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Physicians! Heal thyselves!

(But we'll no' haud oor breaths.)


Below is a long piece, and a short piece, from The Sunday Times about The Tavistock Clinic. 


If you have the time and inclination, they are worth a read.

Thwse articles will

a. boil your blood or

b. curdle it or

c. make it run cold. 


This is a story of child abuse, purely and simply. 

The practices described are unscientific, unprofessional, unethical and unacceptable. 


How the Tavistock gender clinic ran out of control

Hadley Freeman meets the BBC’s Hannah Barnes, who spoke to dozens of former staff and patients, but had to fight to even get her book published

Hadley Freeman

Saturday February 11 2023, 6.00pm, The Sunday Times




It wasn’t easy for Hannah Barnes to get her book published. As the investigations producer for Newsnight and a long-term analytical and documentary journalist, she is used to covering knotty stories and this particular one, she knew better than most, was complex. She had been covering the Gender Identity Development Service (Gids), based at the Tavistock and Portman NHS Foundation Trust in north London — the only one of its kind for children in England and Wales — since 2019 and decided to write a book about it. “I wanted to write a definitive record of what happened because there needs to be one,” she tells me. Not everyone agreed. “None of the big publishing houses would take it,” she says. “Interestingly, there were no negative responses to the proposal. They just said, ‘We couldn’t get it past our junior members of staff.’ ”

Whatever their objections were, they could not have been about the quality of Barnes’s book — Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children is a deeply reported, scrupulously non-judgmental account of the collapse of the NHS service, based on hundreds of hours of interviews with former clinicians and patients. It is also a jaw-dropping insight into failure: failure of leadership, of child safeguarding and of the NHS. When describing the scale of potential medical failings, the clinicians make comparisons with the doping of East German athletes in the 1960s and 1970s and the Mid Staffs scandal of the 2000s, in which up to 1,200 patients died due to poor care. Other insiders discuss it in reference to the Rochdale child abuse scandal, in which people’s inaction led to so many children being so grievously let down.

Gids treats children and young people who express confusion — or dysphoria — about their gender identity, meaning they don’t believe their biological sex reflects who they are. Since the service was nationally commissioned by the NHS in 2009 it has treated thousands of children, helping many of them to gain access to gonadotropin-releasing hormone agonists, known as “puberty blockers”, originally formulated to treat prostate cancer and to castrate male sex offenders, and also used to treat endometriosis and fertility issues. The service will shut this spring, following a deeply critical interim report in February 2022 by Dr Hilary Cass, a highly respected paediatrician who was hired by NHS England to look into the service. Dr Cass concluded that “a fundamentally different service model is needed”.

Gids should be an easy story to tell: many people have been trying to blow the whistle for a long time, but Anna Hutchinson, a clinical psychologist who used to work at the Tavistock Centre, told Barnes that those who spoke up were “always driven out one way or another”.

“It is really not normal for mental health professionals to talk to journalists as openly as they talked to me, and that shows how desperate they were to get the story out,” Barnes says. The clinicians struggled to be heard, just as Barnes later struggled to get her book out; some people prefer censorship to the truth if the latter conflicts with their ideology. And yet, concerns about the service had been in plain sight for years: in February 2019, a 54-page report compiled by Dr David Bell, then a consultant psychiatrist at the trust and the staff governor, was leaked to The Sunday Times. Dr Bell said Gids was providing “woefully inadequate” care to its patients and that its own staff had “ethical concerns” about some of the service’s practices, such as giving “highly disturbed and distressed” children access to puberty blockers. Gids, he concluded, “is not fit for purpose”. Many of Bell’s concerns had been expressed 13 years earlier in a 2006 report on Gids completed by Dr David Taylor — then the trust’s medical director — who described the long-term effects of puberty blockers as “untested and unresearched”.

“Taylor’s recommendations were largely ignored,” Barnes writes, and, in the decade and a half between Taylor and Bell’s reports, Gids would refer more than 1,000 children for puberty blockers, some as young as nine years old. It’s impossible to obtain a precise figure because neither the service nor the endocrinologists who prescribe the blockers could or would provide them to people who have asked for them, including Barnes. One figure they have given is that between 2014 and 2018, 302 children aged 14 or under were referred for blockers. It is generally accepted now that puberty blockers affect bone density, and potentially cognitive and sexual development. “Everything was there — everything. But the lessons were never learnt,” Barnes says.


Because this story touches on gender identity — one of the most sensitive subjects of our era — it has been difficult to get past the ideological battles to see the truth. Was the service helping children become their true selves, as its defenders contended? Or was it pathologising and medicalising unhappy kids and teenagers, as others alleged?

This reflects the fraught, partisan ways people see gender dysphoria: is it akin to being gay and therefore something to be celebrated?; or is it an expression of self-loathing, like an eating disorder, requiring therapeutic intervention? This has led to the current confusion over whether the planned conversion therapy ban should include gender as well as sexuality. “Conversion therapy” obviously sounds terrible, and politicians across the spectrum — from Crispin Blunt on the right to Nadia Whittome on the left — have loudly voiced their support for the inclusion of gender on the bill, which would thereby suggest that therapy for gender dysphoria is analogous to trying to “cure” someone of homosexuality.

But many clinicians argue that including gender would potentially criminalise psychotherapists exploring with their patients the reason for their confusion; after all, a doctor wouldn’t simply validate a bulimic’s desire to be thin — they’d try to find the cause of their inner discomfort and help them learn to love their body. Gids itself has long been conflicted about this complex issue. Dr Taylor wrote in 2005 that staff didn’t agree among themselves about what they were seeing in their patients: “were they treating children distressed because they were trans,” Barnes writes in Time to Think, “or children who identified as trans because they were distressed?”

How did the country’s only NHS clinic for gender dysphoric children not even understand what they were doing, and yet keep doing it? Thanks to Barnes and her book, we now know the answers to those questions, and many more.

Gids was founded in 1989 by Domenico Di Ceglie, an Italian child psychiatrist. His aim was to create a place where young people could talk about their gender identity with “non-judgmental acceptance”. Puberty blockers were available for 16-years-olds who wanted to “pause time” before committing themselves — or not — to gender-changing surgery. (Gids never offered that surgery, which is illegal in England for those under the age of 17, but it did refer patients to the endocrinology clinic, which provided the blockers. Blockers stop the body going through puberty, thereby making it easier — in some ways — for a person later to undergo the surgery.) In 1994 the service became part of the Tavistock and Portman NHS Trust, which was known for its focus on talking therapies. By the early 2000s those working within Gids noted that certain gender activist groups — such as Mermaids, which supports “gender-diverse” kids and their families — were exerting an “astonishing” amount of influence on Gids, especially in regard to encouraging the prescribing of puberty blockers. Barnes writes in her book that Sue Evans, a nurse who worked at Gids at the time, asked a senior manager why Gids couldn’t just focus on talking therapy and not give out body-altering drugs. According to her and another clinician, Barnes writes, the senior manager replied, “It’s because we have this treatment here that people come.”


In around the year 2000, the trust asked Di Ceglie to draw up a report of who its patients were. The results were astonishing. Most of Gids’s patients were boys with an average age of 11. More than 25 per cent of them had spent time in care, 38 per cent came from families with mental health problems and 42 per cent had lost at least one parent, either through separation or death. Most had histories of other problems such as anxiety and physical abuse; almost a quarter had a history of self-harm. No conclusions were drawn and Gids continued to treat gender dysphoria as a cause, rather than a symptom, of adolescent distress.

It was a gender identity clinic in the Netherlands in the late Nineties that came up with the idea of giving blockers to children under 16, and in doing so furnished Gids with the justification it needed. The Dutch clinic said that 12-year-olds could be put on blockers if they had suffered from long-term gender dysphoria, were psychologically stable and in a supportive environment. This was known as the “Dutch protocol”. Pressure groups and some gender specialists encouraged the clinic to follow suit.

Dr Polly Carmichael took over as Gids’s director in 2009 and, in 2011, the service undertook an “early intervention study” to look at the effect of blockers on under-16s, because so little was known about their impact on children. Instead of waiting for the study results, Gids eliminated all age limits on blockers in 2014, letting kids as young as nine access them. At the same time referrals were rocketing, meaning clinicians had less time to assess patients before helping them access blockers. In 2009 Gids had 97 referrals. By 2020 there were 2,500, with a further 4,600 on the waiting list, and clinicians were desperately overstretched. “As the numbers seeking Gids’s help exploded around 2015, there was increased pressure to get through them. In some cases that meant shorter, less thorough assessments. Some clinicians have said there was pressure on them to refer children for blockers because it would free up space to see more children on the waiting list,” Barnes says.


Clinicians were seeing increasingly mentally unwell kids, including those who didn’t just identify as a different gender but as a different nationality and race: “Usually east Asian, Japanese, Korean, that sort of thing,” Dr Matt Bristow, a former Gids clinician, tells Barnes. But this was seen by Gids as irrelevant to their gender identity issues. Past histories of sexual abuse were also ignored: “[A natal girl] who’s being abused by a male, I think a question to ask is whether there’s some relationship between identifying as male and feeling safe,” Bristow says. But, clinicians point out, any concerns raised with their superiors always got the same response: that the kids should be put on the blockers unless they specifically said they didn’t want them. And few kids said that. As one clinician told Barnes: “If a young person is distressed and the only thing that’s offered to them is puberty blockers, they’ll take it, because who would go away with nothing?”

Then there was the number of autistic and same-sex-attracted kids attending the clinic, saying that they were transgender. Less than 2 per cent of children in the UK are thought to have an autism spectrum disorder; at Gids, however, more than a third of their referrals had moderate to severe autistic traits. “Some staff feared they could be unnecessarily medicating autistic children,” Barnes writes.

There were similar fears about gay children. Clinicians recall multiple instances of young people who had suffered homophobic bullying at school or at home, and then identified as trans. According to the clinician Anastassis Spiliadis, “so many times” a family would say, “Thank God my child is trans and not gay or lesbian.” Girls said, “When I hear the word ‘lesbian’ I cringe,” and boys talked to doctors about their disgust at being attracted to other boys. When Gids asked adolescents referred to the service in 2012 about their sexuality, more than 90 per cent of females and 80 per cent of males said they were same-sex attracted or bisexual. Bristow came to believe that Gids was performing “conversion therapy for gay kids” and there was a bleak joke on the team that there would be “no gay people left at the rate Gids was going”. When gay clinicians such as Bristow voiced their concerns to those in charge, they say it was implied that they were not objective because they were gay and therefore “too close” to the work. (Gids does not accept this claim.)

What if becoming trans is — for some people — a way of converting out of being gay? If a boy is attracted to other boys but feels shame about it, then a potential way around that is for him to identify as a girl and therefore insist he’s heterosexual. This possibility complicates the government’s plan — which has cross-party support — for including gender alongside sexuality in the bill to ban conversion therapy, if enabling a young person to change gender is, in itself, sometimes a form of conversion therapy.

I ask Barnes what she thinks and she answers with characteristic caution: “It’s a bit surprising that the NHS has commissioned one of the most experienced paediatricians in the country to undertake what appears to be an incredibly thorough review of this whole area of care, and not wait until she makes those final recommendations before legislating,” she says, weighing every word. (Dr Hilary Cass’s final review is due later this year.)


The sex ratio was also changing to a remarkable degree. When Di Ceglie started his gender clinic, the vast majority of his patients were boys with an average age of 11, and many had suffered from gender distress for years. By 2019-20, girls outnumbered boys at Gids by six to one in some age groups, especially between the ages of 12 to 14, and most hadn’t suffered from gender dysphoria until after the onset of puberty.

Some said this was simply because teenage girls felt more free to be open about their dysphoria. Some clinicians suspected there were other reasons. The clinicians Anna Hutchinson and Melissa Midgen worked at Gids and, after they left, wrote a joint article in 2020 citing a number of potential other factors: the increased “pinkification” and later “pornification” of girlhood; fear of sex and sexuality; social media; collapsing mental health services for adolescents, and so on. “It is important to acknowledge that girls and young women have long recruited their bodies as ways of expressing misery and self-hatred,” Hutchinson and Midgen wrote. And yet Gids’s response was to send these girls to endocrinology for puberty blockers.

The clinicians knew their patients were nothing like those in the Dutch protocol. The latter had been heavily screened, suffered from gender dysphoria since childhood and were psychologically stable with no other mental health issues. “Gids — according to almost every clinician I have spoken to — was referring people under 16 for puberty blockers who did not meet those conditions,” Barnes writes. The majority of children aged 11 to 15 referred to the clinic between 2010 and 2013 were put on blockers. The clinicians tried to reassure themselves by saying the blockers were just giving their patients time to think about what they wanted. They might even alleviate their distress. But in 2016 Gids’s research team presented the initial findings from its early intervention study, which looked at the effect of prescribing blockers to those under 16: although the children said they were “highly satisfied” with their treatment, their mental health and gender-related distress had stayed the same or worsened. And every single one of them had gone on to cross-sex hormones — synthetic testosterone for those born female, oestrogen for natal males. Far from giving them time to think, blockers seemed to put them on a pathway towards surgery. Clinicians were concerned that the service had abandoned NHS best practice. They repeatedly raised this with Carmichael and the executive team, but nothing changed. In just six months in 2018, 11 people who worked at Gids left due to ethical concerns. People who spoke up, such as David Bell and Sonia Appleby, the children’s safeguarding lead for the Tavistock trust, say they were bullied or dismissed. Appleby later won an employment tribunal case against the trust. Bell has said the trust threatened him with disciplinary action in connection with his activities as a whistleblower. He later retired.

Everything the whistleblowers tried to say has been borne out. A 2020 Care Quality Commission inspection of Gids rated the service “inadequate”, and pointed out that some assessments for puberty blockers consisted of only “two or three sessions” and that some staff “felt unable to raise concerns without fear of retribution”. Around the same time, the former Gids patient Keira Bell instigated a judicial review against the trust, arguing that at 16 she had been too young to understand the repercussions of being put on blockers, and that she bitterly regretted her transition. The High Court found in her favour that children are unable to give informed consent to puberty blockers. The Court of Appeal later overturned their verdict on the grounds that it should be up to doctors and not the court to determine competence to consent, but the damage was done: thanks to Bell’s case, it was now public knowledge how shambolic the service had become, unable to provide any data on, for example, how many children with autism they had put on blockers.


So what actually happened at Gids? And why did no one stop it? Barnes’s book suggests multiple credible factors. Activist groups from outside, such as Mermaids and Gendered Intelligence, came to exert undue influence on the service and would complain if they felt things weren’t being done their way. For example, Gendered Intelligence complained to Carmichael, the Gids director, when a clinician dared to express the view publicly that not all children with gender dysphoria would grow up to be transgender. In 2016 an expert in gender reassignment surgery warned Gids that putting young boys on puberty blockers made it more difficult for them to undergo surgery as adults, because their penis hadn’t developed enough for surgeons to construct female genitalia. Instead, surgeons had to use “segments of the bowel” to create a “neo-vagina”. But senior managers rejected calls from its clinicians to put this on a leaflet for patients and families. In the book, Hutchinson is quoted as saying, “I may be wrong, but I think Polly [Carmichael] was afraid of writing things down in case they got into Mermaids’s hands.”

Susie Green was at this point the chief executive of Mermaids and had taken her son, who had been on puberty blockers, to Thailand for gender reassignment surgery on his 16th birthday. In an interview, which is still on YouTube, Green laughingly recalls the difficulties surgeons had in constructing a vagina out of her child’s prepubescent penis. Green stepped down from Mermaids last year.


Money is suspected to have been another issue. When Gids became part of the Tavistock trust, it was such a minor player it wasn’t even in the main building. But by 2020-21, gender services accounted for about a quarter of the trust’s income. David Bell says this allowed the trust to be “blinkered”. The children and adolescent mental health services (CAMHS) possibly had similar blinkers. They were so overstretched it appears they were happy to offload as many kids as possible onto Gids, and then disregard what was actually happening there.

“It’s really striking how few people were willing to question Gids. As one clinician said to me, because it was dealing with gender, there was this ‘cloak of mystery’ around it. There was a sense of ‘Oh, it’s about gender, so we can’t ask the same questions that we would of any other part of the NHS. Such as: is it safe? Where’s the evidence? Where’s the data? And are we listening to people raising concerns?’ These are basic questions that are vital to providing the best care,” Barnes says.

And then there was the outside culture. Basic safeguarding failures at Gids seem to have accelerated from 2014 onwards, at the same time that there was a push for the rights of transgender people. Stonewall, having helped to secure equal marriage, had now turned its sights on the rights of trans people. Susie Green, at Mermaids, gave a TED talk that suggested taking her teenage son for a sex change operation was a parenting template to admire. Meanwhile, the TV networks weighed in. In 2014 CBBC aired a documentary, I Am Leo, about a 13-year-old female on puberty blockers who identifies as a boy — mainly, it seems, because of an abhorrence of dresses and long hair. In 2018 ITV showed the three-part drama Butterfly, about an 11-year-old boy whose desire to be a girl is expressed as a desire to wear dresses and make-up. Susie Green was the lead consultant on the show.


David Bell suggests that the Tavistock trust protected Gids “because they saw it as a way of showing that we weren’t crusty old conservatives; that we were up with the game and cutting-edge”. That the Tavistock clinic was briefly, in the 1930s, a place where homosexual men were brought to be “cured” probably also played a part in the trust’s embrace of gender ideology, as if it were an atonement for a past wrong.

As per Dr Cass’s suggestions, Gids will shut this spring and be replaced with regional hubs, where young people will be seen by doctors with multiple specialties. The obsession with gender, and the ensuing lack of intellectual curiosity at Gids about factors that might contribute to a person’s distress and sense of their identity will, hopefully, be gone.

On the one hand, it feels incredible that such a disaster happened. How did an NHS service medicalise so many autistic and same-sex-attracted young people, unhappy teenage girls and children who simply felt uncomfortable with masculine or feminine templates, with so little knowledge of the causes of their distress or the effects of the medicine? And how did Carmichael, still the director of Gids, suffer no repercussions, whereas those who tried to blow the whistle say they were bullied out of their jobs? On the other hand, it is a miracle that the information is now out. For too long, too many people have turned a blind eye to problems arising from gender ideology, including healthcare for gender dysphoric children — because they have been focused on trying to be on the right side of history, they refused to look at the glaring wrongs.

Barnes knows that some will be angry at her for having written the book. But she also knows that she had to write it: “There’s been this idea that the kind of treatment young people got at Gids — physical interventions — is safe treatment for all gender-distressed children,” she says. “But even among the clinicians working on the front line of this issue, there is no consensus about the best way to care for these kids. There needs to be debate about this, and it needs to come out of the clinic and into society, because this isn’t just about trans people — it’s bigger than that. It’s about children.”


Harriet: ‘Things should have been picked up’

When Harriet said she wanted to be known as Ollie, it took her school just a day to accommodate the change. Fifteen-year-old Ollie, a trans boy, was now a pupil at an all-girls’ school. He wasn’t the only one. He was dating another trans boy, “which gave us both quite a popularity boost”.

Immediately after coming out, Ollie experienced a “honeymoon period”. Being trans seemed like the answer to everything: “Why I’d felt so strange, why I’d felt like I couldn’t relate to most people. There’s a whole list of things I felt I could now explain — sexuality crises, discomfort with being in a single-sex school, not knowing how to interact with my family, hating large social situations.”

A year later, in 2017, Ollie was first seen by Gids. He’d started college as a young man but felt “incredibly insecure” about it. He “saw medically transitioning as a solution”.

Ollie knew what he wanted from Gids: testosterone and then “top surgery” — a term used to describe a double mastectomy and the construction of a more masculine-looking chest. After a five-session assessment spread over seven months, Ollie got a referral to the adult gender identity clinic in Nottingham. He was offered an appointment after 15 months. His medical transition could begin.

Not long after having his breasts removed, Ollie started having doubts. The complications from the double mastectomy were “traumatic”, but Ollie’s health was also deteriorating more generally. He was frequently getting painful urinary infections because of vaginal atrophy, caused by the testosterone.

But it was more than this: Ollie knew he wasn’t a man. What’s more, he knew he was a woman attracted to other women. He stopped taking testosterone in November 2020 and identified once more as female.

Ollie is now Harriet again. She regrets her transition. “I suppose there is anger. I’m not a very angry person. But there are obvious things that should have been picked up.” It’s clear, she thinks now, that her trans identity was “a coping strategy”. “I can at least take comfort in the fact I’m no longer fighting an uphill battle against my own biology.”


Phoebe: ‘Surgery is the best thing I’ve done’

Phoebe told her parents when she was three years old that she was “saving all my Christmas money for an operation to become a lady”. She had been one of a pair of twins — one male, one female. Her female sibling had died midway through the pregnancy. “We think that my mum carried on producing hormones for both sets of twins,” she says.

She was 15 years old when she was first seen by Gids. Bullying would often be discussed at the appointments. “I suffered horrific abuse,” Phoebe explains. “I was taunted for being gay.” It wasn’t easy growing up in the early 2000s as a gender non-conforming boy in west England. “I said to my mum, ‘I’m done being called gay. I’m not being bullied for something that I’m not.’ ”

Phoebe’s desire to live as a woman wasn’t about whom she was attracted to; it was about who she was. “I was physically sick at times over what I saw in the mirror.”

At 16 years old, she was given the go-ahead to go on puberty blockers. Her clinicians at Gids never pushed her towards transition; she led the process throughout. Undergoing surgery just before she turned 20 was the best thing she’s ever done.

Almost a decade later, Phoebe hasn’t once regretted the surgery. But there is one thing she would change if she could. “Before I started hormone blockers I was asked about children. I was, like, ‘Oh my God, yeah, I’d love to be a mum.’ ” NHS fertility services refused to help her to freeze her sperm. The letter she received described the wish to preserve fertility as “at odds” with her pursuit of “gender reassignment”. Furthermore, the request would not be considered because “it does not fulfil our requirements of the welfare of any offspring that would result from the storage of this sperm in the future”.

It was devastating to hear as a 16-year-old. An NHS mental health professional has apologised for this subsequently, but it’s something Phoebe’s cried about in therapy.

Since her transition she has had relationships with men but she has found it difficult. While there are men who will date trans women “with open arms”, she’s not necessarily sure she’s found those men yet. Transitioning has been right for her, but she also thinks it’s right that the process takes time.


Jacob: ‘I was petrified of puberty’

Jacob has never really seen himself as a girl: “Even when I was, like, a toddler, I would go by names from male characters I saw on TV.” In 2014, when Jacob was 11, he had his first appointment at Gids. His mother asked the team if there was any kind of therapy that could help ease his distress. She and Jacob were told there wasn’t. But the clinicians explained: “There’s this thing called hormone blockers. They’ll stop your puberty for as long as you need it to be stopped. And then as soon as you get old enough, you can go on testosterone.”

Jacob was pleased. “A cure is how they sold it to me.” Less invasive options, such as Jacob continuing to dress in the gender he preferred, weren’t discussed. The Gids assessment report stated: “Hormone blockers can provide young people with the opportunity to explore and experiment with their identities without the anxiety and challenges associated with ongoing pubertal development. It is considered to be a fully reversible treatment.”

Life for Jacob was difficult. The blockers slowed down his puberty but they didn’t stop it. “I still got showings,” he says, referring to spots of blood. “I still got breast-tissue development.” His physical health suffered too. He gained “tons of weight”, so much so that he got stretch marks. Then there was the problem with his bones: they kept breaking. “I’d never broken a bone before I started the blockers.” Jacob was advised to take vitamin D. His blood work showed that he was “incredibly deficient”.

After more than four years on the blockers, Jacob felt worse than he ever had before the medication. In 2019 he took his last injection. The improvement to his health was immediate. “I felt so much better in terms of mood. I could sleep better.”

In 2022 Jacob is 19 and still trans. He uses a male name and pronouns, and dresses in a way that he says is typically male. But he’s not on any medication. He hasn’t chosen to take testosterone. “I’m content with just being me. I’m happy dressing as a boy, I’m happy saying that I’m a ‘he’. And if people don’t believe it … it doesn’t really bother me.

“One of the biggest regrets in my life is that I went on blockers. I [did it] because I was petrified of the possibility of puberty.” He says Gids should have prepared him better for that and “not just given me this drug”. “I was a child and I still don’t know how it’s affected me properly or the full damage that it could have done to my body. And that is scary.”

Case studies are extracted from Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children by Hannah Barnes. To be published by Swift Press on 23 February at £20. Some names have been changed



The ‘holy f***’ moment I knew something was wrong at the Tavistock

How Dr Anna Hutchinson, one of the whistleblowers, realised something was very wrong

Hannah Barnes

Sunday February 12 2023, 12.00pm, The Sunday Times



Dr Anna Hutchinson, a senior clinical psychologist at Gids and part of the senior team, joined the clinic at the start of 2013 with significant experience from a number of London’s leading hospitals, including Great Ormond Street Hospital. By late 2014 Gids’s activity was “increasing faster than staffing”. The numbers had exploded, and piles of referrals sat on Hutchinson’s desk for processing. “These piles were ever-present and growing,” she says. “Literally one week to the next, the pile would double. And I remember the first month where we had 100: it was phenomenal. Something was happening.”

“There were no referral criteria … We were accepting everyone,” she says. Moreover, the majority were girls whose gender-related distress had begun after the onset of puberty. And these people had complex needs. Many were self-harming; others were housebound with anxiety; some older adolescents were engaging in risky sexual behaviours. A number came from abusive families, or were living in care.

Hutchinson began to feel uneasy about the numbers and about elements of the care given. But even with her doubts, she was reassured by what she understood about the blocker. She and others were informed regularly by their seniors and the endocrinology team at UCLH, who prescribed the blockers, that the drugs were harmless and reversible. In 2016 Gids’s research team presented the initial findings from the early intervention study that it had begun in 2011, allowing a small group of children aged 12-15 to receive puberty blockers. Remarkably, the service had not waited for the results of the trial before rolling the treatment out: by now, the referring of under-16s for puberty blockers was routine clinical practice at Gids.


How had the first group of young people to have had earlier access to puberty blockers fared? The young researchers did describe success. The children who’d had their puberty blocked reported that they were highly satisfied with their treatment. Hutchinson was therefore surprised when they went on to explain that the children’s gender-related distress and general mental health — when based on clinical measures of things such as self-harm, suicidal ideation and body image — had either plateaued or worsened. Surely, she thought, if the children were making good use of the “pause” that blockers might provide, you’d expect a drop in their levels of distress? That ostensibly was the whole point of the treatment.

She grew alarmed as the presentation continued. Despite the idea that blockers were administered to provide children with more time to think, it was becoming clear that they were all thinking in the same way. In an astonishing aside, the researchers revealed that everyone in the early intervention group had at this point progressed from the blockers on to cross-sex hormones — a treatment with irreversible consequences. Every single one. It was Hutchinson’s “holy f***” moment. And a wake-up call for so many of her colleagues too.


“It exploded the idea that when we were offering the puberty blockers, we were actually offering time to think,” Hutchinson says, “because what are the chances of 100 per cent of people thinking the same thing? It looked to me like it was the opposite. And that once you’re on the [puberty blockers] pathway, you stayed on the pathway, perhaps you thought less.” What’s more, figures of close to 100 per cent are almost unknown in psychological research. Human beings, particularly adolescent ones, are not usually so consistent and predictable.


Hutchinson’s head spun. She knew that if the blockers were actually confirming a trans identity, as suddenly now seemed possible, then there would have to be vulnerable children who would later realise that wasn’t the right path for them. “I was horrified.” If the service was getting this wrong, she said to herself, it was getting it wrong with some of the most vulnerable children and young people there were. Young people who already had difficulties — children who were traumatised or mistreated, autistic children, or those who might grow up to be gay. She cared deeply for the children seeking her help but she began to think that Gids was practising in a way that “wasn’t actually safe”. She feared she may be contributing to a medical scandal, where an NHS service was not stopping to think what else might be going on for so many of these young people.


“I just couldn’t comfortably keep being part of a process that was, I felt, putting children — but also my colleagues — at risk,” Hutchinson explains. Faced with no discernible action from the executive, staff began to look for other ways to raise their concerns, to other people who might listen — and act. Hutchinson approached the Tavistock’s Freedom to Speak Up guardian. At least four other colleagues did the same in 2017. That same year, another four clinicians took their concerns outside Gids to the children’s safeguarding lead for the Tavistock trust.

The service was certainly not functioning well, she says, but there was a feeling that if she could just articulate her fears in a different way, perhaps the executive would “get it”. But they could not reassure her.

• Hadley Freeman: How the Tavistock gender clinic ran out of control

She took part in the official review into Gids with this aim. When that, too, didn’t acknowledge the concerns she and others felt, she went to the top of the Tavistock, but she was not reassured that her concerns were being “properly investigated”.

“That’s when I think I changed as a human being,” Hutchinson reflects. “I just think I became a bit more cynical.” She had gone from believing that positive change could be made, and that there was the goodwill to do that, “to believing this was a system that knew it was taking risks with children’s wellbeing but was not going to do anything about it.” She would have to take her concerns outside the Tavistock in order for them to be acted upon.

© Hannah Barnes 2023. Extracted from Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children by Hannah Barnes, to be published by Swift Press on February 23 at £20

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Aye, but here's the rub.....


In Scotland we, the public,  retain the dubious services of our own Tavistock - The Sandyford Clinic, as Alex Massie points out, and neatly skewers, in today's Times.


The golden rule for Scotland’s Tavistock: see nothing, say nothing, think nothing

For many patients identifying as trans will be the correct outcome. But not for all

Alex Massie

Monday February 13 2023, 5.00pm, The Times




Last March, Dr Hilary Cass, an eminent paediatrician, released an interim report into the provision of gender identity services for children at the Tavistock clinic in London. Her conclusions were damning: the treatment offered was “not a safe or viable long-term option” and services were not subjected to “normal quality controls”. She recommended that the Tavistock clinic be closed.

Now a new book, written by Hannah Barnes, a veteran investigative journalist at the BBC, reveals the true — and shocking — extent of malpractice at the Tavistock. Based on extensive interviews with clinicians and patients, Barnes’s account depicts a service out of control, blithely certain that it was on the right side of history while actually putting hundreds of young people on an irreversible journey to life-changing treatments.

The prescription of drugs that halt the onset of puberty was a routine part of the Tavistock’s approach. Puberty-blockers are prescribed on the basis they give children “time to think”. This sounds like sensitive medicine. The truth was rather different.

In 2016, the Tavistock reported that children given blockers were satisfied with their treatment. But Barnes writes that these same children’s “gender-related distress and general mental health — when based on clinical measures of things such as self-harm, suicidal ideation and body image — had either plateaued or worsened”. “Pausing” puberty did not seem to offer tangible benefits.

Almost all the children monitored in this group progressed from puberty blockers to taking irreversible cross-sex hormones.

“It exploded the idea that when we were offering the puberty blockers, we were actually offering time to think” says Dr Anna Hutchinson, a senior clinical psychologist at the Tavistock. “Because what are the chances of 100 per cent of people thinking the same thing?”

This was a medical motorway with no exits. The Tavistock calamity is a disgrace. But, thanks to whistleblowers and journalists determined to reveal the truth, it is at least a scandal subjected to the pitiless glare of scrutiny.

In Scotland, matters are arranged differently. Here it is considered scandalous to even raise these issues. The pretence that there is nothing to be examined must be maintained, no matter how ridiculous — and even wicked — that may be.

For Scotland has a Tavistock of its own. A decade ago, just 37 children were referred to the specialist Young People’s Gender Service at the Sandyford clinic in Glasgow. In 2021 that figure was 521. The Sandyford clinic operates on the same basis as the now discredited Tavistock clinic.

“We must take these issues seriously,” Nicola Sturgeon said last year, “but we owe it to everybody also to treat these issues incredibly sensitively”. This is code. “Sensitively” here really means “these issues should not be discussed in public”. See nothing, say nothing, think nothing.

The first minister argues that this is a fuss over nothing because only a “small” number of children will be prescribed puberty blockers and, eventually, hormones. It is difficult to imagine any other policy issue in which the life-changing effect of experimental, unproven, medical treatment would be dismissed in such a cavalier fashion. The insouciance on display is as startling as the recklessness.

The lack of curiosity is also extraordinary. According to the Scottish Pathway for Trans Healthcare (Spath), updated last September, “best practice” has “moved away from psychiatric assessments that focus on evaluating how ‘gender dysphoric’ a person is”. Instead, treatment should consider a patient’s “readiness for initiating particular aspects of gender-affirming healthcare”. The conclusion is thereby established before the evidence supporting it.

Counselling should not be considered “a prerequisite for any gender-affirming healthcare”. There is no need to explore the depth or conviction or provenance of a person’s gender discordance. On the contrary, their declared sense of themselves should simply be affirmed. By such means, even those who do not obviously need medical intervention should nevertheless receive it.

According to Spath, “access to hormones and surgeries can act as a prophylactic measure against distress” and “a trans person can have persistent gender incongruence without distress and can still benefit from gender-affirming hormones or surgeries”. Entirely healthy people, that is, should have major body- and life-altering surgery. How can this possibly be right? How can it be remotely ethical?

Little is known about the long-term impact of puberty blockers but there are concerns they may affect the development of children’s brains as well physical growth. Because of this uncertainty, the use of puberty blockers is a matter of increasing concern in England and other countries. In Scotland, though, we pretend there is nothing to see, discuss, or be concerned about. Evidence from elsewhere mysteriously becomes inapplicable as soon as it enters our airspace.

It is important to be clear that identifying as trans is not a problem per se. In many cases this will be backed by clinical evidence. For many patients it will be the correct outcome. But not for all. Plenty of children with gender uncertainty are uncertain about themselves more generally.

According to Dr David Bell, a consultant psychiatrist and Tavistock whistleblower, many of the children “have histories of trauma and are on the autistic spectrum; others are depressed or have family problems. A high proportion are gay and lesbian but are confused about their sexual identity”. This is not an ideal basis for “gender-affirming” care.

At the Tavistock, Hutchinson says, a presumption in favour of gender-affirming care has created “a cohort of people who are medically dependent who’d never needed to be. And not only medically dependent, but perhaps — we don’t know yet — medically damaged”.

If this doesn’t count as a scandal, what could? And yet, officially, there is nothing to see here.

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And, apart from the child abuse....



Gender Bill fiasco betrays values we once held dear

Women have been let down by a policy built on the corruption of basic truths

Gillian Bowditch

Sunday February 12 2023, 12.01am, The Sunday Times




As the row over the Gender Recognition Reform (Scotland) Bill rumbles on — in the last week Alex Salmond, that defender of women’s dignity, has joined the fray and the Scottish Prison Service has done yet another volte-face — it is illuminating to look at how we got here.

Why is legislation, which even the first minister concedes is aimed at a tiny minority, completely consuming Scotland?

The Bill is not primarily about trans rights. It’s not even about women’s rights, although women have woken up to how easily hard-won concessions, which once seemed immutable, can be flouted. The Bill is fundamentally about two things: truth and freedom.

In the past few weeks, the unintended consequences have been laid bare. A violent rapist, self-identifying as a woman, has been accommodated, albeit in a segregated wing, in the woman’s prison estate. While the sex offender has now been removed, it is not an isolated case.

A former female inmate of Cornton Vale has described how naked men in an aroused state would prowl around the showers at the prison, terrifying women prisoners to such an extent that she had a contraceptive coil fitted as she believed she would be raped. Other women were too scared to shower. The Scottish parliament has heard how female prison officers were forced to perform intimate strip searches on these men.

A doctor has written about her concerns for her female patients, who after intimate and upsetting gynaecological examinations, have escaped to that bastion of female refuge, the ladies’ loos, only to discover men in the space. Young girls have described men openly urinating in the once female-only bathrooms at their sports clubs. Women in court have been forced to describe their rapists as “she”.

It’s difficult to write about such scenarios not just because they are distressing but because they have nothing to do with the average trans person, many of whom have faced obstacles and prejudice. The first minister wants to make life easier for this community. Many of those opposing the Bill want that too.

But by championing an ill-conceived piece of legislation, by riding roughshod over the anxieties of women, by dismissing the concerns of experts, by rejecting polls which showed the majority of Scots were opposed, and by engineering the debate to prevent critical voices from being heard, those proponents of the Bill have set back the causes of the trans community by decades.

At the same time, a small minority of protesters and self-appointed trans-rights spokespeople have been given free rein to intimidate and harass those questioning the Bill or opposing the loss of women-only spaces. Terrible injustices have been done to individuals. Nationalists who have opposed the Bill have been vilified by their party.

It’s almost impossible to work out how the Scotland of David Hume and Adam Smith got here. How did a country renowned for its empiricism end up in this terrible position? How did the nation of the Enlightenment get sucked so far into Orwellian groupthink that we almost allowed the state to deprive 50 per cent of the population of a basic right to physical safety, while giving predatory men the kind of protection in law which would prevent anyone from revealing their birth identities?

The answer is stealthily. The danger was real. It started, as tyranny so often does, with the corruption of language. People with no understanding of the power of words began to outlaw the word “woman”. The Lancet went to press with the term “bodies with vaginas”. Mother became a dirty word.

It is no coincidence it was writers, and in particular JK Rowling, who were the first to recognise the threat. The erosion of women’s identities by the outlawing of the language we used to describe ourselves soon snowballed.

It started without discussion or consultation. It continued with oppression. Women who worked out what was happening early on and spoke out were vilified, ostracised and economically disadvantaged. Once woman’s identities were repressed, and their objections censored, their right to safe single-sex spaces became almost redundant.

The reason this dogma got so far is partly the audacity of those pushing the agenda. It was such a bold move; it was hard to fathom. It was partly groupthink and the lack of accountability at Holyrood.

But it is largely because as a society we have buried other inconvenient truths. It is no longer acceptable to challenge so much of the orthodoxy of modern Scotland — be it questioning the cult of victimhood or challenging the mission creep of the state’s involvement in the lives of its citizens. We’ve swallowed so much; another mouthful goes down easily.

Had the timing of the rapist Adam Graham who became Isla Bryson been different, we might have been much further down a path on a road to totalitarianism.

It is both liberating and concerning that those who have ultimately put a stop to this absurdity are not our elected representatives, nor the academics, nor the third-sector organisations designed to protect vulnerable women, nor the party leaders who still can’t define the word “woman”. It was ordinary Scots, who took one look at Isla Bryson and the whole sorry mess, and called it for what it was.







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5 hours ago, forlanssister said:



The impartial BBC at its finest.


Not sure if this is a journalistic endeavour or Sarah Smiths application for leadership of the Scottish Greens.


I listened to Graham on a Spiked podcast and you can tell the difference between them actually wanting to hear what he had to say and this hack job where they just try to catch you out. 


People fall for the BBC/Sky/C4 trap everytime. Do not give them the time or waste your energy trying to explain your position as they are not interested, it is all about them virtue signalling and wanting to discredit views that the vast majority of people hold. 



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