Gender Martyr

Rob Hoogland has been jailed, and the extreme Right are up in arms against it. He was jailed for refusing his child medical treatment which doctors said was necessary, and denying the child’s medical condition, then holding the court in contempt for two years. On being jailed, he expressed remorse and said he had been used as a pawn, and “played”, by transphobes opposing all treatment of trans children.

The child, whose real name I don’t know, socially transitioned at school for a period of years. He did not feel able to tell his parents, and his parents justified his suspicions by completely opposing his treatment. He was assessed by doctors including an endocrinologist who set out a course of treatment. Hoogland refused to co-operate, so the hospital decided they knew best the medical treatment the child needed, and would treat the father’s consent as unnecessary under the law.

Hoogland continued to act up. He was adopted by the hard right, as he says as a pawn for them to use to oppose gender affirming care, and in 2019 the court ordered him to use male pronouns when referring to his son.

In March he was arrested, and, overwhelmed by a sense of his own righteousness backed up by the wealthy, powerful transphobes, he stayed in jail rather than consenting to admit his son’s medical needs. At the hearing on Friday, he finally expressed remorse, so his sentence was reduced to six months.

If the British Columbia Supreme Court publish the judgment, I will have a look at it. However, otherwise, I can only find reports of the case on the nutcase transphobe/ hard right press: New York Post, “Christian Concern”, and a host of tiny websites. “Trans ‘Justice’ has gone haywire” blares some worthless transphobe on some site. No, transphobes feel entitled to ignore medical advice, the needs of their children, and the orders of the court.

What about the detransitioners? ask the phobes. Well, what about the retransitioners. The phobe conditional positive regard- lovebombing any trans man who will detransition, withdrawing the love if they break increasingly stringent rules- works with incessant societal transphobia to make some detransition.

There’s a lot of transphobe money around. Rob Hoogland’s crowdfunder raised $56,000. So the judge ordered him to donate $30,000 to a charity.

The phobes don’t care how many lives they ruin. Trans children can just go hang. Poor Hoogland regrets how the phobes manipulated him, now. Hysterical phobes are milking the story still. There’s a picture of a pair of fists grasping jail bars, the fists brightly lit against blackness in the cell, which hardly reflects Canadian prison conditions now.

I really should not go on Twitter. This morning over breakfast I read a New York Times opinion article about Planned Parenthood, how Margaret Sanger, its founder, was a racist eugenicist, and how the charity should reckon with this blighted heritage. There’s an aside near the end about how language might exclude trans and nonbinary people, and phobes Jesse Singal and Hadley Freeman choose to emphasise this as if PP no longer cared about women. “Misogynistic!” I found that when I ill-advisedly clicked on a link on a facebook trans group.

The obsessive haters in Britain have chosen yet another new name. This time the same tiny group of phobes have decided to call themselves “thoughtful therapists”. Perhaps Robert Withers, the Andrew Wakefield of trans health, is one of them. They oppose law on trans conversion therapy based on the Memorandum of Understanding, even though it is signed by the British Association of Counselling and Psychotherapy and nineteen other health, counselling and psychotherapy organisations. It’s like the American Academy of Pediatrics being condemned by some nutcase far right Christian group with “Pediatrics” in their name.

I hope the robust commitment to rehabilitation of the Canadian justice system does Rob Hoogland some good.

Listening to the transphobes

The Nuffield Council on Bioethics has launched an open consultation on treating gender dysphoric children and adolescents, to which anti-trans campaigners may easily respond. The working group does not include a single trans person. Dr Ruth Pierce has written a detailed critique of the project and its inadequacies. I had a look at the questions.

Nuffield produces reports on ethical issues in bioscience and health. It is funded by the Nuffield Foundation, the Medical Research Council and the Wellcome Trust. This page has links to its work on gender identity. This is its call for evidence.

They start by asking what gender dysphoria is, explaining that some people think it is a medical condition- genetic, hormonal, neurodevelopmental or psychiatric; some think it a social construct, and some a “normal variant of gender expression”. They don’t want a single agreed view, but want to understand how different views affect the approach to care and treatment.

Trans is what some people are, just as gay is. Attempts to suppress our personality fail. Attempts to prevent us from expressing ourselves through transition may succeed, though at the cost of great psychological distress.

Gender dysphoria is the distress at having to conform to the wrong gender, or at living with transphobia including internalised transphobia.

Those anti-trans campaigners who imagine they are left-wing feminists conceive of transgender as a threat to AFAB children: to those who want to transition, whom they call girls, threatened by infertility and physical changes preventing them from living their lives as “adult human females”; and to cis girls generally, from trans girls, whom they characterise as a threat to privacy or even a sexual threat. They cannot believe that transition could ever be right for someone.

However, trans people exist. Transition benefits us. Medical treatment with hormones and surgery at the very least helps us pass better, so to function better in a transphobic society, and at best cures the gender dysphoria arising from our bodies being wrong. Before transition I hated my body. Now I love it.

Anyone asserting that transition is always or mostly wrong is therefore denying reality, and their views should be discounted. However as Ruth Pierce shows the Nuffield press release quotes the approbation of extreme anti-trans campaigners.

Nuffield then asks what social factors are most relevant to the discussion on gender identity, and names a number of possibilities. On “intense sexualisation and objectification of women” I would add rape culture and pervasive sexual violence, but not primarily as having an effect on the trans boys but on the anti-trans campaigners. Many who once were feminist have been traumatised by that sexual violence, and they imagine that trans boys are fleeing it rather than expressing their true selves. It blinds them to the phenomenon of the trans boy who benefits from transition.

Nuffield names “increased visibility of trans individuals in public life”. Well, yes. Rather than trying to conform to the assigned gender, we realise transition might be possible. I felt I could not transition, because the trans women I knew seemed to be having awful lives. When I met some who seemed to prosper, it seemed possible that I could make a go of life as a trans woman, and so I decided to transition.

It does not mention the public transphobic campaigns of the Republican party in the US and the Conservatives and their allies here. That terrifies trans children, and makes them attempt to conform to their assigned gender. It causes mental anguish and even illness. We live in an atmosphere of extreme transphobia. That Nuffield names homophobic bullying but does not explicitly name transphobic bullying shows that they are trying to find a mid point between trans people and the anti-trans campaigners, rather than finding what is right for the children.

Nuffield then asks whether the evidence base justifies the use of puberty blockers and gender affirming hormones (which they call “cross-sex hormones”). I don’t know. There are great difficulties with producing evidence that these treatments are beneficial- the privacy of the trans people involved, the rarity of treatment, and the reasons why treatment is given. Trans children want PB and GAH because they want the right sex characteristics and not the wrong ones. Gender clinics justify treatment as a way of alleviating distress at the time of treatment, not anticipated problems and benefits in the future. That fits Nuffield’s next question- what should be the purpose of PBs?

How should trans children be treated? Before asking this, by way of context, they refer to “desisters”. I would draw attention to people who detransition under the extreme transphobia of society, and later transition again.

Nuffield asks, “Should children be encouraged or supported to transition socially?” Of course. It is the only way to find whether they will prefer life transitioned. But look what Nuffield has to say. Social transition “makes it difficult for young people to change their minds, and in fact increases the likelihood of later medical transition”.

Social transition of cis children is torture. It does not work. This way of presenting the issue makes transition look like a bad thing. The point is, for trans people, social transition makes our lives better. We do it under the pressure of worse transphobia than in Britain now. Nuffield is echoing transphobic talking points.

Nuffield then asks about a range of harms, even those which might be seen as harming those who do not desist, such as, loss of fertility. Stem cells can be made to develop into gametes. That is the way to address loss of fertility. They posit “the negative consequences of disrupting physiological puberty, given the role it might play in the formation and development of a consistent gender identity”. That is mere speculation, simply a more formal way of saying “Don’t indulge them. They’ll grow out of it.” BUT WE DON’T.

This is what Ruth Pierce means about the distress of facing these endless questionnaires, surveys and consultations. I want to cry. Why can Nuffield not see?

Then they ask about consent. They go into detail on the doubts expressed by the judges in the Bell case. They ask, “Do you think that children and adolescents have the capacity to consent to PBs and CSH?” No, scream the anti-trans campaigners. Trans people don’t say there are no risks, just beg the cis gatekeepers to consider the risks of not treating.

Again, the questions make the anti-trans case. “Is there anything distinctive about PB and CSH that they warrant a different standard of consent?” No, not really. All treatment has risks. Should a fifteen year old girl have an abortion? What if she regrets it, and is incapable thereafter of becoming pregnant? There is nothing distinctive, because this is treatment which can have great benefit. Many claims of risk are fearmongering and evidence-free speculation. But transphobes are so wise, and disinterested, in their calls for “transparent public debate”.

My sarcasm is a defence mechanism.

Nuffield asks if there’s anything else you want to say. Getting the distinctions and similarities clear in your mind, clarifying why phobes’ objections are irrelevant, is a particular skill. Not all trans people have that skill. Facing demands for explanation, we might just give up. Nuffield will produce a report over many pages, with many considerations weighed and taken into account, but for us it’s quite simple.

Transition saved my life. It may save others.

I am not going to answer this consultation. I dare to hope someone will express the potential benefits of PB and GAH in such a way that it will be clear to any disinterested person that they should be given, and that only considering the alleviation of current distress to justify treatment is unethical.

Puberty blockers for trans children

Trans children who were receiving puberty blockers before the Bell case can continue getting them if the parents consent. This win is thanks to the Good Law Project’s Trans Defence Fund.

Dame Nathalie Lieven was one of the judges in the Bell case, and says that nothing she says departs in the smallest extent from the Bell judgment. Rather, she has decided that where a child was receiving puberty blockers (PBs) before the Bell judgment, and the parents consent to continue, the NHS can prescribe them on the basis of the parents’ consent.

How else might it be managed? The court could appoint CAFCASS, the Children and Family Court Advisory and Support Service, to prepare a detailed report and the judge would make a decision based on that. It is hard to see how social workers could add anything when parents, doctors and the child involved all wanted to go ahead with treatment. A social worker would be no better than a psychiatrist in judging a child’s maturity and understanding. In this case, CAFCASS was not appointed.

The Bell case still stands, and when it is appealed in June 2021 the “expert” testimony, brought by the anti-trans campaigners, will stand. The court’s findings about the psychology of trans children are findings of fact, which the appeal court will not challenge. GIDS, the Gender Identity Development Service, should have led better evidence, and does not get a second chance.

Before the Bell case, GIDS prescribed PBs on the basis of the child’s consent. The Bell case decided the child was not capable of consenting.

XY was registered at birth as a boy. She is 15. She had always only been interested in girls’ toys and clothes. At primary school she tried to conform to a more male stereotype, but became withdrawn and miserable. She came out to her parents as trans aged 10. Once she transitioned socially at school her confidence grew, and she became much happier. She changed her name by deed poll in 2016, and had seven assessment interviews with GIDS, who also saw her parents, together and separately.

She has never been diagnosed as having an unresolved mental health issue, and she is not autistic, the judge says. An autistic child will face greater barriers to getting the PBs s/he needs.

XY’s Mum, AB, did extensive research on PBs. She was fully aware of potential side effects. The girl started on PBs in July 2019, when she was 13 and had commenced puberty, because the parents did not want her taking unnecessary medication, but the puberty changes were causing considerable distress. They decided not to undertake fertility preservation. At any point before she starts CSH, cross sex hormones, she can stop PBs and freeze sperm, but that would involve developing male secondary sex characteristics. She and her parents have continued to attend GIDS.

The girl’s GP has continued to prescribe PBs. Some other children’s GPs have not. The anti-trans campaigners, represented by Bell’s solicitors, attempted to butt in but failed, in part to protect XY’s anonymity.

The court asks, can the parents consent to PBs, and are PBs in a special category of medical treatment requiring an application to the court?

Parents have a duty in English law to protect their children. Courts can take children away or make decisions for the children, instead of the parents, if it is in the child’s “best interests”, but do not do so lightly. Doctors ask parents to make the most serious decisions about their children’s medical treatment.

The Bell case made it considerably more difficult to demonstrate that a child was capable of consenting to medical treatment, especially PBs. GIDS did not make a further assessment of whether the girl was competent to consent to PBs, so the court treated that question as undecided. If the child was still able to make their own decision, even after the restrictions imposed by Bell, could the parents’ consent be relevant?

Here, the court decides that where the child is capable of consenting, the parents cannot override the child’s decision. But they still have a duty to make a decision in the child’s best interests where the child cannot or will not decide.

The judge says the doctor can rely on the parents’ consent, because the child has not objected to it. I find it inconceivable that GIDS would prescribe CSH or PBs when the child was not enthusiastically in favour. But there has been no further assessment, by the court, social workers, or psychiatrists whether the girl is capable of consent as defined in the Bell case, so the child’s ability to consent is unclear. In that case, where the child and parents both consent, and treatment has started already, the doctors can prescribe PBs.

The court considered whether the Bell case as it stands makes PBs a special category of medical treatment which requires court authorisation, or where it is good practice for doctors to seek court authorisation. Whether it is good practice should be an issue of medical ethics for the General Medical Council. However the law depends on a line of cases on sterilization, where a pregnancy would be disastrous and contraception was not possible. Some of those cases related to women over 18, where parental consent would be irrelevant.

The court looked at two Australian cases. Previously, parents and trans children seeking PBs or CSH had to seek court approval, but after Kelvin’s case, they do not. An Australian judge said loving, caring and committed parents who are intimately aware of their children’s difficulties and deal with their concerns know their children better than a court ever will. They went the opposite direction from the English court in Bell.

GIDS pointed out they were subject to regulatory oversight, from the NHS and ethical rules. There is a review of GIDS looking at treatment of trans children, the Cass review, expected to report this year. The judge observes that whether PBs are therapeutic for trans children is strongly disputed by academic experts, and is a matter for research, not litigation.

The judge decided that PBs are not in a special category where the parents can not consent, and the matter has to come to court. The matter should come to court if the doctors think the parents are being pressured to consent or the doctors disagree amongst themselves. In practice one parent or one doctor can veto treatment, and it must come to court.

Children who had not started PBs before the Bell case are now restricted by NHS guidance.

Once a child reaches 16, the parents cannot consent for them. Bell, who was 17 when she started on T, passionately argued that she could not consent to it, and the law, at least for the moment, agrees. But children 15 or younger on PBs now can continue to get them, based on their parents’ consent, and the courts possibly will not interfere with the Cass review. It is a small win for trans children.

The Good Law Project described the case and published the judgment here.

Puberty blockers for trans children

Do puberty blockers for trans children work? What would success look like?

Dr Polly Carmichael, director of the GIDS, started a study on PB in trans children in 2011. The Bell judgment reports that a paper was being finalised, but one of the authors had not yet responded to issues raised by the peer-reviewers. A sociologist, Michael Biggs, has published a critique of the study which anti-trans campaigners would find devastating.

Ideally, a critique would have psychological and medical expertise Biggs lacks. He appeared transphobic before he started digging: he reports that three MSc students, whom he mocks as “woke”, told him to educate himself on trans children. He quibbles about the word “study”, preferring to call it an “experiment”, because PB has not been licensed, as if he has never heard of a “drug trial”. He quibbles that “it was not a proper randomized trial”, even though such a trial would not be possible: you notice when you undergo puberty, and people around you notice too. He acknowledges that parents were going abroad for PB when it was not available in the UK. Disingenuously, in one railing against PB in children, he says the sample was too small. However, he has found at least part of the results, from newspaper articles, comments by Dr Carmichael, and from Freedom of Information requests. He says the data show no psychological benefit from PB.

GIDS does not follow up its patients after they turn 18. Well, it’s a young people’s service, and a medical service providing treatment rather than a service studying trans teenagers. Medical intervention (including follow-up) should be for the good of the patient, not primarily to increase knowledge. However, if we are to justify PB, we need success stories.

The Court in Bell heard evidence from a trans man, now 20, who wished that PB were started earlier, as that would have prevented the need for breast surgery.

Biggs comments on the first person to get PB because he was trans, who at 35, Biggs says, was depressed and “could not sustain a romantic relationship”. The report is here. It says “He was functioning well psychologically”, and that “At age 29, he had a serious relationship with a woman, which lasted for 5 years.” Five years is more sustained than some 35 year olds might have managed. It notes bone mineral density was within normal range, yet Biggs chooses to highlight that as a risk of PB.

I found Biggs’ pdf linked from the “Bayswater Support Group”, which pretends to be for parents “looking for the best support for our children”, yet only gives resources opposing transition. It is the same old stuff, from the same old anti-trans campaigners, repackaged yet again with an irrelevant name. It is attached to “Easyfundraising”, which has recorded £7.70 raised and five supporters as of 7 December.

Whether B’s case is a success or failure might depend on who is looking, and what details they choose to emphasise. I have chosen details to make Biggs’ critique look bad. I am trans. Yet his selective quotation of B’s case shows his bias.

What might success look like? Adolescence can be a horrible time, even if you are heterosexual and more or less fit conventional gender stereotypes. Gays and lesbians find it harder. And then there is trans. The comparator for the trans child is not the more or less happy straight or gay twenty-something, now in a relationship and starting a career, but the child of parents like Mrs A who originated the Keira Bell case. Having had their desire to transition uncompromisingly resisted, are children happier? If they were, would we not hear more from them?

Possibly not. They might not want the attention. But- the only one the new/old hate group can point to is Jessie Maynard, who was 16 in 2016, and wrote then that she was happier than she would have been trying to pass as a boy. However she was never assessed by GIDS. Could they not approach her for her thoughts now?

Some detransitioners write blogs, tweet, and campaign. That is brave of them. More are getting together. Soon they may be seeking damages from GIDS.

If everything really is wonderful, might some who transitioned as teenagers come forward now? The bravery would be even greater. They may pass and be living in stealth, and not want to come out as members of a hated and stigmatised group. But without their stories, it may prove impossible for any more teenagers to benefit from the treatment they had.

If someone is trans, there are only bad choices. You can muddle along in the assigned gender. This is painful and uncomfortable. You can transition. It’s a choice of denying your true self, or being your true self and exposing yourself to all the hate and prejudice.

If you transition, you can take hormones and have surgery, and make your body approximate to that of the acquired gender. It’s a problem that too much hope is attached to this. It takes years, and during the process people tend to think that it will sort all their problems, only to find at the end that it has not. We need realistic expectations of what such treatment can achieve. So, again, we need the stories of transitioned people.

That of the actor Elliot Page is not enough. He/they is particularly talented, and has enjoyed success. Compare him to other actors with similar prominence at the time of his announcement. More ordinary teens are unlikely to have similar careers. Still, it’s good for him to come out, as part of a process of normalising trans, and I am glad he feels able to transition.

Gender variant children are not ill, and do not “desist”

What does it mean to say that gender variant children are not ill? What are the problems with studies which assume they are, and can we learn anything from those studies?

Some studies purport to show that trans children “desist”, and become cis as they mature, so should on no account be treated as trans. “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender-nonconforming children” by Julia Temple Newhook and others shows the problems with these studies and their assumptions. Nine academics in diverse disciplines including medicine, psychology, social work, gender advocacy, education and paediatrics considered and tore apart those studies, and gave an alternative way forward.

Based on the studies, the media suggest that 80% of trans children will identify as cis in adolescence or adulthood, so should not be treated as trans as children. However, the research is flawed. It is based on a definition of “Gender Identity Disorder in Children” from DSM IV, which included behaviour, rather than “Gender Dysphoria”, diagnosed by cross-gender identification and distress with physical sex characteristics and associated gender roles. It failed to recognise the WPATH principle that transgender identity is a matter of diversity, not pathology.

Behaviour: in DSM IV, “intense desire to participate in the stereotypical games and pastimes of the other sex” was one of the criteria. So, a little boy who liked skipping, and playing with “playmates of the other sex”, might be whisked off to the gender clinic for an assessment, and, suitably shamed and frightened, two years later he would report that indeed he had desisted.

We are not ill. We do not need to be made well. We certainly do not need to be made normal. So much of our treatment attempts to make us fit in, to be acceptable to “normal” people. However, there are huge advantages to being “normal”: being seen or treated as weird sucks. Seeing us as ill can mean wanting to make us well: wanting us to be happy conforming to gender stereotypes, ideally those assigned at birth, and if that proves impossible, gender stereotypes and an approximation of the sex characteristics of the other sex. Wanting to be accepted, we may go along with that.

Children exploring gender in a transphobic society face great pressures, and the older studies incidentally describe that. They show that statements of gender identity or gender dysphoria in childhood may indicate similar feelings in adulthood.

Three of the four defective studies included children who did not have a diagnosis of GID, but had simply been referred to a gender clinic. Three assumed any participant who could not be assessed for follow-up had desisted, even though it was possible that they still considered themselves trans, but did not want to medically transition with hormones or surgery. All reassessed children in their teens, one as early as 14, which gives no idea what they will be like as adults. Perhaps they felt unable to transition by that age, but transitioned later. Therefore, the reported desistance rate is hugely inflated.

The parents of the children in the studies brought them to a clinic, indicating they thought there was a problem, but where parents validate their children’s gender identity the children are likely to have a different, arguably healthier, life-course.

The studies used the term “desistence”, which originates in criminology. Gender variance was seen as sick. Being cis was seen as normal. So transgender identity was only viewed as valid if static and unwavering throughout life. Few trans people do not waver sometimes, in the face of family and societal pressure to be normal.

The studies referred to the children as “boys and girls” based on their assigned gender. Their identity was less important. There was no acknowledgment of nonbinary identity. They were too keen to call people “desisters”- for example, an AMAB person aged 18 “still desired to be a woman, with breasts and the possibility of giving birth. However, he (sic) considered himself 50% male and 50% female.”

The studies assumed a stable gender identity is a positive health outcome, so pushed children towards that, but where gender identity is fluid or slower to develop the child may still be developing in a healthy way. Different identities are a different way of seeing onesself, under different levels of self-knowledge and differing vulnerability to differing pressures from others. The journey of self-discovery may be lifelong.

The language to describe identities improves. I had not heard of nonbinary when I transitioned.

Some people imagine that desisters grow up to be gay and not trans. Again this is a way of seeing a person who may be nonbinary and androphile or gynephile. If people do not fit categories, then it is the categories that must change.

There was intensive treatment of the children, with questionable goals. Healthy children may have their self-esteem damaged by being brought into stigmatising diagnostic and treatment settings. Treatment was often designed to lower the odds that they would grow up transgender, or to “reduce GID persistence”, claiming transsexualism, with social stigma and a lifetime of medical treatment, is undesirable.

However, as some children become trans adults, these efforts to make us fit a more normal box can be traumatic. The Netherlands clinic discouraged social transition before puberty, though it can make children happier. Children’s rights to autonomy and self-determination were subordinated to clinicians’ concepts, beliefs and desired outcomes.

Did the children feel some obligation to go along with treatment and participation in the research, as a condition of having their gender variance taken seriously?

Temple-Newhook and others say,

These ethical concerns raise questions about the validity of research with children whose parents believe they have a medical problem, who are subjected to a high level of testing and treatment, who are disallowed or discouraged from asserting their own gender identity, and who are being raised in a broader society that often punishes perceived transgressions of male and female boundaries.

When children think being gay or trans is seen as bad, they often pretend not to be. The social pressure is intense, and cruelly shaming.

The older studies did not consider that attempting to delay or prevent transition could be harmful to the patient’s self-respect and sense of self. They assumed unknowable future adult needs should supersede known childhood needs. Contradicting that, the older research mentions “a de-transitioning girl and her mother who expressed gratitude for her opportunity to live as a boy for a time, and felt that if she had been forced to live as a girl for her entire childhood, that her mental health would have suffered.”

It is not true to suggest that “a potential future shift in a child’s gender identity is a justification for suppressing or redirecting their assertion of identity in childhood”.

From a developmental perspective, a child who is repeatedly discouraged when she earnestly insists on being called “she,” is learning, on a fundamental level, that (1) she cannot trust her own knowledge of herself and, (2) the adults she depends on may not value her for who she knows herself to be.

Trans children and adults are not sick. We need affirmed for our innate worth as diverse humanity.

The study, by Julia Temple Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett, is available here.

Hat tip to Reubs J Walsh.

Keira Bell v Tavistock Gender Identity Development Service

After the case of Quincy (or Keira) Bell, it will be exceptionally difficult for a trans child under 18 in the UK to get puberty blockers. The High Court has decided that the evidence the Gender Identity Development Service (GIDS) had to justify prescribing puberty blockers was insufficient, and children were not capable of consenting to the treatment.

The court did not consider all the benefit that the trans child will get from puberty blockers. It may be possible for individual trans children and their families to take court action to get that relief. It may be that a better understanding of the benefits from puberty blockers, or simply a better way of explaining those benefits, will enable trans children to get the treatment they need. However they will have to go through legal proceedings to demonstrate sufficient consent, as well as to convince psychiatrists that the treatment is appropriate, and the ethical and practical concerns for each will be different.

The court’s judgment discussed at length the GIDS practice, which bent over backwards to protect any cis child and avoid transition. Families may simply go abroad and go private, and have far less protection, as one family referred to in the case did.

This is how the court made its decision. Continue reading

Pushing tomboys to change their gender?

The Department for Education has issued guidance on Relationships and Sex Education, and the Daily Mail started a culture war. “Teachers are told to stop pushing tomboys to change their gender”, it said. “Tomboys must not be encouraged to think they should change sex just because of the way they like to dress or play, schools have been told.”

I agree. I don’t like the word “tomboy”- girls ask, “Why call me a ‘boy’?” Just because they don’t like pink, or skirts, or even worse because they climb trees as well as liking ballet, does not make them any sort of “boy”. I disagree with all gender stereotypes, and find the adjective “harmful” tautologous. Oddly enough, neither the Statutory Guidance, nor the separate Guidance, uses the word. Where schools depart from statutory guidance, they “need to have good reasons”. Guidance is less binding. The Mail is wrong to call it “instructions”.

The Mail quotes out of context, from the Guidance.

You should not reinforce harmful stereotypes, for instance by suggesting that children might be a different gender based on their personality and interests or the clothes they prefer to wear. Resources used in teaching about this topic must always be age-appropriate and evidence based. Materials which suggest that non-conformity to gender stereotypes should be seen as synonymous with having a different gender identity should not be used and you should not work with external agencies or organisations that produce such material.

I don’t know whether that was written out of ignorance, or with the intention of permitting Mermaids to continue to provide resources. Mermaids never suggested that non-conformity was synonymous with having a different gender identity, only that some children really do have a different gender identity and they will flourish if allowed to transition. Trans people exist. We should be worried, if the guidance echoed transphobe organisations, suggesting that gender identity is a falsehood, the product of gender stereotypes, but it does not.

The Mail quotes the “Safe Schools Alliance”, so I looked them up. They are a transphobe organisation, currently taking legal action to get the Crown Prosecution Service to withdraw from the Stonewall Diversity Champions programme, and against Oxfordshire County Council because they believed the council’s guidance was too accepting of trans people. The first thing they say about themselves is that they are against gender identity policies they find too pro-trans. They do not disclose their funding. They are happy to damage Britain’s leading LGBT charity because of their loathing of trans. They object to “trans lobby groups push[ing] policies which allow males into female spaces”. Well, they call trans girls “males”. They want to prevent transition.

Enough of the propaganda. What do the Guidance and Statutory Guidance actually say? Continue reading

Is Alex trans?

Alex, aged 16, visits his psychotherapist. They discuss his relationship with his parents and friends. Alex identifies as trans and has worn a binder since age 14, but has, with his parents, chosen not to use puberty blockers as they have the side effect of lowering mood and energy. He is a high-achieving student at an all-girls school, and could be perceived as a young, shy, effeminate boy just before puberty. He suffers with fatigue, disrupted sleep, anxiety, eating difficulties, superficial self harm and mild obsessive compulsive disorder symptoms.

Will he be encouraged to transition? Will his psychotherapist examine any underlying issues which might cause him to identify as trans? Online, I read the therapist’s account of the session, then clinical commentary by two psychotherapists: Amanda Keenan, child and adolescent psychotherapist, who trained at the Tavistock clinic, and Margaret Rustin, child and adolescent psychotherapist who was head of child psychotherapy at the Tavistock for 24 years. The Tavistock runs the English Gender Identity Development Service, as well as other services. There are also maunderings from disgraced psychotherapist Robert Withers, which are more revealing about himself than the case.

Before transition, everyone thought he was really gay, really butch, but he began living as male, at first on the internet, when he felt he was being himself. He felt better, and wanted this for the rest of his life. Accordingly he socially transitioned. He tells his therapist how he hates conflict, and when someone shouts at him “My inner thoughts take the side of whoever shouts at me”, and then he thinks of himself as an idiot. He would like to talk back, but part of him forbids him to.

His psychotherapist suggests that coming out as trans gives him a narrative about what causes his problems, and wonders if the trans narrative makes a vulnerable part of him feel safer. The narrative shuts others down, and it is useful that school is “scared” about being transphobic. The narrative legitimates his feelings of hurt, vulnerability, fragility and anxiety, and there are lots of people (trans activists) backing him up.

Alex agreed when the therapist suggested his belief that he is trans prevents him from being in touch with that vulnerable part. The therapist suggested trying to find layers of meaning without intervening hormonally. They suggested his trans identification gave legitimacy to his “weirdness”. Alex agreed. They agreed to revisit at the next session.

Alex suffered years of stomach pains before his parents took him seriously, and his doctor diagnosed him with lactose intolerance. He is angry that when his brother had stomach pain after eating ice cream his parents immediately believed the brother.

Amanda Keenan says Alex is trying to avoid and defend against the challenges of adolescence. Some adolescents overachieve academically as a way of avoiding emotional conflict. Alex’s intellectualisation, thinking about his difficulties, might get in the way of learning from emotional experience. She considers his eating difficulties reinforce her sense that he finds it hard to digest emotion. His friends are like a gang, there to support and defend each other. She wonders if “Alex unconsciously provokes others to shout at him in the service of punishing himself”.

She finds him strongly defended. She says he wants control, and fears being in touch with feeling. Keenan says the therapist is in a difficult position, either to be blamed like Alex’s father, or being forced to support him like his friends?

Margaret Rustin “suggests that the dissonance between Alex’s sense of himself as a person and the perception of others was very painful to him. He is relieved when he can assert his sense of reality in opposition to what others think they see.” He assumes his therapist will be on his side in his conflicts with father and friends. She might see his symptoms “as evidence of aggression turned against the self due to anxiety about expressing it in relationships”. She notes the privilege children can get from being ill, and needing parental attention or NHS care.

At the end of the session, “the therapist suddenly notes his deflated tiredness, signalling the failure of the manic solution which a masculine identity had seemed to offer him, and which is so seductive when separation looms… I would suggest that behind the choice of a masculine identity is anxiety about femininity seen by Alex as inferior, passive, weak and depressed. His intellect (clearly a powerful one) is by contrast experienced as a male aspect of himself, able to have a voice and a position and exist in its own right, not needy and dependent.”

I don’t know whether Alex is trans, or whether he will transition. However I note that he is not on puberty blockers, and that therapists associated with the Tavistock are questioning his trans identification, and keen to find explanations of it.

What about Withers’ witterings? They are more revealing of himself than of Alex. He writes, “In my own experience, working with people who use the trans narrative to distance themselves from feelings of vulnerability in this way can evoke hard to reach feelings of hatred in the countertransference.” Counter-transference is the therapist’s feeling. Withers reiterates his false claim that ethics might prevent a therapist from exploring what is underlying a trans identification, and cites his own paper.

The whole paper is publicly available. While the heading is “clinical commentary by Robert Withers”, the therapist’s account and Keenan’s and Rustin’s comments are included. I find it reassuring. Suggestions that children are forcibly transitioned are belied by the care of the three child psychotherapists. If Alex is trans I feel he will be supported in his transition. If she is not, I feel she will be helped to navigate the difficulties of adolescence.