Helen Webberley

[Signalbox]

Looks like Helem Webberley's substantive case has finally been listed for 26th July 2021

www.mpts-uk.org/hearings-and-decisions/medical-practitioners-tribunals/dr-helen-webberley-jul-21

That's very important evidence.

Good for him.

Oh, another point. It's the desired blocking effect that is reversible. That statement about reversibility would also not cover any potential side-effects.

But the word "reversible" is thrown around as if it was almost a synonym for "safe" or "harmless".

I think I get it.

Years of puberty blockers from age eleven, make a child different in ways that cannot be undone.

What the drug is doing stops when the patient stops taking the drug. That's what "reversible" means here.

Correct.

As opposed to, say, testosterone or estrogen, which have permanent effects.

Although to some extent the "reversibility" arises from the fact it's an "indirect" treatment.

If you had the opposite of a hormone blocker - some way to make the female body produce testosterone - that too might be "reversible". But the testosterone produced would have a permanent effect.

Thanks very much Signalbox and Necessary

Today's exciting installment...

Today Dr Agnew was due to give evidence. Dr Agnew is a Paediatric psychologist (and from what I can work out, another of the GMC’s expert witnesses.)

It’s a bit confusing but it seems that an application was made by Ian Stern (HW counsel) for more time due to more material being provided by the GMC to Dr Agnew resulting in an updated statement. Dr A’s updated statement refers to the statement of Dr Pasterski (Webberly’s expert). The defence wished to produce their own statement in relation to this before Dr A gave evidence. Dr A would then need to evaluate the new statement before giving evidence. So it was decided that the statements needed to be written, shared, agreed, read and evaluated by all parties before Dr A’s evidence can be heard. It seems that Dr P is dismissive of Dr A and his relevant expertise and considers that Dr A knows nothing about gender dysphoria. Therefore, no witness were heard today and Dr Agnew’s evidence will start tomorrow at 9.30.

Thanks for your time and work on this @Signalbox

@Leafstamp

Thanks for your time and work on this *@Signalbox*

No worries. I love a court room drama!

@NecessaryScene

Oh, another point. It's the desired blocking effect that is reversible. That statement about reversibility would also not cover any potential side-effects.

But the word "reversible" is thrown around as if it was almost a synonym for "safe" or "harmless".

What side effects? PBs pause puberty which continues once the PBs are stopped. The normal nonsense myth is infertility but I am interested as to what side effects there are and especially that are not reversible.

What side effects? PBs pause puberty which continues once the PBs are stopped. The normal nonsense myth is infertility but I am interested as to what side effects there are and especially that are not reversible.

Bone health is one concern. I posted a link to this paper on Wednesday.

research.vu.nl/ws/portalfiles/portal/95648455/418506.pdf#page=59

Obviously they will be infertile if they follow the puberty blockers with cross sex hormones and never actually go through puberty.

What side effects? PBs pause puberty which continues once the PBs are stopped.

Typical use of blockers isn't to take them and then stop, though.

Typical use (98%+) is to take them and then progress to hormones, so the two drugs need to be assessed as one treatment path.

Just a few of the many possible side effects of this treatment include infertility, sexual function damaged or entirely gone, menopause in your early 20s, vaginal prolapse, (often needing a hysterectomy), pain on orgasm (FTM), for those who begin blockers at Tanner stage 2: genitals too small for SRS (MTF), no one knows what it does to the brain as there have been no studies in people but a small study on animals suggests blockers may stunt intelligence.

For an example of how blockers then hormones can mess up your chance of having a functional sex life or kids, see Jazz Jennings. Started on blockers young, has never developed adult genitals nor a sex drive. Has a neo-vagina but no sexual feelings (last time Jazz spoke about this, anyway).

Instead of shilling for pharmaceutical companies selling this experimental treatment to be used on kids, why not ask yourself what you think the effect might be on a young person if their genitals are never given the chance to develep into adult, sexually functional genitals? Or how it affects kids to see their friends go through puberty and for them to be held back.

Can you remember how much you changed in your teenage years? What would it have been like if your brain had been prevented from maturing in line with your peers and you'd been kept artificially immature?

Plus bone issues as mentioned above, plus stroke risk, cardio problems etc etc.

Lupron (one of the family of drugs used as blockers) has shit loads of complaints about it, when used for a variety of conditions. Try reading articles like this to get a better idea of it.

www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/

@DisgustedofManchester

You do realise practically every drug on the planet as side effects?

Here are those listed for Prostap 3 DCS, but you can easily Google the patient information leaflet if you’re interested in any other drugs used as puberty blockers.

Very common (may affect more than 1 in 10 people)

Weight changes, hot flushes, sweating, muscle weakness, bone pain, loss of interest in sexual intercourse, inability to have an erection, a reduction in size and function of the testes, tiredness or skin reactions at the injection site (these include skin hardening, redness, pain, abscesses, swelling, nodules, ulcers and skin damage).

Common (may affect up to 1 in 10 people)

Loss of appetite, difficulty sleeping, depression, mood changes (with long-term use), headache, nausea, abnormalities in liver function or liver blood tests, joint pain, swelling of the breast tissue or swelling in your ankles.

Uncommon (may affect up to 1 in 100 people)

Mood changes (with short-term use), dizziness, tingling in the hands or feet, diarrhoea, vomiting, muscle ache or weakness in the legs.

Not known (frequency cannot be estimated from the available data)

Blood tests may show anaemia (low red cell counts), low counts in white cells or platelets, allergic reactions (may include symptoms of rash, itching, wheals or a serious allergic reaction which causes difficulty breathing or dizziness), changes in blood lipids (cholesterol) or blood sugar, paralysis, seizure, altered vision, pounding heartbeats, changes in ECG (QT prolongation), blood clots in lungs, high or low blood pressure, jaundice, fracture of the spine, thinning of bone, difficulty passing urine, fever, chills, inflammation of lungs or lung disease.

www.medicines.org.uk/emc/product/4651/pil#gref

I see you possibly mean that side effects will stop if you stop the drug?

If so, many things in that list don’t sound completely reversible to me, or certainly not guaranteed over any short period of time.

A summary of Friday's evidence (Dr Agnew (Paediatric psychologist) can be found here...

threadreaderapp.com/thread/1428694558079131656.html

There have been news reports and cases for years about Lupron side effects. I can't imagine who decided to give it to children over a long period spanning many years, the complaints from relatively short term use in adults seem so troubling.

www.ktnv.com/news/investigations/more-women-come-forward-with-complaints-about-lupron-side-effects

"What side effects? PBs pause puberty which continues once the PBs are stopped."

There is only evidence (and limited evidence at that) for that where PBs are prescribed to children with precocious puberty.

In the case of children diagnosed with precocious puberty, PBs are used to halt abnormal development.

In those patients PBs are typically discontinued at the earliest possible time to allow the child to go through an early, but not precocious puberty. (Around nine years of age or so.)

These children are going through a normal puberty at a normal time for children (precocious puberty is almost always caused by underlying health conditions or as a result of medical treatments for other serious health conditions). And they still suffer horrendous longterm side effects.

In the case of children diagnosed with gender dysphoria, PBs are used to halt normal development.

When PBs are discontinued, the child does not proceed with normal development because it a) lags far behind its peers - and we've had various accounts of how damaging that is - and b) the body continues to age throughout the adolescent years even though puberty is halted.

There is enough evidence for instance to show that when brain development is arrested through the use of GnRH analogues (only called PBs when used to halt puberty), the brain is permanently altered (such as a lower IQ and certain brain functions like spatial memory).

I wrote a long comment on page 22 of this very thread about the dangers of PBs. Here is a brief quote about the effect they have on the brain:

What's less known is that GnRH analogues are extremely powerful neural function modulators, also causing debilitating mental health issues, including severe depression, personality disorders, suicidality, anxiety and other mood disorders.

The EU completed a review of mental health issues caused by GnRH-analogues in 2010. Since then warnings about the drugs causing depression and suicides have had to be added to the patient leaflets in the EU.

As for bone density, the best known side effect, there is currently no evidence that it ever recovers once PBs are discontinued. Some studies suggest it does not and the child ends up with bone density below the level of post-menopausal women (i.e. the lowest levels in healthy persons).

The normal nonsense myth is infertility but I am interested as to what side effects there are and especially that are not reversible.

It is neither nonsense nor a myth. If PBs are followed by cross-sex hormones, infertility is unavoidable. If PBs are discontinued before that step is taken, infertility may be an outcome (cf the well known issues in adult transgender patients who discontinue the use of blockers in order to have a baby and in whom fertility does not recover).

The side effects are very well documented in tens of thousands of patients. You could read my earlier comment if you want to get an idea. But don't take my word for it, I urge you to read up on them for yourself.

Brief overview of 23rd August.

Today the evidence of Dr Agnew continued.

There is some discussion around the extent of Dr Agnew’s expertise Dr Agnew confirms that he has treated patients with a diagnosis of GD but has not himself diagnosed GD in a patient. Dr Agnew says that patients come to him when they have autism or ADHD and he then encounters these patients. he has worked with patients with autism and with ADHD who are dysphoric. Dr A has never been part of an MDT for a GD youth. Many of the patients Dr A sees would already be within the process and already changed their names etc. The reason these patients came to Dr Agnew was to explore their autism or ADHD. There is discussion around WPATH and the guidelines and MDTs and duty of care.

One of the issues in relation to Pt C was whether or not Pt C had ADHD and if this needed resolving or support. Dr A had suggested that the WPATH guidance says that MH should be assessed for co morbidities and these should be added to the overall treatment plan because this can help to alleviate GD. Dr A says that WPATH guidelines are very clear that coinciding conditions should be addressed and he says that his reading is that you deal with the coinciding conditions first as they can complicate GD. Other diagnosis should be fully explored.

There is a discussion about the treatment of patient A.
Prof Gary Butler writes to Pt A’s GP and sets out case and asks to review in 2-3 months, and encloses shared care agreement. In another letter GB mentions discussion re fertility loss and review with a nurse in 3/12. Then there is evidence of a failure to engage and Pt A is discharged from the service. There is various other evidence of interactions with HCP that Dr A agrees “feels like and MDT approach”, although Dr A cannot see any evidence that they have ensured “Gillick competency”. There is more discussion in relation to MDTs and how they function.

SJ asks if it could be argued that Dr W is a specialist and therefore could just refer if necessary. Dr A says that although GPs are skilled they do not always necessarily know when additional skills may be needed which is why WPATH say MDT approach is necessary. Dr A’s opinion is that medical doctors aren’t in the position of knowing someone’s psychological needs as that is not where their training is. This is why MDT is important.

Dr A says that he is not suggesting that HW should have had a full MDT available but he cannot see much communication or sharing of information with existing services. The MDT approach needs to be there.

A panel member asks about the University of Calf guidance and that HW states she was following that guidance and what is wrong with that? Dr A says that he wasn’t aware that HW was using a “spoke and hub model” [from what I can work out hub and spoke is where you have a central clinician who then refers out if any other issues] and if she was it wasn’t clear from her notes. Dr A’s main concern was the underlying coexisting conditions.

Dr A says he is sympathetic to Mermaids and HW. Thinks this is a difficult area of healthcare and that these people are just trying to help.

Chair asking questions about whether Dr A is aware of HW’s level of expertise when he criticised her “hub and spoke” approach to treating GD patients. Dr A says he thought she was just a GP when he wrote his report. Chair says she isn’t a normal GP she is a “trans GP”, a specialist with considerable learning. Chair asks if that informs her approach to these 3 patients? Dr A says this question should be directed at another GP as he is not trained as a GP. Dr A says considerable consent processes still need to be in place and if they were then a “hub and spoke” approach could work.

Chair calls Dr A an “MDT man” states that Pt A wasn’t happy with the MDT approach because if they had been they wouldn’t have gone to see HW, they would have stayed with the MDT. HW says the 3 compelling reasons for starting Pt A on hrt were that they were part of a twin and being left behind, that they were in stealth mode and didn’t want to be exposed and the risk of suicide.

Discussion over whether or not CBT can help with treating GD. Dr A says that CBT won’t help you get over GD but it may help you get over your distress so it’s important to have access to it.

Discussion around HW communication with the Tavi. When Pt A disclosed that he was seeing HW to the NHS they ended his treatment with themselves. Dr A is asked if this may have prevented HW from interacting with the NHS. SJ intervenes stating that there is no evidence that HW attempted to communicate with the NHS, that she did not respond to PGB’s contact and that the NHS regs mean they have to discharge when patients are seeking help elsewhere.

Dr A says that “Hub and spoke” risks missing an identified need. Patient A, B and C all had unidentified ADHD/ASD and this would have been picked up by an MDT.

End of Dr A evidence

There are no more witnesses today but there is some discussion in relation to 2 further expert reports (from the defence) which are to be served on the GMC. This could delay the progress of the hearing because the expert reports refer to each other and may affect the order of things. Lots of discussion about which witnesses will be heard when and how much time will be needed. Argument around the admissibility of the new expert reports (for various reasons) but chair says this can be decided once the reports have been read. Resumes tomorrow at 10am.

Umm...

Chair says she isn’t a normal GP she is a “trans GP”, a specialist with considerable learning.



The chairperson said this? I'm at a loss.

Thanks again @Signalbox for keeping this thread updated.

I thought it was established that she didn't have considerable learning (even more so for the relevant time period)? That comment shocked me too

I thought her only qualification in this area was an online course by GIRES.

www.mumsnet.com/Talk/womens_rights/3497770-RC-for-GPs-scraps-GIRES-developed-course

It does rather emphasise that no-one here knows what they're doing. There's no good evidence backing any of this up. It is all just wishful thinking to a large extent.

Dr A says he is sympathetic to Mermaids and HW. Thinks this is a difficult area of healthcare and that these people are just trying to help.

"Trying to help" can cover an awful fucking lot of sins. There's a reason the Hippocratic Oath is "First, do no harm", not "just try to help".

Armed with an arsenal of drugs and surgical implements someone "just trying to help" who doesn't know what they're doing can do an awful lot of fucking harm.

And everyone needs to cover their backs so even Dr K who prescribes puberty blockers to 9 year olds when asked about bad side effects says 'it doesn't seem so bad and anyway we monitor closely'

@ThinkWittyThoughts

Umm...

Chair says she isn’t a normal GP she is a “trans GP”, a specialist with considerable learning.



The chairperson said this? I'm at a loss.

Thanks again @Signalbox for keeping this thread updated.

The panel obviously have access to information that we don’t but this was an odd thing for a panel member to state in the evidence phase especially since we’ve not heard evidence from HW yet.