Monumental UK Ruling and Our New Gender Podcast!

Accusations of Transphobia Stifle Much-needed Debate

Now that the High Court in London has judged that it is no longer appropriate to use experimental treatment paths on gender-dysphoric children, the ethics of prescribing puberty blockers are being reassessed in other countries around the world.

Keira Bell and Mrs. A, the mother of a 15-year-old autistic girl, took this case against the Gender Identity Development Service (GIDS) as they wished to stop children as young as 10 years old being prescribed puberty blockers.

This judicial review was headed by the one of the UK's top judges, thousands of pages of expert testimony were considered and ultimately it was judged that children lack the capacity to consent to medical treatment which negatively impacts their fertility and their future sexual fulfilment.

Gender-dysphoric Irish children will be heavily impacted by this decision as the system of clinicians from GIDS flying over to Ireland on a monthly basis to run clinics for Irish children can no longer be upheld. It is critical that these vulnerable kids are urgently provided with a crisis management plan encompassing in-depth psychological support.

A significant aspect of the problem is that these highly vulnerable children have been told online that this is life-saving treatment and without it they might turn to suicide. Leaving the inappropriateness of this message aside, gender-dysphoric children all over the UK and Ireland will consequently feel extremely distressed as they truly believe that medication is the sole answer to all their problems.

In fact, as the details of this judicial review emerged, it turns out that the data on the effectiveness of puberty blockers in helping children with gender dysphoria is inconclusive.

Keira Bell was a tomboy when she was a little girl. She played football and loved TV wrestling and superheroes. But Keira's home life was difficult as her mother was an alcoholic and when she was four years old her heavily religious father left home. However, just like many gender non-conforming girls, it was when Keira hit puberty that things started going seriously wrong.

Puberty is a difficult process - especially for girls, who have to contend with the messy business of periods and the stark shock of having their body perceived as sexual before they have come to terms with being sexual.

Lesbian, gay or bisexual children are often hardest hit as they can feel ashamed of their same-sex attraction. Teenage lesbians are particularly prone to feeling like there is no place for them in society and these days they often try, just as Keira did, to 'trans the gay away'. Puberty blockers stop any developing sexual feelings. These days identifying as trans is viewed as edgy, while lesbian is just another porn category.

Keira hated her developing body and felt judged for her "butch" appearance. By 14, Keira had stopped going to school and instead stayed locked in her room, playing video games and surfing the net. Keira discovered trans activists on YouTube and became transfixed by this idea. She presented at GIDS when she was 15 years old. Within 12 months she was prescribed puberty blockers and moved to cross-sex hormones at 17. By then she was living alone in a youth hostel in Cambridgeshire, feeling ever more isolated.

"I still felt out of place, but I had something to latch on to. It felt like my life was progressing. Transition gave me a focus, took my mind off a lot of other things," she said.
When she was 20, she had her breasts removed.

As a psychotherapist I am a founding member of the International Association of Therapists for Desisters and Detransitioners. I often hear accounts from detransitioners about the dawning realisation that no matter how they changed their appearance; no matter how much medication they took or how many surgeries they underwent, they couldn't quite lose the feeling that they weren't yet finished.

Transitioning is a continuous process, the medication needs to be continued right until the person dies, and if the person stops taking the cross-sex hormones, then the body reverts to their biological sex. It is notable that many detransitioners don't make an actual decision to detransition - instead they simply stop injecting the cross-sex hormones. The effort involved in maintaining the transitioning process becomes too exhausting and so they just stop.

Keira Bell is now 23 years old. She has an Adam's apple, a deep voice, facial hair, body hair and she is coming to terms with her double mastectomy; but she also has a loving partner and is learning to accept her body as it is. One of the reasons why Keira took this court case, along with Mrs A, was because she became increasingly angry at the way trans activists were trying to shut down academic inquiry about the issue.

Historically, until the last decade or so, it was mostly middle-aged men who transitioned. Suddenly there has been a flip in the statistics and there has been a 3,000% rise in the numbers of girls presenting at gender clinics, a high number of whom have been diagnosed with autism. Nobody knows why there has been this sudden shift, nor do we know why there is no corresponding trend to transition among middle-aged women. This is why we need the freedom to discuss whether it could be that our hyper-sexualised, ultra-gendered world is very difficult for gender non-conforming girls.

In 2018, when my friend and colleague Dr. Lisa Littman analysed the phenomenon of "rapid-onset gender dysphoria" among teenage girls, Brown University removed this peer-reviewed study from its website following protests from trans activists that this study was "transphobic". Equally, Professor Donal O'Shea, the clinical lead for the National Gender Service, was also accused of being transphobic when he pointed out that the controversial World Professional Association for Transgender Health (WPATH) guidelines were not fit for purpose and aligning with them would result in significant harm to patients.

New organisations such as the LGB Alliance, The Countess Didn't Fight For This and Women's Space Ireland have been recently established in a bid to discuss issues as various as lesbian erasure, the issue of male-bodied trans women in female prisons and the question of trans women in sport - but these groups have already been condemned as transphobic. There are currently two male-bodied violent offenders housed in the female prison in Limerick. Yet women in Britain have been assaulted and raped by trans women in prisons and, as a result, the UK prison policy has already been reformed.

None of these issues is simple and so we need room for thoughtful discussion. But how can we come to any progressive solutions if people are called transphobic at every turn? More importantly, how can doctors and clinicians hope to 'first, do no harm' if doctors and clinicians are not allowed to freely discuss different treatment paths for vulnerable children? This conversation is unavoidable and we will have to grapple with these thorny issues. The conversation in the UK has started - but they had to go to court to have it.

Could Ireland perhaps do it differently?