It is possible you are more likely to be trans if you are autistic.
The Tavistock have been urged to do research on this, or at the very least collate figures from people referred to them. So far any "evidence" is anecdotal.
I thought the whole point of puberty blockers was to make space for children to develop and mature and not have to make an early decision about gender if they felt uncomfortable ?
That's the theory, but the problem is that the drug used destroys eggs in females and soerm production capacity in males so the individual is always going to end up sterile, whether or not they transition fully. In females the voice is pernanently lowered too.
It is possible you are more likely to be trans if you are autistic.
The Tavistock have been urged to do research on this, or at the very least collate figures from people referred to them. So far any "evidence" is anecdotal.
I thought the whole point of puberty blockers was to make space for children to develop and mature and not have to make an early decision about gender if they felt uncomfortable ?
That's the theory, but the problem is that the drug used destroys eggs in females and soerm production capacity in males so the individual is always going to end up sterile, whether or not they transition fully. In females the voice is pernanently lowered too.
I boil the court decision down to 2 things mainly:
1. The medical treatment with medications to stop puberty has some side effects documented from samples of children other than transgender, and the court wonders why the clinic isn't collecting this even though their own info sheets given to patients state some of this derived from the non-trans sample.
2. That transgender medical treatment is life changing, and thus should require parental involvement in consent for treatment.
The question I derive is how many children-patients approach the clinic and are in disagreement with their parents about starting the puberty blocking medications, and at what ages are these children when this conflict is noted. Do I understand the history of the clinic being that if a child wants the treatment and parents disagree, the clinic in the past would treat the child without parental consent?
It would strike me that it is always unwise to be triangulated between members of a family, and this conflict would be a red flag of something to be dealt with family therapy or via legal before proceeding with treatment.
I suspect the Tavistock would not have lost this case had it been able to prove that it either or both:
could demonstrate that use of puberty blockers did not inexorably progress to gender hormones and transition;
This jumped out at me from my quick read of the decision yesterday. The problem though is that if the client was correctly assessed as transgender at the outset I suspect it's not particularly likely that they're going to suddenly change their minds two years down the road. At least, it seems wrongheaded for the Court to assume the opposite. It basically means that the Court ends up using evidence that the people whom Tavistock assessed as transgender at the outset were correctly assessed as such, as evidence that they're not doing their job properly.
The problem was that Keira Bell, one of the people bringing the case, was saying loudly and clearly that in her case she had been assessed as transgender, inaccurately, and had been pushed inexorably down the transitioning path. Now I do realise that the detransitioning outliers are being used as a stick to bludgeon the whole premise of transgender into submission by transphobes, so I fondly imagined organisations involved in transitioning young people would ensure that there is evidence demonstrating the need for transitioning in their patients.
Assuming Tavistock are accurately diagnosing transgender youngsters before treatment, then presumably they had records showing that: follow up confirmations, follow ups some years later, continuing monitoring throughout the treatment? That they were unable to produce that evidence in court is concerning.
I haven't had a chance to read the whole decision yet (it sounds like a depressing read, so I am not exactly chomping at the bit), but it looks like Tavistock may have had some bad facts to deal with. I will say that some of the more enthusiastic advocacy I've run into (particularly from UK sources) gave me cause for concern, but I don't know to what extent that applies to Tavistock particularly. If there's an appearance that people are throwing caution to the wind, there's going to be a backlash, and that means that people who need treatment are not going to get it.
I read the Keira Bell page you linked to. She seems to have gone a full 180 from identifying to as trans to full-on trans denialism (i.e., nobody is trans). It would be interesting to know the history here. I appreciate that if you were badly mistreated by the system, that may not be great for perspective, so her current hardline ideological take may be perfectly consistent with the system actually having assessed her improperly and treated her badly. But as with the ex-gays, the hardline ideological take worries me - is her experience driving her views, or are her newfound views distorting her interpretation of her experience?
[Crosspost with Marsupial, with whom I share the concerns about Keira Bell's turnaround - but she's one of people who brought the legal action]
To start with, the published protocols from GIDS are here, where the first step is given as assessment and exploration. What Keira Bell is saying does not match those protocols, and she is one person making allegations. We only know her side of this story. We only have her account of which treatments she did and didn't have and what she is saying is against the treatment protocols, but what she describes is an inexorable process:
I was a gender non-conforming child and later struggled with hatred for my female body, low self-esteem and found it hard to connect with people throughout my teens. At the age of 14 I really began to struggle with my sense of identity and especially the thought of becoming a woman. I thought I found the answer to my problems when I discovered transsexualism and stories of transsexual people on the internet. Soon after, I began to pursue this path. This led to the GIDS where I was welcomed and affirmed as a boy. It wasn't long before I was injecting GnRHa analogues ("puberty blockers"), then cross sex-hormones and when I was 20 a double mastectomy procedure. By then I had believed a lie (that my real problem was being trapped in the wrong body) and had been helped to believe that lie by the very people who were meant to help me.
<snip>
... In my tormented state of mind I was not able to identify how incredibly destructive transition was. As an adult I now realise that medical transition was unnecessary and something I wish I had avoided. ... I had peripheral doubts on and off throughout transitioning but pushed through these ... being affirmed as a boy by the clinical team that worked with me.
And a Women's Place UK interview (yep, I know, not renown for transgender positive statements - understatement):
Instead of questioning the underlying problems, such as depression, self-hatred and low self-esteem, with compassion and care, the NHS’s gender clinic for children advised this teenage girl that she was indeed male, and that the best treatment for her dysphoria was to immediately begin blockers which would stop her puberty development.
Following three separate, one-hour appointments, GIDS put Keira Bell on a pathway that began with puberty blockers at 16, cross-sex hormones at 17, and resulted in a double mastectomy by the age of 20. We do not know enough about the long-term impact of puberty blockers and cross-sex hormones, or their effect on children’s cognitive and reproductive development, but Keira knows that this medical treatment did not resolve the dysphoria she was experiencing.
It's in the court decision at #27 and #28 re Tavistock needing to "collate" the data.
It's in #63 and #101 re eggs and sperm.h family therapy or via legal before proceeding with treatment.
@NOprophet_NØprofit That is not a source for The Organist's statements. That judgement very carefully uses words like "could" or "may" and does not state that the drugs do have these causes. For instance, the judgement has lines like "We do not fully know how hormone blockers will affect bone strength, the development of your sexual organs, body shape or your final adult height" in 63.
So yes, a citation for that statement is still needed @TheOrganist . The evidence does not support your statements. Please do not make wide factual statements without a valid link of reasonable quality.
The NHS website is non-committal about side-effects of blockers. I think it is cross-sex hormones which have known side-effects, and commonly on the internet they are confused.
[Crosspost with Marsupial, with whom I share the concerns about Keira Bell's turnaround - but she's one of people who brought the legal action]
To start with, the published protocols from GIDS are here, where the first step is given as assessment and exploration. What Keira Bell is saying does not match those protocols, and she is one person making allegations. We only know her side of this story. We only have her account of which treatments she did and didn't have and what she is saying is against the treatment protocols, but what she describes is an inexorable process:
I was a gender non-conforming child and later struggled with hatred for my female body, low self-esteem and found it hard to connect with people throughout my teens. At the age of 14 I really began to struggle with my sense of identity and especially the thought of becoming a woman. I thought I found the answer to my problems when I discovered transsexualism and stories of transsexual people on the internet. Soon after, I began to pursue this path. This led to the GIDS where I was welcomed and affirmed as a boy. It wasn't long before I was injecting GnRHa analogues ("puberty blockers"), then cross sex-hormones and when I was 20 a double mastectomy procedure. By then I had believed a lie (that my real problem was being trapped in the wrong body) and had been helped to believe that lie by the very people who were meant to help me.
<snip>
... In my tormented state of mind I was not able to identify how incredibly destructive transition was. As an adult I now realise that medical transition was unnecessary and something I wish I had avoided. ... I had peripheral doubts on and off throughout transitioning but pushed through these ... being affirmed as a boy by the clinical team that worked with me.
And a Women's Place UK interview (yep, I know, not renown for transgender positive statements - understatement):
Instead of questioning the underlying problems, such as depression, self-hatred and low self-esteem, with compassion and care, the NHS’s gender clinic for children advised this teenage girl that she was indeed male, and that the best treatment for her dysphoria was to immediately begin blockers which would stop her puberty development.
Following three separate, one-hour appointments, GIDS put Keira Bell on a pathway that began with puberty blockers at 16, cross-sex hormones at 17, and resulted in a double mastectomy by the age of 20. We do not know enough about the long-term impact of puberty blockers and cross-sex hormones, or their effect on children’s cognitive and reproductive development, but Keira knows that this medical treatment did not resolve the dysphoria she was experiencing.
But. Even the court are saying that 16 she would have capacity to consent to puberty blockers ?
Also, how do you block puberty in someone of 16 - what we usually mean by puberty generally starts in your early teens ?
I suspect the Tavistock would not have lost this case had it been able to prove that it either or both:
could demonstrate that use of puberty blockers did not inexorably progress to gender hormones and transition;
This jumped out at me from my quick read of the decision yesterday. The problem though is that if the client was correctly assessed as transgender at the outset I suspect it's not particularly likely that they're going to suddenly change their minds two years down the road. At least, it seems wrongheaded for the Court to assume the opposite. It basically means that the Court ends up using evidence that the people whom Tavistock assessed as transgender at the outset were correctly assessed as such, as evidence that they're not doing their job properly.
Yes that is weird, plus given the waiting list for GIDS is about 2 years and how difficult it is to get as far an assessment, you’d have thought that would partially filter out people who are likely to change their mind.
We consider that it would be appropriate for clinicians to involve the court in any case where there may be any doubt as to whether the long-term best interests of a 16 or 17 year old would be served by the clinical interventions at issue in this case. para 147
so is casting doubt on the ability of 16 year olds to consent to puberty blockers or gender dysphoria treatment. The judgement notes that normally young people aged over 16 would not be a part of the law considered but felt that the issues were so complex because the drugs had profound effects on the psyche and body that were irreversible while the young person was developing into that person, and that young people were unable to cast their minds ahead to understanding the effects of poor sexual function or inability to give birth that it was not possible for them to give informed consent and that they could never become Gillick competent in this field. Therefore it was worth requesting court approval for young people aged 16 and 17.
From the introduction and background section of the judgement, paragraph 15,
GIDS recognises three stages of physical intervention that may be appropriate in cases of GD. Stage 1 is the administration of GnRHa (one form of puberty blocker). This is clinically appropriate for children and young people who have reached Tanner Stage 2 of puberty and above. Tanner Stage 2 marks the beginning of the physical development of puberty. In natal girls this is the start of development of the breasts, and in boys the testicles and scrotum begin to get larger. Stage 2 of the treatment is the administration of cross-sex hormones (CSH) which can only be prescribed from around the age of 16. Stage 3 is gender reassignment surgery which is only available via adult services to
people aged over 18.
Yes, my wife just said I am wrong on Gillick, and the Tavi will have to restrict treatments considerably, even with parental approval. But it's going to appeal. Trans kids must be feeling like shit. Internet sales of hormone blockers will soar.
Just looking at the news reports, and they seem to confirm your wife’s interpretation. This strikes me as an astonishing act of judicial hubris - under the guise of a decision about capacity to consent they are telling doctors what treatments they can and cannot offer to their patients in the exercise of their medical judgment.
We consider that it would be appropriate for clinicians to involve the court in any case where there may be any doubt as to whether the long-term best interests of a 16 or 17 year old would be served by the clinical interventions at issue in this case. para 147
so is casting doubt on the ability of 16 year olds to consent to puberty blockers or gender dysphoria treatment. The judgement notes that normally young people aged over 16 would not be a part of the law considered but felt that the issues were so complex because the drugs had profound effects on the psyche and body that were irreversible while the young person was developing into that person, and that young people were unable to cast their minds ahead to understanding the effects of poor sexual function or inability to give birth that it was not possible for them to give informed consent and that they could never become Gillick competent in this field. Therefore it was worth requesting court approval for young people aged 16 and 17.
From the introduction and background section of the judgement, paragraph 15,
GIDS recognises three stages of physical intervention that may be appropriate in cases of GD. Stage 1 is the administration of GnRHa (one form of puberty blocker). This is clinically appropriate for children and young people who have reached Tanner Stage 2 of puberty and above. Tanner Stage 2 marks the beginning of the physical development of puberty. In natal girls this is the start of development of the breasts, and in boys the testicles and scrotum begin to get larger. Stage 2 of the treatment is the administration of cross-sex hormones (CSH) which can only be prescribed from around the age of 16. Stage 3 is gender reassignment surgery which is only available via adult services to
people aged over 18.
They can’t have capacity to consider the prospect of infertility at 16 but they can legally get pregnant and have a child ? Does parenthood not have profound effects on the psyche, body and the rest of your life ?
Nowhere have I said I agree with this ruling - I don't, I'm looking on with horror at the coach and horses driven through the concept of Gillick competence, bearing in mind that Gillick case considered whether girls under the age of 16 could consent to contraception in the absence of their parents and has since been extended to cover most if not all medical treatments.
In para 9 of the introduction and background to the judgement (pdf link) it is stated that:
The sole legal issue in the case is the circumstances in which a child or young person may be competent to give valid consent to treatment in law and the process by which consent to the treatment is obtained.
The hearing noted that the accounts of Keira Bell's treatment were disputed, but still this case was
brought by way of judicial review of the GIDS policy and practice, rather than a challenge to an individual treatment decision, it is not possible to give a detailed analysis of the facts of an individual case and the degree to which all the matters referred to by Dr Carmichael were explored in the particular case (para 19)
although that was discussed in paragraphs 78 and 79 and is under a separate review. This whole case is a challenge to the GIDS service.
I hope for other medical treatments this judgement will not apply as an exception to Gillick competency (which is discussed in the judgement in Section D, starting at paragraph 105). This is mentioned in paragraph 126:
First, the question as to whether a person under the age of 16 is Gillick competent to
make the relevant decision will depend on the nature of the treatment proposed as well as that person’s individual characteristics. The assessment is necessarily an individual one. Where the decision is significant and life changing then there is a greater onus to ensure that the child understands and is able to weigh the information, see Re S at para 60.
and
Fourthly, however, that does not mean that every individual under 16 can achieve Gillick competence in relation to the treatment proposed. As we discuss below, where the consequences of the treatment are profound, the benefits unclear and the long-term consequences to a material degree unknown, it may be that Gillick competence cannot be achieved, however much information and supportive discussion is undertaken. para 129
There are caveats in the judgement that puberty blockers should be considered separately as when used as per instructions they have side effects that are far reaching and affect the young person irreversibly, and that the hormones work against the normal function of the young person in stopping puberty - para 134 and
In other cases, medical treatment is used to remedy, or alleviate the symptoms of, a diagnosed physical or mental condition, and the effects of that treatment are direct and usually apparent. The position in relation to puberty blockers would not seem to reflect that description. para 135
and
... the use of puberty blockers is not itself a neutral process by which time stands still for the child on PBs, whether physically or psychologically. PBs prevent the child going through puberty in the normal biological process. As a minimum it seems to us that this means that the child is not undergoing the physical and consequential psychological changes which would contribute to the understanding of a person’s identity. There is an argument that for some children at least, this may confirm the child’s chosen gender identity at the time they begin the use of puberty blockers and to that extent, confirm their GD and increase the likelihood of some children moving on to cross-sex hormones. para 137
I worry that this judgement could be used to challenge other medical interventions offered to under 16s such as the prescription of contraceptive hormones, the morning after pill, abortion and treatment of pregnancy for those young people.
Having read rather more of the judgement I am also going to retract this point:
I suspect the Tavistock would not have lost this case had it been able to prove that it either or both:
could demonstrate that use of puberty blockers did not inexorably progress to gender hormones and transition;
could show that the young people in their service had sufficient psychological support to explore their doubts and these were listened to when expressed
The fact that this has been tried in such a way to challenge Gillick is really unhelpful.
But leave the other point as from further reading of the judgement, it seems that the court objected to the use of puberty blockers as they were used a precursor for other treatment, the court was not convinced of the neutrality of the treatment and not convinced that GIDS obtained proper consent.
The court gained the strong impression from the evidence and from those submissions that it was extremely unusual for either GIDS or the Trusts to refuse to give PBs on the ground that the young person was not competent to give consent. The approach adopted appears to be to continue giving the child more information and to have more discussions until s/he is considered Gillick competent or is discharged. para 44
and did not have the statistics to show how often this occurred.
The critique made is that puberty blockers are described as a pause to allow consideration of the gender dysphoria but should really be described as a step to reduce the changes (and sometimes reverse) of puberty minimising surgery and additional treatment later. (para 52)
As is clear from the literature and referred to by the HRA, the other purpose of giving PBs is stopping the development of the physical effects of puberty (something that
obviously varies depending on at what age and stage in pubertal development the PBs
are commenced) because slowing or preventing the early development of secondary
sex characteristics during puberty can make a later transition (both medical and social)
to living as the opposite sex easier. para 55
I wonder why the judgement did not consider that many of the young people discharged without treatment or not reaching the service at all possibly fulfil their requirements of disallowing young people the treatment if they are not suitable, in that those young people who persist to treatment are to some extent going to be self-selecting. However, the failure of GIDS to provide statistics to demonstrate this weakened their case.
I don't think anyone expected such a reactionary judgment. Presumably, gender clinics are in turmoil, and all treatments for under 18s will be ruled out, but not counselling. The anti-trans groups have tasted red meat, and will be gunning for more, their hatred of the Tavi is something to behold, they will want it closed down, that is, the gender clinic. The militants say that trans doesn't exist.
I don't know if Gillick itself is under threat, although I would expect anti-abortion groups to campaign for removal.
I don't know what trans people are going to do, there is a tidal wave of trans phobia in the UK, the right wing are in charge. Help.
While I agree it's a right wing prejudice, it's important to recognise that it is being brought into left wing spaces as a wolf in sheep's clothing by those who claim these horrifying attacks on a scapegoated group are 'feminism'.
I'm sorry to report that in this guise it has grabbed a number of the internal levers of power in the SNP in recent elections to the National Executive Committee. We now have a women's convener and an Equalities convener who are transphobes (the Equalities convener has blocked a shocking amount of LGBT commenters on Scottish Twitter because most LGBT people want nothing to do with this prejudice) One of the most important MPs who works against trans people's rights is now on the committee too. These are people who want the Putinist TV presenter, whose own advocate was caught on video describing him as 'sex pest' - Alex Salmond- welcomed back into the party. Where women's actual needs to be safe from powerful men, and to get justice in an often reactionary legal system are concerned, they apparently don't care.
Keen observers of what has been going on in Russia, Hungary and Poland will see how the right used going after trans people there to mobilise social conservatism and then accelerated attacks on all LGBT people and on women's reproductive rights. Rule of law was undermined to go after their chosen scapegoats for their moral panic.
The absolute dangers who got in in the SNP touted themselves for election on a supposedly left wing slate. Many prominent figures in the party thought a high-minded silence and being above 'faction' and 'for unity' was more important than speaking up on trans people's rights. Meanwhile the social conservatives organised, and they are a threat to both civic nationalism and to actual feminism. I can't overstate how important it is to delegitimise this prejudice in left wing spaces and not to appease it.
I wonder why the judgement did not consider that many of the young people discharged without treatment or not reaching the service at all possibly fulfil their requirements of disallowing young people the treatment if they are not suitable, in that those young people who persist to treatment are to some extent going to be self-selecting. However, the failure of GIDS to provide statistics to demonstrate this weakened their case.
I wonder if that point was argued before the Court.
I thought the whole point of puberty blockers was to make space for children to develop and mature and not have to make an early decision about gender if they felt uncomfortable ?
That's the theory, but the problem is that the drug used destroys eggs in females and soerm production capacity in males so the individual is always going to end up sterile, whether or not they transition fully. In females the voice is pernanently lowered too.
Just because I was looking to see if I could answer the question from GeeD, I found the rebuttal of this information in paragraph 61 of the judgement (link):
“Puberty blocking treatment is fully reversible (see for example section 2.0 of the Endocrine Society’s Clinical Practice Guidelines…). By fully reversible I mean that the administration of puberty blockers in young people has no irreversible physical consequences, for example for fertility, voice deepening or breast growth”.
The hormones that seem to being confused here are the Cross Sex Hormones (CSH), which are not administered until later in the process.
There are concerns, but they are uncertain, as described in paragraph 62:
“Ethical dilemmas continue to exist around … the uncertainty of apparent long-term physical consequences of puberty blocking on bone density, fertility, brain development and surgical options.”
The court objected to the use of puberty blockers as GIDS/the Tavistock had no evidence as to how many young people chose not to continue on to cross-sex hormones, partly because that often did not happen in their service but in adult services. The comparable Dutch figure was 1.9%.
I suspect, @Gee D the answer to your question is found in paragraph 77, the final paragraph of Section A, the introduction and background:
As already indicated, it is not our role to adjudicate on the reasons for persistence or otherwise of GD. However, the nature of this issue highlights the highly complex and unusual nature of this treatment and the great difficulty there is in fully understanding its implications for the individual young person. In short, the treatment may be supporting the persistence of GD in circumstances in which it is at least possible that without that treatment, the GD would resolve itself.
I suspect that the judges reasoned that puberty blockers and the other treatments of young people during adolescence prevented those young people from exploring other issues. Which, whether they are putting caveats about not their "role to adjudicate on the reasons for persistence or otherwise of GD" or not, suggests to me that the decision comes from a strong disinclination to give credence to the diagnoses made by GIDS/the Tavistock, and by their judgement prevents any treatment of any young person under the age of 16 and most under the age of 18.
Thanks @Curiosity killed for those references. I tried to make my way through the reasons earlier this week, and admit to finding it somewhat difficult to understand exactly what evidence they heard and what findings they made in relation to that evidence. There are considerations that seem to have been quite important to their decision that seem to come completely out of the blue in their reasons - for instance the evidence of a neuroscientist who doesn’t appear to have any expertise specifically in gender identity (in children, or at all) but whose evidence on teenage decision-making they seem to be relying on heavily. It don’t think anyone doubts that teenagers are not as good at making decisions as adults, but surely specific evidence as to cross-sex gender identity is actually experienced in teenagers is more relevant to the issue than this general (and obvious) point. But as you say, they don’t seem to trust the people who have actually spent their careers actually working with transgender people, with the results we see in their decision.
I was fascinated to see that Australia has 'Gillick competence' as a concept too and seems to have rejected previously the new approach taken here in the UK as
A 2016 study found the requirement for court involvement in treatment decisions was ‘unnecessary, as well as deeply harmful’ for TGD youth and families. The study found the process was costly, delayed treatment and had damaging psychological impacts, compromising mental health and treatment efficacy.
I suppose the question is what does a court have to add the decision-making process if the client, the clinician, and the parents are all on board? (except potentially screwing it up...). This is not something where courts inherently have institutional expertise.
Declaring that what they agree upon is legal gives them confidence that in proceeding along the agreed path they are not committing an offence or otherwise leaving themselves open to action.
Declaring that what they agree upon is legal gives them confidence that in proceeding along the agreed path they are not committing an offence or otherwise leaving themselves open to action.
For every single case, each and every time someone applies for puberty blockers for gender dysphoria? Because that's what that court case requires for anyone under the age of 16 and for most cases under the age of 18.
Declaring that what they agree upon is legal gives them confidence that in proceeding along the agreed path they are not committing an offence or otherwise leaving themselves open to action.
For every single case, each and every time someone applies for puberty blockers for gender dysphoria? Because that's what that court case requires for anyone under the age of 16 and for most cases under the age of 18.
In effect, it stops treatment, doesn't it? How many people would contemplate a court case, in order to get treatment? Maybe a small number. Gillick seems to have been wiped out.
Also, I don't think it will stop there. The transphobic groups, including some feminists, seem to want the Tavi closed, ditto gender clinics. The most extreme seem to be saying that transgender is a mental illness, or a hoax.
Declaring that what they agree upon is legal gives them confidence that in proceeding along the agreed path they are not committing an offence or otherwise leaving themselves open to action.
I'm a long way from being an expert on the law of medical consent, but AIUI the general rule is that consent is the basis for legality and obviates the need for a court order. If it didn't then judges wouldn't be left with much time to do anything else. As far as I know, you don't need a court order to amputate a disease-ravaged limb from a 15-year-old - certainly a life-changing intervention - if amputation is believed to be medically necessary and the appropriate people consent. Why would you need a court order then for puberty-blockers?
And to come back to my original point, what is a judge going to add to the decision-making process, except possibly getting it wrong? He's going to hear evidence from the clinician that the intervention is medically appropriate, and evidence that the parents and the client are on board. Is he going to give intervener status to Keira Bell to argue the opposite side of the issue? What legitimate interest could she (or anyone else) possibly have in the outcome?
They are worried the children will end up sterile, basically.
And as any woman of childbearing age, without children, who has tried to get a sterilisation will tell you - most people struggle to believe those who don’t want children really mean it, really will maintain that opinion, really understand the implications etc etc
most people struggle to believe those who don’t want children really mean it, really will maintain that opinion, really understand the implications etc etc
I think there's some truth in that, though I'd add that they probably understand the implications of not having children better than people who do want children understand the implications of having them.
I’m sorry but this is really unhelpful. You’ve read some of the concerns that people have expressed upthread and you haven’t substantively addressed any of them. If you actually do understand what practical implications this will have for people seeking medical care for gender dysphoria I would be very interested to know your views, because personally I find this decision very worrying.
What I have said is specific as the judgment goes. As is said in the summary of the case, what was before the Court was not the sort of direct question you're posing; it was a question of judicial review of an administrative board charged with the responsibility of determining whether permission for medical treatment had had regard to correct material in coming to its conclusion. It does set out the sorts of matters which are summarised in the paragraphs I referred to.
The questions involved are very much more complex than (for example) deciding the criteria for a range of treatment from a simple tonsillectomy to serious brain surgery. That's why it's near impossible to summarise in point form how a medical practitioner should proceed. Most operative treatment is irreversible, but there would be very few other treatments where there may be a change of mind. Optional plastic surgery would be perhaps the closest and I'd imagine that a practitioner would ask questions just as probing as this Court sets out.
I am only guessing, but would say that this decision will probably delay the age at which corrective treatment is carried out for those with gender dysphoria.
Does it help if I say that the judgment does not give a tick-the-boxes check list but rather talks about the sorts of things which should be going through the mind of a competent specialist.
That was my impression too, but obviously this is a situation where delay tends to defeat the purpose. I would be interested to see what evidence the Court had before them in making this decision. They seem to be thinking of it in much the same way you do - as something akin to optional plastic surgery where there is no downside to waiting. I would be very surprised if the clinicians involved saw things the same way.
Incidentally, the Court has stayed the effect of its decision pending appeal.
They seem to be thinking of it in much the same way you do - as something akin to optional plastic surgery where there is no downside to waiting.
I don't see it in those terms, but was using that example in trying to explain how I understood what the Court was saying. FWIW, I can see potential for very real risks in waiting for the young person involved, particularly if that person is already seeing signs of the onset of puberty with its inevitable consequences of their ending up with even more pronounced physical characteristics of the wrong gender.
Does it help if I say that the judgment does not give a tick-the-boxes check list but rather talks about the sorts of things which should be going through the mind of a competent specialist.
[cross-post with your last post]
I suppose the question is, where do these criteria come from? The concern I have is that gender identity is frequently extremely poorly understood outside a fairly narrow community that includes few if any judges. Needless to say, there should be evidence on all this, and if the judges understood and absorbed this evidence then they have a least a fighting chance of getting it right. The problem is that there are things they say in the decision that seem so wrongheaded that it raises the question whether they actually did this. As I say, I would be interested to see the record.
It seems to have come from the submissions the parties made to the Court. A court does not and should not go off looking for evidence or arguments beyond those presented in court.
Should the court, however, accept biased submissions? or submissions with an agenda?
According to the coverage I read of this case, early on, the evidence from any charities advocating for transgender rights was thrown out and not heard, while the anti-transgender group, Transgender Trend* were invited to submit evidence - Pink News news story link. Which makes me wonder what other evidence was found inadmissable.
The lawyer for the plaintiff, Paul Conrathe has an agenda - according to yesterday's papers the next thing he and Kiera Bell are planning to challenge is discussion of transgender issues on social media - Observer article from 6 December 2020. Jolyon Maugham of the Good Law project commented on this lawyer in the context of this case on Twitter here (link) and the similarities of Conrathe's challenges to abortion in various cases. Another Twitter user has listed the number of challenges to transgender that Paul Conrathe is involved in here - link to thread reader - and according to that thread, Conrathe is linked to the far right hate group Alliance Defending Freedom.
The Tavistock / GIDS have shot themselves in both feet by not evidencing and publishing their work. If they'd been able to quantify the number of young people diagnosed with gender dysphoria in the UK and to then be able to say x% of those young people are referred to GIDS, y% of those young people wait out the maybe four years to an appointment, and z% of those young people are given puberty blockers. From the stories in the press, the service is chaotic and other charities are getting involved so many of the young people on the waiting list are prescribed puberty blockers before reaching GIDS - link to i-news story from August 2020. However, this case seems to part of a concerted attack to shut down the service and all transgender treatment entirely. The proscription on treatment with puberty blockers under the age of 16 is effectively limiting treatments available.
Should the court, however, accept biased submissions? or submissions with an agenda?
Each party's submission would seek to put that party's case in the best possible light. A court would read each and the oral arguments presented and then pick though the elements of each and how those relate to any previous cases in the are. But apart from those pretty obvious points, I don't know how to interpret your statement.
To add that at some point, a court will say that it largely accepts the submissions of Party A rather than of B, because those of A are more in accordance with previously decided cases, or any relevant statute.
Comments
Citation required.
It's in the court decision at #27 and #28 re Tavistock needing to "collate" the data.
It's in #63 and #101 re eggs and sperm.
I just did a search for the relevant words within the PDF of the decision in the link to the decision.
The link again to the court decision is Here.
I boil the court decision down to 2 things mainly:
1. The medical treatment with medications to stop puberty has some side effects documented from samples of children other than transgender, and the court wonders why the clinic isn't collecting this even though their own info sheets given to patients state some of this derived from the non-trans sample.
2. That transgender medical treatment is life changing, and thus should require parental involvement in consent for treatment.
The question I derive is how many children-patients approach the clinic and are in disagreement with their parents about starting the puberty blocking medications, and at what ages are these children when this conflict is noted. Do I understand the history of the clinic being that if a child wants the treatment and parents disagree, the clinic in the past would treat the child without parental consent?
It would strike me that it is always unwise to be triangulated between members of a family, and this conflict would be a red flag of something to be dealt with family therapy or via legal before proceeding with treatment.
This jumped out at me from my quick read of the decision yesterday. The problem though is that if the client was correctly assessed as transgender at the outset I suspect it's not particularly likely that they're going to suddenly change their minds two years down the road. At least, it seems wrongheaded for the Court to assume the opposite. It basically means that the Court ends up using evidence that the people whom Tavistock assessed as transgender at the outset were correctly assessed as such, as evidence that they're not doing their job properly.
Assuming Tavistock are accurately diagnosing transgender youngsters before treatment, then presumably they had records showing that: follow up confirmations, follow ups some years later, continuing monitoring throughout the treatment? That they were unable to produce that evidence in court is concerning.
I haven't had a chance to read the whole decision yet (it sounds like a depressing read, so I am not exactly chomping at the bit), but it looks like Tavistock may have had some bad facts to deal with. I will say that some of the more enthusiastic advocacy I've run into (particularly from UK sources) gave me cause for concern, but I don't know to what extent that applies to Tavistock particularly. If there's an appearance that people are throwing caution to the wind, there's going to be a backlash, and that means that people who need treatment are not going to get it.
I read the Keira Bell page you linked to. She seems to have gone a full 180 from identifying to as trans to full-on trans denialism (i.e., nobody is trans). It would be interesting to know the history here. I appreciate that if you were badly mistreated by the system, that may not be great for perspective, so her current hardline ideological take may be perfectly consistent with the system actually having assessed her improperly and treated her badly. But as with the ex-gays, the hardline ideological take worries me - is her experience driving her views, or are her newfound views distorting her interpretation of her experience?
To start with, the published protocols from GIDS are here, where the first step is given as assessment and exploration. What Keira Bell is saying does not match those protocols, and she is one person making allegations. We only know her side of this story. We only have her account of which treatments she did and didn't have and what she is saying is against the treatment protocols, but what she describes is an inexorable process:
Keira Bell wrote on her crowdfunder page:
<snip>
And a Women's Place UK interview (yep, I know, not renown for transgender positive statements - understatement):
@NOprophet_NØprofit That is not a source for The Organist's statements. That judgement very carefully uses words like "could" or "may" and does not state that the drugs do have these causes. For instance, the judgement has lines like "We do not fully know how hormone blockers will affect bone strength, the development of your sexual organs, body shape or your final adult height" in 63.
So yes, a citation for that statement is still needed @TheOrganist . The evidence does not support your statements. Please do not make wide factual statements without a valid link of reasonable quality.
Gwai,
Epiphanies host
But. Even the court are saying that 16 she would have capacity to consent to puberty blockers ?
Also, how do you block puberty in someone of 16 - what we usually mean by puberty generally starts in your early teens ?
Yes that is weird, plus given the waiting list for GIDS is about 2 years and how difficult it is to get as far an assessment, you’d have thought that would partially filter out people who are likely to change their mind.
The judgement (pdf link) actually says: so is casting doubt on the ability of 16 year olds to consent to puberty blockers or gender dysphoria treatment. The judgement notes that normally young people aged over 16 would not be a part of the law considered but felt that the issues were so complex because the drugs had profound effects on the psyche and body that were irreversible while the young person was developing into that person, and that young people were unable to cast their minds ahead to understanding the effects of poor sexual function or inability to give birth that it was not possible for them to give informed consent and that they could never become Gillick competent in this field. Therefore it was worth requesting court approval for young people aged 16 and 17.
From the introduction and background section of the judgement, paragraph 15,
Just looking at the news reports, and they seem to confirm your wife’s interpretation. This strikes me as an astonishing act of judicial hubris - under the guise of a decision about capacity to consent they are telling doctors what treatments they can and cannot offer to their patients in the exercise of their medical judgment.
They can’t have capacity to consider the prospect of infertility at 16 but they can legally get pregnant and have a child ? Does parenthood not have profound effects on the psyche, body and the rest of your life ?
In para 9 of the introduction and background to the judgement (pdf link) it is stated that: The hearing noted that the accounts of Keira Bell's treatment were disputed, but still this case was although that was discussed in paragraphs 78 and 79 and is under a separate review. This whole case is a challenge to the GIDS service.
I hope for other medical treatments this judgement will not apply as an exception to Gillick competency (which is discussed in the judgement in Section D, starting at paragraph 105). This is mentioned in paragraph 126: and There are caveats in the judgement that puberty blockers should be considered separately as when used as per instructions they have side effects that are far reaching and affect the young person irreversibly, and that the hormones work against the normal function of the young person in stopping puberty - para 134 and and I worry that this judgement could be used to challenge other medical interventions offered to under 16s such as the prescription of contraceptive hormones, the morning after pill, abortion and treatment of pregnancy for those young people.
Having read rather more of the judgement I am also going to retract this point:
But leave the other point as from further reading of the judgement, it seems that the court objected to the use of puberty blockers as they were used a precursor for other treatment, the court was not convinced of the neutrality of the treatment and not convinced that GIDS obtained proper consent.
and did not have the statistics to show how often this occurred.
The critique made is that puberty blockers are described as a pause to allow consideration of the gender dysphoria but should really be described as a step to reduce the changes (and sometimes reverse) of puberty minimising surgery and additional treatment later. (para 52)
I wonder why the judgement did not consider that many of the young people discharged without treatment or not reaching the service at all possibly fulfil their requirements of disallowing young people the treatment if they are not suitable, in that those young people who persist to treatment are to some extent going to be self-selecting. However, the failure of GIDS to provide statistics to demonstrate this weakened their case.
I don't know if Gillick itself is under threat, although I would expect anti-abortion groups to campaign for removal.
I don't know what trans people are going to do, there is a tidal wave of trans phobia in the UK, the right wing are in charge. Help.
I'm sorry to report that in this guise it has grabbed a number of the internal levers of power in the SNP in recent elections to the National Executive Committee. We now have a women's convener and an Equalities convener who are transphobes (the Equalities convener has blocked a shocking amount of LGBT commenters on Scottish Twitter because most LGBT people want nothing to do with this prejudice) One of the most important MPs who works against trans people's rights is now on the committee too. These are people who want the Putinist TV presenter, whose own advocate was caught on video describing him as 'sex pest' - Alex Salmond- welcomed back into the party. Where women's actual needs to be safe from powerful men, and to get justice in an often reactionary legal system are concerned, they apparently don't care.
Keen observers of what has been going on in Russia, Hungary and Poland will see how the right used going after trans people there to mobilise social conservatism and then accelerated attacks on all LGBT people and on women's reproductive rights. Rule of law was undermined to go after their chosen scapegoats for their moral panic.
The absolute dangers who got in in the SNP touted themselves for election on a supposedly left wing slate. Many prominent figures in the party thought a high-minded silence and being above 'faction' and 'for unity' was more important than speaking up on trans people's rights. Meanwhile the social conservatives organised, and they are a threat to both civic nationalism and to actual feminism. I can't overstate how important it is to delegitimise this prejudice in left wing spaces and not to appease it.
And then playing the victim when their bigotry gets called out.
I wonder if that point was argued before the Court.
Just because I was looking to see if I could answer the question from GeeD, I found the rebuttal of this information in paragraph 61 of the judgement (link): The hormones that seem to being confused here are the Cross Sex Hormones (CSH), which are not administered until later in the process.
There are concerns, but they are uncertain, as described in paragraph 62:
The court objected to the use of puberty blockers as GIDS/the Tavistock had no evidence as to how many young people chose not to continue on to cross-sex hormones, partly because that often did not happen in their service but in adult services. The comparable Dutch figure was 1.9%.
I suspect, @Gee D the answer to your question is found in paragraph 77, the final paragraph of Section A, the introduction and background: I suspect that the judges reasoned that puberty blockers and the other treatments of young people during adolescence prevented those young people from exploring other issues. Which, whether they are putting caveats about not their "role to adjudicate on the reasons for persistence or otherwise of GD" or not, suggests to me that the decision comes from a strong disinclination to give credence to the diagnoses made by GIDS/the Tavistock, and by their judgement prevents any treatment of any young person under the age of 16 and most under the age of 18.
https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15181
Why does not going through puberty lower your voice?
For every single case, each and every time someone applies for puberty blockers for gender dysphoria? Because that's what that court case requires for anyone under the age of 16 and for most cases under the age of 18.
In effect, it stops treatment, doesn't it? How many people would contemplate a court case, in order to get treatment? Maybe a small number. Gillick seems to have been wiped out.
I'm a long way from being an expert on the law of medical consent, but AIUI the general rule is that consent is the basis for legality and obviates the need for a court order. If it didn't then judges wouldn't be left with much time to do anything else. As far as I know, you don't need a court order to amputate a disease-ravaged limb from a 15-year-old - certainly a life-changing intervention - if amputation is believed to be medically necessary and the appropriate people consent. Why would you need a court order then for puberty-blockers?
And to come back to my original point, what is a judge going to add to the decision-making process, except possibly getting it wrong? He's going to hear evidence from the clinician that the intervention is medically appropriate, and evidence that the parents and the client are on board. Is he going to give intervener status to Keira Bell to argue the opposite side of the issue? What legitimate interest could she (or anyone else) possibly have in the outcome?
And as any woman of childbearing age, without children, who has tried to get a sterilisation will tell you - most people struggle to believe those who don’t want children really mean it, really will maintain that opinion, really understand the implications etc etc
The questions involved are very much more complex than (for example) deciding the criteria for a range of treatment from a simple tonsillectomy to serious brain surgery. That's why it's near impossible to summarise in point form how a medical practitioner should proceed. Most operative treatment is irreversible, but there would be very few other treatments where there may be a change of mind. Optional plastic surgery would be perhaps the closest and I'd imagine that a practitioner would ask questions just as probing as this Court sets out.
I am only guessing, but would say that this decision will probably delay the age at which corrective treatment is carried out for those with gender dysphoria.
Incidentally, the Court has stayed the effect of its decision pending appeal.
I don't see it in those terms, but was using that example in trying to explain how I understood what the Court was saying. FWIW, I can see potential for very real risks in waiting for the young person involved, particularly if that person is already seeing signs of the onset of puberty with its inevitable consequences of their ending up with even more pronounced physical characteristics of the wrong gender.
[cross-post with your last post]
I suppose the question is, where do these criteria come from? The concern I have is that gender identity is frequently extremely poorly understood outside a fairly narrow community that includes few if any judges. Needless to say, there should be evidence on all this, and if the judges understood and absorbed this evidence then they have a least a fighting chance of getting it right. The problem is that there are things they say in the decision that seem so wrongheaded that it raises the question whether they actually did this. As I say, I would be interested to see the record.
According to the coverage I read of this case, early on, the evidence from any charities advocating for transgender rights was thrown out and not heard, while the anti-transgender group, Transgender Trend* were invited to submit evidence - Pink News news story link. Which makes me wonder what other evidence was found inadmissable.
The lawyer for the plaintiff, Paul Conrathe has an agenda - according to yesterday's papers the next thing he and Kiera Bell are planning to challenge is discussion of transgender issues on social media - Observer article from 6 December 2020. Jolyon Maugham of the Good Law project commented on this lawyer in the context of this case on Twitter here (link) and the similarities of Conrathe's challenges to abortion in various cases. Another Twitter user has listed the number of challenges to transgender that Paul Conrathe is involved in here - link to thread reader - and according to that thread, Conrathe is linked to the far right hate group Alliance Defending Freedom.
The Tavistock / GIDS have shot themselves in both feet by not evidencing and publishing their work. If they'd been able to quantify the number of young people diagnosed with gender dysphoria in the UK and to then be able to say x% of those young people are referred to GIDS, y% of those young people wait out the maybe four years to an appointment, and z% of those young people are given puberty blockers. From the stories in the press, the service is chaotic and other charities are getting involved so many of the young people on the waiting list are prescribed puberty blockers before reaching GIDS - link to i-news story from August 2020. However, this case seems to part of a concerted attack to shut down the service and all transgender treatment entirely. The proscription on treatment with puberty blockers under the age of 16 is effectively limiting treatments available.
* link to story in Schools Week criticising Transgender Trend materials
Each party's submission would seek to put that party's case in the best possible light. A court would read each and the oral arguments presented and then pick though the elements of each and how those relate to any previous cases in the are. But apart from those pretty obvious points, I don't know how to interpret your statement.