ITV: The Clinic- NHS Scandal

[mightymam]

Anyone watching this on ITV just now? Fascinating so far. Surprised to see Sajid Javid in it!

From what I've read on the subject of trans kids, there seem to be a lot of male children who like playing with dolls.

How ingrained must the sexism be that your conclusion is "the boys' bodies are therefore wrong" and not "maybe playing with dolls isn't related to being male or female"?

Wow, great to see an article in the guardian acknowledging the omertà around trans medicine, and further, acknowledging that it’s a problem

Hearing Libby talk about growing up, having children, was really heart breaking.

Yes it was heartbreaking. I wonder what they mean when they say this. Presumably the only options for many of these children will be adoption or surrogacy and I doubt many of them are resilient enough to be adopters. No wonder there is a push for surrogacy laws to be relaxed. There will be thousands of these children in the future who have infertility issues. Nowhere near enough consideration is given to what it actually means to render yourself infertile and how children may be setting themselves up for a whole new round of heartbreak and mental health issues.

Not to forget that Libby may be autistic, have ADHD, have been subject to abuse, etc. or be suffering from a myriad of other conditions that are identified as causal factors for young people identifying as trans.

I thought that was a pretty well balanced programme and I urge everybody who can to catch up with it. Lots of focus on this thread on poor Libby, but we also heard recorded testimony from Keira Bell, and they interviewed a young woman called Jasmine, who detransitioned after very similar cursory assessment at GIDS - can't remember for sure if she was also referred for puberty blockers, but I think she was. She was then passed on to the adult service and ended up on cross-hormones for a year and also in that time had a double mastectomy. It was only after that she finally realised none of it was making her feel any better (she had a history of self-harm, which had been ignored ) and she detransitioned. She said that at that point the adult service said OK, you'll be removed from our patient list and if you ever want to come back you'll have to start the referral process all over again. And that was that. No attempt whatsoever to follow up how she was. She is left with a permanently deep voice and has to shave every day. One year of testosterone!

Also extended contributions from Sue Evans, Marcus Evans, David Bell, David Taylor, Paul Conrathe and two GIDS clinicians who contributed on condition of anonymity (they are dismayed by CASS and think everything was fine). Brief contributions from the Fox Botherer, again attempting to suggest this is an attempt to get rid of Gillick competence - they didn't have him on camera saying it was all a right-wing Christian evangelical plot, but I think he has said that on Twitter, on the grounds that Paul Conrathe is a Christian as well as a solicitor. Jaw dropping contributions from Susie Green, as already mentioned.

It was OK, and it's really good this is getting such mainstream coverage at last.

It's a pity there wasn't much discussion about the actual risks of PB, either in themselves or as part of the almost inevitable pathway to cross sex hormones. It would be easy for someone to come away wondering what the big deal was with a drug which was hard-sold as a simple 'pause button'.

Also there was no mention of the proportion of children seen by GIDS who are same sex attracted and while autism was mentioned in relation to the judicial review hearing, it was never made clear just how high the proportion of autistic children is.

I agree, but they only had an hour, and there is so much to cover. I thought it was a telling moment when Sue Evans said that during the judicial review she brought with Keira the judges asked the Tavistock barrister how many children prescribed puberty blockers were diagnosed as on the autistic spectrum. The barrister asked Polly Carmichael, who was in court, and she couldn't answer. The judges asked for the information to be provided the next day. The Tavistock couldn't do it. They'd put all these children onto an experimental hormone treatment with no clue about the long-term effects, knowing that the vast majority of them would move onto cross-hormones, and they were so incurious about this that they weren't tracking the co-morbidities or looking for patterns.

Yes, the lack of data and record keeping is shocking.

Even so, I thinks it's a shame they didn't include some of the basic stats we now know - 35% moderate to severe autistic traits, 80-90% same sex attracted and also, of course, the huge shift from overwhelmingly boys to overwhelmingly girls.

Yes, they could definitely usefully have mentioned that shift from mostly male to mostly female patients, as it is so striking.

I was quite glad to hear Jolyon Maugham say that after KB won her case the prescribing of PBs and cross-sex hormones had stopped and although the NHS won the appeal this didn't actually make any difference and it didn't go back to the pre KB situation. I'd often wondered how much they had resumed their normal service but seems as if they were scuppered for good.

Also I hadn't realised that SJ had actually ordered that GIDS be closed.

Yes, Keira Bell and Susan Evans changed everything

On reflection I do think the appeal decision was correct - it's not for judges to assess Gillick competence. Paul Conrathe was a good choice for this case because he really knows his stuff in these areas but he is a conservative christian who appeared to be very excited by the precedent this would have created had it not been overturned.

We got the best outcome possible from this judicial review:

1. loads of sunlight
2. a very clear, sobering outline of everything a child needs to understand before giving Gillick competent consent to PBs
3. no dangerous precedent

Even when we lose, we win.

For some parents so would guess a low self esteem after a lifetime of being told that they are constantly wrong. They were groomed by peers, schools, left wing politicians, ITV Butterfly/BBC/Ch4 types, Owen Jones types, GPs and charities too. They are told boys shouldn't play with dolls and then that there is something wrong with the body. The parents can be autistic and vulnerable too.

The groomers should face consequences in my opinion.

I am trying to watch it on catch up but we have an ongoing issue with our internet connection dropping.

Sue Evans is really good.

Managed to watch it all.

What was very striking is Libby, in typical teenager attitude, when asked about making the decision to transition at such a young age was "I can and I just did". I am sure a few years back Kiera and Jasmine would have said exactly the same thing. I also felt that there was a little convincing oneself with the comment about how great it was that so many are coming out as trans and how wonderful it was.

As an aside I wish it had been made very clear that those masked, aggressive protestors were on the 'pro-trans' side of the debate.

I thought it was a well balanced programme, but was disappointed that they didn't mention how many of the kids who transition are, in fact, lesbian and gay and that was joked about by some GIDS staff. Also a glaring omission was the lack of discussion regarding the disproportionately high number of girls and young women now transitioning. GIDS has no answer for that and they blooming well should have, as they have facilitated it.

I think the thing about Gillick competence is that a child doesn't suddenly become Gillick competent for everything.

A 5 year old can understand, "Yes this medicine doesn't taste nice but it will make you get better", I'm not saying a 5 year old is Gillick competent but you can explain medicine on a basic level.

Libby and Jessica are both old enough to understand puberty blockers but only if they have been explained properly and what cross sex hormones do. Libby is totally oblivious, so I'd say she isn't competent.

Jessica does understand but unfortunately from experience rather than from it being explained to her.

So sad. For them and for the other children.

I often wonder how relevant Gillick is when

A) we don't really know what the long term effects of puberty blockers are, so they can't be explained anyway and

B) we DO know that surgery is not very effective and does not result in working genitals but it seems that is not properly explained along with all the other complications so patients are being lied to.....

If this was clearly set out in front of parents and kids from the outset, would they still 'consent'?

As a layperson, what I can never get my head round is this:

• Puberty blockers stop all parts of the body maturing, including the brain.
• We all know that children's brains work differently to adults', and children lack life experience too, so their capacity to assess risk and to make life-altering decisions is obviously not as good as you would hope an adult's would be.
• And yet - a child on puberty blockers, who may be 16 but will still have a pre-pubertal brain, is considered competent to decide whether to go onto cross-hormones, which will result in infertility and quite possibly mean they will never experience orgasm or have any sort of sexual response.

Doesn't add up, does it?

except if your overwhelming urge is to change the bodies of children who don't comply with societal norms

then you can make anything add up

Physician: I don’t know. I pray that there is a change. One of the things I’ve been thinking about is what puberty blockers do to children. This medication is called a “gonadotropin releasing hormone agonist” and it comes in the form of monthly injections or an implant. And because it simulates the activity of this hormone, it shuts down the activity of the hypothalamus. The hypothalamus is this almond-sized structure in your brain, it’s one of the most primal structures we have, and it controls all the other hormonal structures in your body—your sexual development, your emotions, your fight-or-flight response, everything. But it shouldn’t be described in such cold physiological terms because your hypothalamus is not just a hormone factory. It’s this system that allows you to stand in awe of the beauty of a sunset, or to hear the sounds of orchestral music and to stop whatever you’re doing and want to listen. And I always think that if someone were to ask me, Where is it that you would look for the divine spark in each individual? I would say that it would be somewhere “beneath the inner chamber,” which is the Greek derivation of the term hypothalamus. To shut down that system is to shut down what makes us human.

They can't consent to this or no fertility.

Well probably the first programme on this issue that I've been able to watch without my blood pressure soaring!
Hope this is a sign of things to come. The balance is subtly shifting.

I was pondering on whether Gillick competence is ever likely to apply when dealing with treatment for mental health disorders, but there is a double problem here.

A child can presumably give consent to treatment for anorexia, but the treatment for anorexia involves doing something the child doesn’t want. Their mental health disorder is driving them the other way.

With transitioning, the child generally desperately wants the treatment. You can explain it to them all you like, but I don’t see how you can ever really assess whether they fully understood the consequences, but just agree because it’s what they want.

If a girl wants contraceptive pills, it can be ascertained that she understands. She also wants them, but presumably the doctor assesses whether she is also rational at the same time.

I don’t think we can assume any child with gender dysphoria can be truly rational about weighing future side effects against what their dysphoria (or peer or parental pressure) is urgently telling them, right now. I almost feel that having a diagnosis of gender dysphoria more or less disqualifies you from being considered rational enough to assess consent.

Which is all related to the fact that affirmation is basically enabling (or even encouraging) a mental health disorder, rather than trying to control or moderate it or its effects.

I think it significant that the program hasn't come from the bbc

Thankyou, I didn’t know that background.