own pink and blue boxes.

It's not clear to me that this judgement will only have an effect on the person XY highame. Even if that was what the judge intended, it isn't clear to me that others won't misinterpret the judgement to have a broader application.

The main take away for me is that any medical practitioner who isn't involved in a cowboy operation will look at these two decisions and feel an enormous sense of responsibility to tread incredibly carefully in the knowledge that they're experimenting on children.

I think what worries me is that the Bell judgement was also not a decision on the quality of the evidence - because that's the role of medical science, not the law. But if, for various reasons, the science is basically quackery, where are the legal safeguards? Where is the line between 'currently unproven, experimental treatment' and 'discredited treatment for which multiple trials have failed to find evidence of efficacy'?

***

I think this is the problem. The level of capture within the NHS means that the lack of a robust evidence base is tolerated where it would maybe not be in other specialties.

The courts are right to throw decisions about safety & effectiveness of treatments back to the medical profession. But we are relying on the norms of that profession to hold when, as pp's have pointed out this area of medicine has been treated very differently. The extracts of the ruling above show how aware the judges are that this treatment is very different. It defies the usual framework that Dr's work within in treating the body and mind.

So we are waiting initially for the Nice guidelines which a pp says are due within the week. And then for the cass review. The cass review hasn't tweeted since Jan and no Web site has appeared. I hope that's not a bad sign. But between them and the court judgements I am hoping that the normal standards for medical evidence & risk will be applied.

1) It doesn’t match my experience of the parents of the 20 or so trans children I have had contact with. They would universally want the child to be who they are, be that trans or gay.

(2) The piece is unquantified. What proportion of parents at the Tavi does that relate to?

I’m sorry to say the levels of hysteria, plain on these threads, particularly from those with no experience on trans individuals or children, about the needs of a very small minority, is really quite surprising.

What's surprising is that the Tavistock falls into your category of 'those with no experience of trans individuals or children', but i'm afraid it is their clinicians who were worried there 'would be no gay children left'. Who claimed that 'it feels like conversion therapy for gay children' and that 'homophobia is driving a surge in ‘transgender’ young people'.

www.thetimes.co.uk/article/it-feels-like-conversion-therapy-for-gay-children-say-clinicians-pvsckdvq2

Sonia Appleby, the Tavistock safeguarding lead, has raised questions which were systematically ignored. Their own safeguard lead. She is taking them to court.

The out of control homophobia has even lead hundreds and hundreds of youngsters to invent a new sexual orientation, for goodness sake. One that they are fervently hoping will be impervious to homophobia. But no, 'super' sites everywhere are being targeted.

Frankly, I have never seen such vitriol targeted at homosexuals.

Trigger warning: disturbing homophobia
mobile.twitter.com/hatpinwoman/status/1367799126943993857

And of course expecting women to be uninformed and 'hysterical' is a common mistake and, given this is the feminist board, entirely unsurprising.

I’m sorry to say the levels of hysteria, plain on these threads, particularly from those with no experience on trans individuals or children, about the needs of a very small minority, is really quite surprising.

So your response to women discussing a court judgment and voicing concern for the wellbeing and safety of children is to call us hysterical and paranoid. Is that the best 'argument' you have?

You surely have spent enough time here by now to know that many posters on here have children or other relatives who identify as transgender. And you don't need to know any 'trans children' to understand that safeguarding is just as important for such children as it is for any other children.

But perhaps you can help by explaining exactly what you mean when you talk about 'trans children'. From the judgment:

12. XY came out to her parents as transgender when she was 10 years old in Year 5. According to AB, XY had always only been interested in girls’ toys and clothes. When at primary school she, for a period, tried to conform to a more “male” stereotype but she was utterly miserable, became very withdrawn, and was shy and unhappy, particularly at school.

13. She came out to her parents about being transgender after reading a book where one of the main characters was transgender. According to her mother, once she started going to school as a girl her confidence grew, and she became much happier.

I see a boy who doesn't like male stereotypes, and don't think they fit his personality. You see a 'trans child'. What is the difference and how is an objective diagnosis made before setting such a child on a lifelong medical pathway with irreversible changes to their body?

How many parents would stand by and allow their child to be medicated with experimental medication that is likely to render their child infertile if they weren't 100% convinced that there was no alternative?

But that is just the thing. Carl Monaghan, in his conclusion stated unequivocally that parents cannot give informed consent to their child receiving puberty blockers, because there isn't enough information to base their decision on.

This court judgement has no impact on that assessment. Unlike in the US, we do not operate the kind of informed consent model whereby the patient (or their representatives) accepts all responsibility and absolves doctors of theirs. So in the case of detransitioners whose parents consented on their behalf, those parents can later seek to hold the clinic to account.

That is not a hypothetical scenario, but something I expect will happen within the next five years.

Sorry, Carl Heneghan!

I see a boy who doesn't like male stereotypes, and don't think they fit his personality. You see a 'trans child'. What is the difference and how is an objective diagnosis made before setting such a child on a lifelong medical pathway with irreversible changes to their body?

I, too, would very much like to know what is the difference. Because to me it looks very much like pathologising a completely understandable behaviour.

(Is pathologising a word?)

I didn't quite get right what I was trying to say above:

It's not clear to me that this judgement will only have an effect on the person XY or children in the same circumstances highame. Even if that was what the judge intended, it isn't clear to me that others won't expansively misinterpret the judgement to have a broader application.

Many posters here have children, relatives or husbands here who "identify" as trans or transition.

I have personal experience with children identifying as trans, it's common in children with asd.

SirVix

Yes, I have teenage daughters. We know a girl who suddenly identified as trans at 16, was quickly put on cross sex hormones , and at 17 had her breasts removed ( not in the UK). My elder dd is 16 and four or five of her friends have gone through identifying as boys, using binders etc
She says that the older ones seem to be moving on from that to identifying as non binary. A couple of these girls have ASD, possibly more. When you read othe reports on the sexual harassment and abuse girls are facing in schools, the effect of porn culture on boys in particular and the way girls are viewed, then it is completely understandable that girls want to opt out of womanhood
These are girls who need radical feminism, but are instead being fed sexism, and unknowingly enforcing their own pink and blue boxes

My sister, a teacher, recently had a boy whom she had taught for many years, declare himself a woman.Never any inkling of this before. The numbers of children being referred to GIDS stood at about 50-70 for many years until they suddenly soared to 2,500 over a few years. Any other medical condition showing such a sudden rise, seem across the developed world, would have researchers crawling all over it. The world of violent porn freely available to any schoolboy, shows a world where women enjoy being punched, burnt, tied up, throttled. Its no wonder so many girls want out.

Thank you Datun and others. Calling women who don't agree with you 'hysterical' isn't very original is it?

The service was also inadequate for the 50-70 children per year who were being referred prior to the sudden surge in cases.

@NotBadConsidering

Why are we pretending that parents putting their kids onto puberty blockers for their own desires rather than the child’s, or that concerns about abuse being ignored are just a “hypothetical” when there are transcripts from the Tavistock staff advising these things have already happened?

Context must always be considered.

In addition to the list InvisibleDragon gives in post at 9.27, there are other social trends we should be considering.

We know that there has been a huge rise in eating disorders in children over lockdown, and a general trend in a rise of body dsymorphia which many attribute to social media and photo manipulation giving unrealistic impressions of what people look like.

The other social trend is even more alarming.

www.bbc.co.uk/news/amp/health-56253759
Children's doctors given fabricated illness guidance

The Royal College of Paediatrics and Child Health (RCPCH) says cases where parents know there's nothing wrong are rare.

Instead genuine, if misplaced, health anxieties are more common.

They advise referring to "perplexing symptoms" instead of "fabricated or induced illness".

Paediatricians say there has been a rise in cases where children are repeatedly brought in, despite nothing being found to be wrong.

The unexplained symptoms could be because a genuine condition has not yet been diagnosed.

And there are cases where a parent or carer might make up or cause illness in their children - a rare form of abuse which used to be known as Munchausen's By Proxy Syndrome.

But often, doctors say, it is genuine concerns - and they believe the rise may be fuelled by bad information online.

And

Much of the medical literature around Munchausen's By Proxy has focused on parents trying to deceive doctors by falsifying medical records, symptoms or causing their children to become ill.

But Dr Alison Steele, the RCPCH's safeguarding officer said it was "very rare for parents or carers to deliberately induce illness in a child by, for example, poisoning them or withholding treatment.

"Most cases are based on incorrect beliefs or misplaced anxiety which, unchecked, can cause children to undergo harms ranging from missing school and seeing friends, to undergoing unnecessary and painful or even harmful tests and treatments".

Now I can think of a parent of a child in DS's class who has a concerning level of health anxiety and i know she has put her daughter through unnecessary stress because of it. Its awful to be aware of and I've tried to avoid her because there is very little that i could do. I find it distressing as a result. (I believe the school are aware of it though as Ive mentioned it quietly to a friend who works there).

I can definitely think of threads on MN where a parent has asked about their child in the context of them being potentially trans. The child in question has been 3 or 4 and the parent is applying politics rather than having an awareness of normal child development because its been promoted to a point which is unhealthy and people told to 'be kind' & being berated for not being open minded enough rather than being reassured that not conforming to stereotypes is perfectly normal and healthy and not a cause for 'needing to assist yoyr child to transition'.

We should be talking about these issues, homophobia, autism, lack of proper general mental health support etc at least as much as we are bombarded by puff pieces in the media about trans kids.

We aren't because its not trendy. And this in itself should set alarm bells ringing.

The roll and influence of adults and social group pressure in an unhealthy way, most definitely needs unpicking. Its not. And we should be concerned by this absence of balance from our awareness of identity development in children.

@Datun

I see a boy who doesn't like male stereotypes, and don't think they fit his personality. You see a 'trans child'. What is the difference and how is an objective diagnosis made before setting such a child on a lifelong medical pathway with irreversible changes to their body?

I, too, would very much like to know what is the difference. Because to me it looks very much like pathologising a completely understandable behaviour.

(Is pathologising a word?)

Yes it is.

And there's real concern that this is a rising problem in general with health due to dr google and health anxiety being encouraged by numerous 'awareness' campaigns which have created a 'market' for themselves in order to help raise money.

Dr Margaret McCartney is one of several who has written about health inequality and the 'worried well' which has created a situation where people who have need for healthcare cant access it but more privileged types are taking up precious time for no reason because of this dynamic.

Its certainly not an issue which is just about the rise of trans kids but a much wider one about the commercialisation of the health market and the charity sector (where else have we seen this) which is creating a wave of social health panic which is completely unnecessary and isnt balanced by an ability to do a proper risk assessment and is driven by media sensationalism and driving to the extremes on everything (again part of a pattern where moderates and moderation have become increasingly unrepresented and reflected in the media).

These trends do not begin and end wuth trans. It's definitely not about trans. Its about why trans as a thing has appeared at this exact moment in time because the social conditions are fostering it.

I think the phrase im struggling to phrase is something about a lose of all perspective because the issues around this have lost context and reasoning as counter weights to extreme ideology and excess anxiety.

We are population which is displaying signs of massive levels of stress across the board in all areas of social interaction. Just at a time where we have hyper-social levels of interaction. Its almost as if we cannot compute and process the levels of information that are being fed at us in a healthy way which is able to filter out harmful stuff and moderate the messages our brains get.

I’m still a little confused.

Parents have rights to consent for medical treatment when our children cannot consent - we all do this everyday.

But this is about consenting for medicalisation that will introduce disease - stopping necessary puberty, reduction in bone density, prevention of maturation of gametes/sterility etc - when no such disease was there before. This is treatment that actively diseases the child.

Also, if the child can’t consent - how can any parent/clinician know if the child really believes/fully knows what they are saying to then provide consent on their behalf. Seems a catch 22 to me.