The judgment in Keira Bell's case will be given tomorrow

[MaudTheInvincible]

The judgment of the Tavistock's appeal of the case will be given at 2pm.

www.gov.uk/government/publications/royal-courts-of-justice-cause-list/royal-courts-of-justice-daily-cause-list

Brave Keira. You have done so much to protect children from ideologically driven healthcare around the world. Your integrity and courage is inspiring and rare in this ridiculous day and age. 💚🤍💜

Professor I've found the thread referred to here.

There was even one who told us that teaching young female teenagers about anal sex and to avoid telling them the high risk associated (even after a emergency doctor came on the thread to inform us of the damage she has witnessed to girls during anal sex) was necessary to remove any stigma for males.

Take wine.
www.mumsnet.com/Talk/womens_rights/4090953-Gay-mens-magazine-bullied-into-grovelling

I don't know where we went into the effects on mature female height.

I can't speak with any authority on the reasons that kids would seek referral to a gender identity development service that don't include gender dysphoria. Only the ones that do, of whom I was one.

The barriers to seeking a referral are much lower now - lack of access to information and social stigma being the primary ones - and referrals are much higher as a result. Unfortunately, there are several new barriers to entry now, and it seems that they are quite literally brick-wall barriers, currently.

As the GIDS site reveals, we've actually moved onto the backlog of 2018 referrals for initial appointment now! Hooray. 2017 was the figure quoted last year when the initial Bell case ruling was made, and is relevant because: One year on, and how many of that 'class of 2017', who have already been waiting several years, have even seen an endocrinologist to be put on blockers?

Not a single person under 17 has been referred and seen by endocrinology since December. Not a single person. inews.co.uk/news/health/transgender-young-people-nhs-hormone-treatment-puberty-blockers-transition-1205675

The treatment situation for trans kids isn't just actively worse than it was 20 years ago - they simply cannot get treatment right now. It's been completely extinguished as a realistic option they can access within a meaningful timeframe by a combination of chronic underresourcing and this case.

I think a solution I'd like to see is local CAMH (let's not even go there about their underfunding and waiting lists though) seeing this as core business and offering therapy and then having local partnerships with endocrinology services if necessary. Of course I would hope it just would not be never for many if they had timely access to therapeutic support.

GIDS is clearly not making anyone happy. Too little prescribing for those who want easier access to hormones and too much for those who want more care and guidance in advance of that.
It seems like a failing organisation.
Surely it's time the whole thing was dismantled and the money reinvested in properly commissioned local services
Triage by waiting list is not 'watchful waiting' it's neglectful waiting and quite likely young people are more entrenched in their desire for transition and hormones by the time they get an appt because their only support is mermaids and the internet.
That's if they haven't obtained internet prescriptions from charlatans with no oversight.

Your use here of "trans kids" is a unisex term that obscures health disparities in treatment for female patients.

What worked out for you, at a time when patients were predominately male, does not have the same outcomes for female transitioners such as Keira Bell.

This is what happens to girls when Lupron is used temporarily to delay puberty.

extract

For years, Sharissa Derricott, 30, had no idea why her body seemed to be failing. At 21, a surgeon replaced her deteriorated jaw joint. She’s been diagnosed with degenerative disc disease and fibromyalgia, a chronic pain condition. Her teeth are shedding enamel and cracking.

None of it made sense to her until she discovered a community of women online who describe similar symptoms and have one thing in common: All had taken a drug called Lupron.

Thousands of parents chose to inject their daughters with the drug, which was approved to shut down puberty in young girls but also is commonly used off-label to help short kids grow taller.

The drug’s pediatric version comes with few warnings about long-term side effects. It is also used in adults to fight prostate cancer or relieve uterine pain and the Food and Drug Administration has warnings on the drug’s adult labels about a variety of side effects.

More than 10,000 adverse event reports filed with the FDA reflect the experiences of women who’ve taken Lupron. The reports describe everything from brittle bones to faulty joints.

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

Used long-term to prevent the completion of female puberty, it seems to stunt height. How does this benefit female transitioners?

Yes, it's almost like doctors are starting to realise the treatment path is based on shaky or non-existent evidence, and they're laying themselves open to lawsuits, isn't it?

This seems the right moment to highlight the appalling state of the Tavistock / GIDs - a service for children with the latest CQC report rating it as inadequate, identifying concerns related to clinical practice, safeguarding procedures, and assessments of capacity and consent to treatment.
Keira's case exposed the untested "experimental" nature of the treatment for children with a wholesale lack of evidence and research (short and long term) and highlighted concerns that staff had about inappropriate influences from adult political pressure groups. Oh - and they have just had to pay compensation to their safeguarding lead because their treatment of her damaged her professional reputation and “prevented her from proper work on safeguarding”.

The idea that anyone believes that this is a fit and proper service to treat this most vulnerable and often very unwell group of children is quite frankly incredible. Hopefully the forthcoming Cass report will centre children's safety and wellbeing, not the ideological demands of adults. It must insist on high quality, effective therapeutic treatment for every child with no more hiding from safeguarding issues, along with in depth exploration of every single child's capacity to give full informed consent to;
the future loss of their fertility and what that means for their adult relationships and family life
the loss of a healthy unmedicated body
full understanding of any impact on their future sex lives

All before any medical or surgical interventions. This is the very least that we should expect for children.

Triage by waiting list is not 'watchful waiting' it's neglectful waiting and quite likely young people are more entrenched in their desire for transition and hormones by the time they get an appt because their only support is mermaids and the internet.
That's if they haven't obtained internet prescriptions from charlatans with no oversight.

This is true. But likewise I can see why GPs and local mental health services don't want to get too involved. There's too much at stake politically. If a prescription is refused, it can be misconstrued as discrimination. Who would want to deal with patients like that? "Give me x or I'll sue you?"

Thank you purgatory. I had half typed out post to check what the Prof was wanting but you found the thread I believe.

I don’t think it was the only thread where this was said, but it is one example.

HTH Professor.

If I was the GP for a patient who was being programmed by Mermaids, it would be quite a relief to punt them along to GIDS and wash my hands of them. I know that sounds cruel, but the alternative would be allowing myself to be coerced into following their preferred treatment plan, regardless of my medical opinion, training level, or acceptance of risk. Much better to divert them to the national centre of whatever and deal with any anxiety or depression in the normal way.

Decentralising such a specialist service isn't feasible, I don't think. We're still talking thousands not hundreds of thousands of these children. They don't do brain surgery at my local non-A&E hospital for the same reason, surely.

What's usually overlooked in the criticism of gender services is the freedom healthcare professionals have to choose the field they work in.

The barriers to seeking a referral are much lower now - lack of access to information and social stigma being the primary ones - and referrals are much higher as a result. Unfortunately, there are several new barriers to entry now, and it seems that they are quite literally brick-wall barriers, currently.

Referrals are much higher, yes. Agreed. Why are they much higher? Why are there huge increases of FEMALE transitioners? I think it is quite blinkered thinking to believe it is only due to the lowering of barriers. And it is incredibly harmful to ignore that there is an issue.

And also probably shows the lack of experience with this group. As a parent of a teen, I have watched whole groups of young female teens declare themselves to be trans with some getting referred to the clinics. That is whole groups declaring themselves trans in a matter of months.

There is such a disturbing lack of curiosity about this group, particularly with the rise in significant poor mental health issues with females due to many issues society is throwing at them, and the intersection with growth in awareness of ADHD & ASD. And support groups simply not interested and telling people, including parents that it is just natural and it is transphobic to question why.

As the GIDS site reveals, we've actually moved onto the backlog of 2018 referrals for initial appointment now! Hooray. 2017 was the figure quoted last year when the initial Bell case ruling was made, and is relevant because: One year on, and how many of that 'class of 2017', who have already been waiting several years, have even seen an endocrinologist to be put on blockers?

Please do not infer that the Bell case ruling has caused these issues. Lay the blame solely at the service providers. They were not able to present any evidence that their treatment path actually was the best for any young patient, and certainly not females. They were the ones not following up to be able to assess treatments options.

The blame is on them, and who ever the fuck is recommending affirming only treatment plans without evidence that it is working for a large portion of the cohort. So, blame the ones who did not do the reviews, or were recommended that any reviews were problematic.

Not a single person under 17 has been referred and seen by endocrinology since December. Not a single person. inews.co.uk/news/health/transgender-young-people-nhs-hormone-treatment-puberty-blockers-transition-1205675

And do you believe that all children are capable of being able to make that decision with fully capacity? At what age? Really. What age?

The treatment situation for trans kids isn't just actively worse than it was 20 years ago - they simply cannot get treatment right now. It's been completely extinguished as a realistic option they can access within a meaningful timeframe by a combination of chronic underresourcing and this case.

I fully support the expansion of capacity to cope with the current needs. I agree the situation is dire and needs to be addressed.

I don't agree that offering affirming only is the only treatment that should be offered though. And I certainly do not agree that patients should be rapidly processed to catch up. Significant investment in resources needs to be made.

That includes significant investment world wide for treatment options and for what is causing the spike in young FEMALE transitioners as opposed to males.

As a local mental health services person (not CAMH though) I must admit I dread any gender dysphoria referrals because I did not ever get any training on this as it was a niche issue when I trained and I am indeed terrified of being branded a transphobe if I do anything other than affirm. It's a great cop out for me to refer on to the endless tertiary services waiting list because I can thereby avoid any confrontation. It is likely not the right thing for the patient though.

You might say though that Drs are not the only ones copping out. The whole focus on getting prescribed hormones and 'becoming' the opposite sex could also be seen as a huge cop out from opening oneself up to challenge and difficult psychotherapeutic work to discuss why you might feel that way in the first place and really think about how your life will be if you go down that road (not a whole lot happier says the evidence).
In psychiatry we should be quite good at giving people what they really need rather than what they think they might need. That's why hormone treatment should only be offered in the context of therapy because it's life changing stuff.

In the olden days you could be pretty sure (at least I thought you could) that people were required to have a lot of discussion and therapy and lived experience before any prescriptions were issued and certainly before any surgery was done. The approach was very cautious. I am not sure when it all changed but I have been shocked by the revelations from the Tavi that whistleblowers and the court case uncovered as I really did believe that this cautious psychotherapeutic approach was still the norm and that, especially for children, hormones would be a last resort.

Just saw this on twitter.

Today in howling at the moon just seen a young woman who reported her rape at the age of 15, her case may be heard by the end of this year, she is now 19. 4 YEARS!!!! SHE WAS A CHILD.

twitter.com/jessphillips/status/1441346709343256578?s=19

Yes the waiting lists for everything are crazy long at the moment. I know someone whose child has been waiting three years for an ASD assessment and has been told they have at least another year to wait. CAMHS services are horrendously underfunded, young people in all kinds of distress are struggling to get seen at all let alone any meaningful help.

@CovoidOfAllHumanity: Triage by waiting list is not 'watchful waiting' it's neglectful waiting Yeah, agreed, it's just as bad as triage by ignorance or privilege, and all of these methods involve no treatment whatsoever - not even being seen to be treated. All of these are issues that can definitely be fixed, but they require us to not be at the mercy of decades of NHS underfunding, and that, sadly, won't happen with the Tories in.

quite likely young people are more entrenched in their desire for transition and hormones by the time they get an appt because their only support is mermaids and the internet. This seems possible, though I think you disagree with a lot of posters here? I thought the main argument against blockers was that waiting was supposed to be what causes people to desist, rather than intensifying their desperation? You certainly seem more willing to entertain the idea that they can be a positive thing.

That's if they haven't obtained internet prescriptions from charlatans with no oversight. Yeah that's...ugh. I wouldn't be surprised if people were at that level of desperation in December last year.

Do you think a GIDS that was slain and resurrected in the form of local services would be vulnerable to lobbying from pressure groups and unsympathetic local authorities in practice?

@LongBlobson

Yes the waiting lists for everything are crazy long at the moment. I know someone whose child has been waiting three years for an ASD assessment and has been told they have at least another year to wait. CAMHS services are horrendously underfunded, young people in all kinds of distress are struggling to get seen at all let alone any meaningful help.

It's just horrendous across the board, and it makes me so sad to see people outright discussing being poisoned against voting for the way out.

being poisoned against voting for the way out

I think losing the legal definition of "woman" is even worse than having underfunded services. It's a position I weighed up, due to the potential irreversibility of the impact on women's rights. Its my right to hold that opinion, and it doesn't mean I'm poisoned. That is a patronising view.

Good grief Butterfly, how can you misinterpret CovoidOfAllHumanity 's nuanced child centred post stating that it is quite likely young people are more entrenched in their desire for transition and hormones by the time they get an appt because their only support is mermaids and the internet.
Your response? This seems possible, though I think you disagree with a lot of posters here? I thought the main argument against blockers was that waiting was supposed to be what causes people to desist, rather than intensifying their desperation? You certainly seem more willing to entertain the idea that they can be a positive thing.

In your desperation to drive wedges between posters, you completely ignored Covoid's wise point that:
The whole focus on getting prescribed hormones and 'becoming' the opposite sex could also be seen as a huge cop out from opening oneself up to challenge and difficult psychotherapeutic work.

Butterfly you are on a parenting site.
At least open your mind a centimetre to the notion that parents might understand their own children.
newdiscourses.com/2021/03/youre-not-trans-youre-just-weird/
Editor’s note: This hypothetically open letter was originally posted by its anonymous author on Medium and was rapidly removed as “hate speech.” We found it to be a refreshing dose of honesty, a charming and relatable open letter from one parent to other parents (not to the child, obviously!) about dealing with a challenging and dangerous moment in raising children, especially “weird” adolescents who search for their identities harder than others and risk making life-damaging mistakes in a way never before possible. We are reposting it here on New Discourses with the permission of the author.

quillette.com/author/angus-fox/

In my ongoing Quillette series, where I narrate the experiences of parents who feel sidelined and attacked, I advance the notion of hyper-ruminative transgenderism — a term which the wonderful Stella O’Malley and I came up with to describe precisely this kind of trans-identification. The notion is fairly simple: transgender identities can emerge from excessive rumination over discomfort, trauma or the feeling of being at odds with the world.

@MrsOvertonsWindow

Good grief Butterfly, how can you misinterpret CovoidOfAllHumanity 's nuanced child centred post stating that it is quite likely young people are more entrenched in their desire for transition and hormones by the time they get an appt because their only support is mermaids and the internet. Your response? This seems possible, though I think you disagree with a lot of posters here? I thought the main argument against blockers was that waiting was supposed to be what causes people to desist, rather than intensifying their desperation? You certainly seem more willing to entertain the idea that they can be a positive thing.

In your desperation to drive wedges between posters, you completely ignored Covoid's wise point that:
The whole focus on getting prescribed hormones and 'becoming' the opposite sex could also be seen as a huge cop out from opening oneself up to challenge and difficult psychotherapeutic work.

I think the reason that Butterfly keeps misunderstanding other posters is because their belief system is so different from most of the other people posting on here.

Butterfly believes that children can 'be trans' and that this is an immutable fact about them. I don't believe that children 'are trans', I believe that a child who thinks this about themself is reacting to something else in their life. In order to believe in trans identities in children you have to believe that we all have a sort of gendered soul.

So while Butterfly thinks that they need simple affirmation and drugs, once the child has detected the gender of their soul, I believe that they need psychotherapy to help them to understand why they have a belief that their body is 'wrong'.

If you believe that children just 'are trans', any psychotherapy looks like conversion therapy, as it would if the child was gay or lesbian. Butterfly's belief system doesn't allow for other possibilities of why a child might believe that they are transgender, such as internalised homophobia, a reaction to abuse or bullying, autism or many other reasons why a child might identify in this way.

I thought the main argument against blockers was that waiting was supposed to be what causes people to desist, rather than intensifying their desperation?

What part of ‘puberty blockers and Testosterone have significant long term health risks for females’ is not being clearly communicated here?

From Angus Fox

A Scottish detransitioner called Sinéad Watson has recently written about the effect of her journey on her mother. While Sinéad was going through her original reassignment process, her mother was deep in grief, yet couldn’t articulate this, being afraid that their relationship might deteriorate if she did so. So Sinéad’s mother put a brave face on it, supporting her daughter even as she was doing what she believed was the wrong thing. As Sinéad writes:

She was a grieving mother with nobody and nowhere to turn to, because her grief was painted as transphobic and hateful, when in fact it was the opposite. It was unconditional love for her daughter that forced her to support me and stay by my side even though it hurt her. Nobody ever asked her how she was. Nobody ever checked in to see how she was handling the loss of her youngest daughter. People just kept saying “good for her,” while she cried herself to sleep after looking at my baby pictures. My mum didn’t question or challenge me because she didn’t want to lose me. [But] the gender clinic had no such pressure. It was their job to question and challenge me—to evaluate my (clearly) poor mental health and treat me accordingly. Instead, they handed me HRT [hormone replacement therapy] and surgery … The parents of trans people receive so little support or compassion. It is not transphobic for you to grieve, and don’t let anyone tell you otherwise.

There seems to be little point in blaming either parent or child in this situation. If Sinéad and her mother had been living in a culture where the prospect of such drastic medical changes could be discussed freely, the outcome for their family—and for Sinéad’s body—might have been radically different.

Thank you OldCrone - that's helpful. It's the harm that's happening to children that distresses me most and it's always good to be reminded why some just don't see what's happening as harmful.

The treatment situation for trans kids isn't just actively worse than it was 20 years ago - they simply cannot get treatment right now. It's been completely extinguished as a realistic option they can access within a meaningful timeframe by a combination of chronic underresourcing and this case.

This is the crux of the problem isn’t it? The perception that “treatment” MUST include and in fact be dominated by hormone treatment involving puberty blockers and wrong sex hormones, despite there is no evidence to support such practice and indications it doesn’t help. Only those who evangelically believe in this pathway as a saviour would take the stance that “treatment” - total - has been denied.

The alternative view is that a good number of children in this time period have been prevented from having their bodies irrevocably harmed by people consenting on their behalf for treatments that ultimately won’t help them and may not be right for them.

If hormone treatments are right for these children then they can now wait until they reach an age at which they are able to fully consent.