I was asked by Mandy Payne at Health Sense to review Bad Therapy due to be published today and agreed because an earlier book by Abigail Shrier, Irreversible Damage, had worked for me.
Reviews of Bad Therapy are tumbling out at the moment – the Daily Mail has two – one by the Mail – Generation Sicknote and one by Abigail.
The Mail front page review neatly has a link to the last few posts on RxISK about Fertility – the banner at the top stating Earning 100K and too Poor to have a Baby – See Fertility and Desire and Fertility and Military.
The Mail and Abigail may have got lucky. The Resolution Foundation, who are Left Leaning as the Mail tells us, has just issued a report. BBC Coverage of the Resolution report is more dispassionate than the Mail’s. It pulls out the key point which is 18-30 year olds are now the sickest generation – much more so than middle-aged people – and much more than they used to be. Something has gone or is going badly wrong.
This is the group of people who aren’t having children the way they once did and aren’t able to work. You wouldn’t guess from what the reviews say that they are not the generation Abigail is talking about.
Why the Kids
Shortly after publication in 2022, I read Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Daughters which covered happenings on America’s Transgender front. It was well written with good cases illustrating its central points.
I found it a compelling read for other reasons. Whatever about the many issues the Transgender phenomenon raises – and it raises so many it is hard to find the right word to put after Transgender – one element leapt out at me. Several parents of children featured, the author said, had been true blue Democrat voters, but their daughters predicament converted them, and they would now vote Republican.
This may have struck me because I’d heard something similar from American colleagues alarmed at vaccine mandates. They too had been true blue Democrats but would now vote Republican.
Reading Bad Therapy you might think America was the only country on earth or should I say the only two countries – it is so cloven into two halves.
If you are looking for a book to tell you about trauma and mental health, therapies for trauma, or developments in psychotherapy, this is not the book for you. The subtitle – Why the Kids aren’t Growing Up is what the book is about – it might have been Alice in Nightmare Land.
But if you want some sense as to why a Republican may end up in the White House in November, these may be books to read. The anger in The Transgender Craze is well-controlled and laser-focused. (I use the subtitle as irreversible physical damage is not the focus). This is a book that would, now that the mandates are gone, likely bolster possibly wavering intentions of my Democrat friends to vote Republican.
I’m less sure what effect Why the Kids aren’t Growing Up might have. It has more detail, more vignettes, and outlines many more expert views. I found the detail overwhelming, and the expertise one-sided. What I mean by one-sided is something felt missing that I initially thought was the other side. It took time to realize it wasn’t.
Vaccines mandates affected all of us and, having had some exposure to the American medical and political scene, it was easy to translate what the Americans I knew were thinking. Whether you agree with the Shrier position in Transgender or not, transgender stand-offs happen all over the West, making it easy to grasp her position.
Why the Kids Aren’t Growing Up deals with American kids and schools. To gauge whether the apparent lunacy being described is over the top, you need some experience of American schools and millennials. Some of my friends who once voted Democrats have heard things about schools, but I have no sense they see things as quite as crazy as Why The Kids suggests.
What I finally realized about the book is that if the author is describing a psychosis, what’s missing is not the balance that comes from getting the other side, it’s an account of how the psychosis developed. Rather than delineate a legitimate role for trauma-informed care and separate that out from a trauma-informed education system, the author had me wondering what her sound and fury signified.
The core argument behind the details is never clearly spelt out, but it seems to be that there has been an extension down to school level of Critical Race Theory – Diversity, Equity and Inclusion programs – Woke. The Identity Ideologies, that have strangled left-wing politics and progressive aspirations in America, are now like bindweed strangling American childhood.
Americans do things enthusiastically. The progressive Left, keen to improve the general lot, support bureaucracies, at least in universities, to ensure the latest creed will finally realize the New Jerusalem, unlike the previous ones that fell short. This Deep State, as Republicans see this bureaucracy, is generating Deep Divisions. The dynamic began before Trump and may have swept him to power without him knowing much about it. In 2024, the Republicans are likely to be more calculating.
What the book lacks is a description of the origins of what is happening. There is no introduction or coda to slot the lunacy into place. This makes for a mass of unanchored detail. Having so many experts wheeled out to agree that what is happening is crazy fails to work because the crazy system is clearly built on expertise, but we are not told whose expertise or why this trumps the views of the experts the author lines up.
We are not put in a position to decide for ourselves. The author pleads for a return to common sense, which for most of us means seeing things the way I see them. Her common sense seems to be vote Republican.
The Democrat reformers who are defying common sense appear to lay claim to a purity of intention that echoes the focus on authenticity on American College campuses leading up to 1968. The political culture back then had become a therapeutic one. Psychoanalysis was going to stop wars. Homosexuality was a disease and Republicans like Goldwater and Reagan were latent homosexuals. But a country that could put a man on the moon would soon be able to cure this and usher in an era of peace and prosperity in the land of milk and honey.
Where technologies and markets were the domain of the Right, health and education were bastions of the Left then – and now.
Herbert Marcuse, perhaps the most influential thinker on the Left, and a leading figure in 1968, came from the Frankfurt School, whose signature theme was a marriage of Marx and Freud aimed at both understanding the failure of a salvific revolution to happen, the regression to Global War instead, and how to overcome systemic resistance to progress.
Marcuse elaborated Critical Theory before the War. Neither it nor he were remotely Freudian. By the 1960s, he had moved even further away from Freud. He was struck by our increasing one-dimensionality and the operationalism that drove this. After 1968, operationalism became even more dominant and in the form of DSM-III, aimed at rolling back the therapeutic state, removed psychoanalysis from medicine.
After 1968, the pendulum of American enthusiasms began swinging in the opposite direction. College students and other Americans replaced social authenticity with gender authenticity and a wellness achievable through medical technologies targeted at the diversities encoded in DSM IV and 5. Health has replaced holiness and medicine can now do miraculous things, even transform women into men. Prescription drugs and vaccines are sacraments – something that can only do good and cannot harm. We used to quarantine people who were infected, we now quarantine people who question the efficacy of treatments.
After his death, Marcuse’s critical theory, which he had long abandoned, came back to life in the hands his student, Angela Davis, and his third wife, Erica Sherover Marcuse, becoming Critical Race Theory, Critical Sex Theory, a DEI Deep State, and Woke. These flowered during Obama’s presidency – despite Obama speaking out against Woke.
The drugs sit in the background to both the Transgender Craze and Why the Kids aren’t Growing Up. Neither Abigail on one side nor Critical Race Theorists on the other grapple with the intersections they generate, which is surprising given the police function prescription-only availability involves. There is no grappling with Randomized Controlled Trials (RCTs), the operational engines that drive the pharmaceutical juggernaut forward. Perhaps because RCTs claim to provide a knowledge that is universal, and the Left has traditionally aspired to a mandatable universality.
Who would I vote for? Beyond race or sex, those most downtrodden at present are those harmed by the clerics of the Church or Tribe they belong to, whether prescribing or non-prescribing clerics.
They need a representative to say its intolerable that treatment articles most of us think are designed to help us live the lives we want to live, aren’t written for this purpose, are entirely ghostwritten, and essentially fraudulent, with regulators, the medical profession and medical journals washing their hands of this.
Therapists (or their representatives), who preach trauma informed care, shrink back from helping patients damaged and traumatized by drug or non-drug treatment stand up to their abuser. Trauma side researchers bury inconvenient results just as readily as drug companies and can be as ideologically biased as drug side physicians.
We call the resulting conflicts Culture Wars. They aren’t. Culture, like science, is built on achievements we can all celebrate. We are dealing with Propaganda Wars – a blood sport fought by Culture Warriors who in the 1960s had the Kids ducking beneath desks to protect them from atomic bombs.
The Kids grew up okay then. I’m inclined to think they will today also but the exposure of Americans so early in life to drug and therapy inputs is leading to falls in life expectancy and fertility for this generation. When the Kids, who do get to grow up, look back will they ask – Where were the Adults?
“She is likely to need those qualities once the mental-health establishment and educators get a look at Bad Therapy.”
“The book is peppered with interviews with doctors and psychologists, including Frank Furedi and Jordan Peterson, but also many less controversial names, sounding the alarm in different ways over what Bad Therapy claims is an industry out of control.” – Financial Times
“In Bad Therapy, bestselling investigative journalist Abigail Shrier argues that the problem isn’t the kids – it’s the mental health experts” – Amazon.
Kay S. Hymowitz is a City Journal contributing editor and the William E. Simon Fellow at the Manhattan Institute.
https://www.city-journal.org/article/review-of-bad-therapy-why-the-kids-arent-growing-up
Abigail Shrier’s first book, 2020’s Irreversible Damage, launched the mother of all cancel campaigns. Because the book attributed the sudden and inexplicable rise in juvenile gender anxiety to social contagion rather than the activist-approved explanation of social progress, Shrier, an occasional contributor to City Journal, was branded a “transphobe.” Amazon employees demanded the company remove the book from its virtual shelves. Unlike the suits at Target, who briefly did exactly that, Amazon stopped short of cancelling the book and settled for banning any paid advertising. Despite growing questions about juvenile transgender treatment, including among practitioners, many libraries continue to treat Irreversible Damage as radioactive. Only last month, a Japanese publisher reneged on plans to publish the book, proving that, whether or not transgenderism is contagious, the urge to cancel those out of line with approved ideas unquestionably is.
Shrier’s new book Bad Therapy, an astute and impassioned analysis of the mental-health crisis now afflicting adolescents, may cause a similar emotional meltdown in some corners of American culture. Shrier’s target is more expansive than it was in Irreversible Damage; she aims her fire at…
More…
It’s a good thing that Shrier has shown herself to be a brave and determined woman in the (continuing) rocky aftermath of Irreversible Damage. She is likely to need those qualities once the mental-health establishment and educators get a look at Bad Therapy.
Alice Through the ‘Cooking’ Glass…
Once upon a time, children were raised on stories that taught the value of perseverance (The Little Engine That Could), preparation (The three Little Pigs) and hard work (The Little Red Hen). Today, books such as Brandon and the Bipolar bear, My Bipolar Roller Coaster Feelings Book, and Turbo max teach the wee ones the importance of psychotropic medication compliance.
In the post-industrial wasteland we live in, many of us have more value to our rulers as consumers of medical interventions than we do as soldiers or workers.
Patrick
This is a wonderful comment. Thanks.
David
Wooh – this is an interesting slant…
Synopsis:
Drawing on interviews with therapist parents, children, and child psychiatrists, the author explores the idea that children of psychiatrists suffer emotionally as a result of their parent’s personality, training, and outlook
https://www.abebooks.co.uk/servlet/BookDetailsPL?bi=31615113481&dest=gbr&ref_=ps_ms_391300534&cm_mmc=msn-_-uk_shopp_used-_-naa-_-naa&msclkid=ffdbc71f8be6190f6cf2a2ff2c60a34e
In 1990, someone was looking into ‘children suffering emotionally’
This was even before we knew much about the drugging of children and Fluoxetine; the one antidepressant recommended for children. Paroxetine and other SSRIs were dished out by doctors to children, also with horrifying results.
Children of the Cure
https://samizdathealth.org/children-of-the-cure/
Our ‘Wolf Suit’ protection…
Where the Wild Things Are is a 1963 children’s picture book written and illustrated by American writer and illustrator Maurice Sendak
“The greatest children’s book of all time” – As voted for by BBC’s culture poll.
One night Max puts on his wolf suit and makes mischief – so his mother calls him ‘Wild Thing’ and sends him to bed without his supper.
That night a forest begins to grow in Max’s room, an ocean rushes by with a boat to take Max to the place where the wild things are… Max tames the wild things and crowns himself as their king, and then the wild rumpus begins!
Where the Wild Things Are…
There are few other examples in medicine of unguided, faith-led “therapy”
There is evidence that there is no reliable evidence concerning benefits of the use of Puberty Blockers or Cross-sex Hormones in minors.
https://econtent.hogrefe.com/doi/suppl/10.1024/1422-4917/a000972/suppl_file/1422-4917_a000972_esm1.pdf
Dr. Augusto Germán Roux reposted
Aaron Kheriaty
@AaronKheriatyMD
Please read this entire thread and the accompanying report by @_CryMiaRiver. It shocks the conscience. I tried to warn early on that WPATH was a transgender advocacy group, not a credible medical/scientific society capable of establishing standards of care. These WPATH files establish this beyond reasonable doubt. So-called gender affirmative care, especially as it is currently practiced, is nothing more than a form of organized child abuse, with the victims often being vulnerable young people with serious mental illness. This craze will go down in the annals of medical infamy. We need to stop these practices, before more people are irreversibly harmed.
Michael Shellenberger
@shellenberger
THE WPATH FILES Advocates of gender-affirming care say it’s evidence-based. But now, newly released internal files from the World Professional Association for Transgender Health (WPATH) prove that the practice of transgender medicine is neither scientific nor medical.
American Medical Association, The Endocrine Society, the American Academy of Pediatrics, and thousands of doctors worldwide rely on WPATH.
It is considered the leading global authority on gender medicine. And yet WPATH’s internal files, which include written discussions and a video, reveal that its members know they are creating victims and not getting “informed consent.”
Victims include a 10-year-old girl, a 13-year-old developmentally delayed adolescent, and individuals suffering from schizophrenia and other serious mental illnesses.
The injuries described in the WPATH Files include sterilization, loss of sexual function, liver tumors, and death.
WPATH members indicate repeatedly that they know that many children and their parents don’t understand the effects that puberty blockers, hormones, and surgeries will have on their bodies. And yet, they continue to perform and advocate for gender medicine.
The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults.
It will go down as one of the worst medical scandals in history.
https://environmentalprogress.org/big-news/wpath-files
Michael Shellenberger
@shellenberger
·
Mar 4
Why I Am Publishing WPATH Files And How I Got Them
https://twitter.com/shellenberger/status/1764800595473686865
What follows are simply a few highlights. People with a serious interest in the topic should read the report and all the files:
These issues might need a health warning. As Annie suggests the materials cited need reading but they also need a certain skepticism or at least sensitivity to context. The claim for one of the greatest medical scandals in history that Abigail Shrier would likely endorse based on her first book needs balancing against the Trauma industry claims she fingers in her second book. These need balancing against the serious harms to millions – far more than the minute fraction affected by puberty blockind drugs – caused by psychiatric drugs that Peter Goetzsche and many others alert us to and aks us to swap these drugs for CBT which has created memories of abuse that never happened and ultimately disabled millions.
One of the questions must be not the question of why we normal people read accounts like the one’s Annie points to and wonder where all the abnormal people who do these things come from but rather how can normal people like you and me end up doing these things. Listing horrors without getting to grips with the slippery slope within all of us that can lead to horros is becomes self-defeating and abusive in its own right
David
RxISKMaking Medicines Safer for All of Us
Transgender Meds: A Call for Reports
July 8, 2019 18 Comments
This post is an invitation to report on drugs prescribed to transgender people.
Hi David,
there is a wider issue in how psychotherapists are trained these days or maybe even have always been trained. I’d love to share some insights and experiences I have had during training. There is a “therapeutic” sub-culture that is ignorant at best and cultist at worst.
Martha
Martha
It would be good to get your thoughts on this. It might even make a blog post rather than just a comment. The point with the book is its got nothing to do with actual clinical treatment per se – behaviour therapy for OCD for instance – its all mixed up with right wing critiques of a culture of everyone is harmed, helicoptering parents and Woke agendas. It ends up being a tedious read. Your comments on therapeutic culture might shed light on this
David
Straight Talking…
https://www.youtube.com/watch?v=4roLI_Gb12I
Feb 29, 2024 The Dr. Jordan B. Peterson Podcast
Dr. Jordan Peterson speaks with best-selling author Abigail Shrier. They discuss her landmark first book, “Irreversible Damage,” as well as her latest publication, available now: “Bad Therapy:
Why The Kids Aren’t Growing Up”. From this, they break down the state of the therapeutic industry, the overgrown tendency of professionals to “treat the well, rather than the sick,” the existence and need for necessary trauma, and the now-generational impact of harmful therapy, and by extension, harmful parenting.
Abigail Shrier received the Barbara Olson Award for Excellence and Independence in Journalism in 2021. Her best-selling book, Irreversible Damage: The Transgender Craze Seducing Our Daughters (2020), was named a “Best Book” by the Economist and the Times (of London). It has been translated into ten languages. Her upcoming publication, Bad Therapy: Why The Kids Aren’t Growing Up is slated for release in early 2024.
This episode was recorded on December 14th, 2023
Rua Da Boavista,
Guimarães,
Portugal
18th December 2019
Dear Mr Madrigal-Borloz
I am writing in response to your call for input on your ‘Report for so-called conversion therapy’. I recognise that your invitation was to ‘states’ and to organisations and that your request was to address the specific questions you presented. Unfortunately, I’m not aware of an organisation that is established enough to submit responses to those questions that represent the position outlined below but I do believe that there are many individuals who would agree with what I set below and I would like to ask you to consider my response on this basis.
I am a UK trained Clinical Psychologist who previously worked at the Tavistock & Portman NHS Gender Identity Development services (for children and adolescents) in Leeds, England. I resigned from my post partly because I believed that the gender identity assessments for children and young people were not thorough enough nor based on sufficiently robust evidence given the profundity and irreversibility of the medical interventions that children and young people were seeking that may lead to compromised fertility and compromised capacity for sexual function.
I was also very concerned that many of the young people who wished to transition had not had sufficient time nor received sufficient, compassionate support to accept their homosexual orientation, indeed there were young people wishing to transition who had experienced homophobic bullying or had parents who held homophobic beliefs.
I am deeply alarmed that there are gender clinicians and activists who are seeking to restrict gender identity assessments even further under the guise of ‘conversion therapy’ and even claiming that psychological assessment prior to the medical pathway is ‘dehumanising’. I believe that Clinical Psychologists and other professionals working with children and adolescents are already deeply anxious of being accused of transphobia if they question a child or adolescents transgender identification. I believe that further restrictions will only serve to make clinicians and professionals more anxious which would not be in the best interest of children and adolescents.
Definitions of conversion therapy in relation to gender identity and Zucker et al as purported example
Wright, Candy and King (2018) state that “conversion therapy for TGD people is a general term to describe treatments that aim to suppress or divert affirmed gender; in short to make the person cisgender, that is, no longer TGD.” (Wright et al. define TGD as ‘transgender and gender diverse’).
Their definition is notably more concrete and uses different terminology to the definition given in The Memorandum of Understanding (Keogh et al. 2016): “’conversion therapy’ is an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis.”
Wright et al. state that Zucker, Wood, Singh & Bradley’s (2012) paper met their inclusion criteria as a ‘case study of conversion therapy’ in their Systematic Review of Conversion Therapies. In my opinion Zucker et al. (2012) is a comprehensive description of the developmental, biopsychosocial model that underpinned their work with Gender Dysphoric children at Center for Addictions and Mental Health in Toronto, Canada in 2008. Dr Zucker is a Clinical Psychologist who had led the service for decades and has published extensively on Gender Dysphoria. In 2014 there was a public petition against Zucker that stated that “Part of his dehumanizing practices include teaching transgender children to be “more content with their biological gender.” Zucker was fired in 2015 but has since received an apology from CAMH as well as a large financial settlement.
I think that Wright et al.’s claim that Zucker et al. (2012) were practicing conversion therapy should be scrutinised. I can’t imagine that most UK Clinical Psychologists would agree with Wright et al. and that, instead, they would be satisfied that Zucker et al.’s summary of the 26 children (aged 3 years old to 10 years old) that attended their Gender Identity Service in 2008 shows that they were undertaking thorough psychological assessments, working systemically and providing individual psychological formulations and treatment plans to enable families to understand their child’s gender dysphoria and support them without incurring the potential risks to physical health and mental health posed by GnRHas/’puberty blockers’ and Cross Sex Hormones.
What alternative approach do Wright et al. propose for the gender dysphoric 3 to 10 year olds who attended Zucker’s clinic? I would like to see the authors describe an alternative assessment and treatment model for pre-pubescents that is also underpinned by developmental psychology with the same level of transparency and rigour as Zucker et al.
Wright et al. also state, “little consideration has been made of the concept that denying access may constitute a form of conversion therapy, obliging those who meet the criteria for a gender dysphoria diagnosis to continue physically in their natal sex.” It would be helpful if the authors could confirm whether they are referring to puberty blockers here. Are they saying that ‘denying’ puberty blockers to a child is a form of conversion therapy? It is a grave omission of Wright et al. to not present the potential long term implications of puberty blockers which include compromised fertility and compromised sexual function.
I believe that it is a great loss to all children with gender dysphoria and all professionals who seek to understand them that Ken Zucker’s clinic was closed down. I see nothing ‘dehumanizing’ in the 2012 account of the approach they were taking in 2008. I see an approach that considers the child and their family holistically and compassionately and is grounded in psychological theories and the (limited) evidence base. I think it is a great shame that Zucker’s work is being described in this way as I do not believe the practice described constitutes conversion therapy and I believe that there should be an opportunity to present a different opinion.
Controversies
As I’m sure you’re aware the subject of paediatric gender transition is highly contentious and that there are particular activists and lobbyists who are calling for the removal of ‘gatekeeping’ for medical interventions such as GnRHas/’puberty blockers’ to children and cross sex hormones to adolescents (Ashley, 2018) even though this practice has never been subject to randomised controlled trial.
You might also be aware that Brown University researcher, Dr Lisa Littman, recently published on the subject of ‘Rapid Onset Gender Dysphoria’ (ROGD) a concept that fits with many parents observations of their children’s wish to change gender. Since her study was published Littman has been subjected to intense and sustained criticism from transgender activists who dismiss her work as ‘junk science’ (Jontry, 2018) and at the 2019 USPATH conference the USPATH Board Member Dr Maddie Deutsch also referred to Dr Littman’s work as ‘junk science’. I consider this unprofessional behaviour that serves to discourage others from investigating whether ‘ROGD’ is a valid way of conceptualising the steep increase of referrals of teenage females to gender clinics across Northern Europe and North America.
Detransitioners
For decades there have been reports of adults who realised that their medical transition was a mistake and have sought to reverse it (Bindel, 2007) and more recently there have been increasing reports on ‘detransitioners’ across the lifespan (Cohen & Barnes, 2019) .
We are seeing collectives of detransitioners emerging such as ‘Detrans Advocacy Network’ (https://twitter.com/DetransAdNet) who recently launched their organisation with an event in Manchester featuring a panel of young, detransitioned women. Although the sound quality is poor I hope that you will persevere with this important document and that you will observe that the young women who have been harmed by the ‘affirmative model of gender identity’ and who should not have been put on the medical pathway by their gender clinicians are all lesbians, some of whom underwent both mastectomy and hysterectomy before realising that medical transition was a mistake. If you wish to make sense of why young lesbians might be at greater risk of being harmed by the ‘affirmative model’ I cannot recommend highly enough ‘Internalised Homophobia is More Powerful than you Know’ (2019) by GNC Centric and Thomasin.
I also urge you to read the posts on ‘detrans reddit’ (https://www.reddit.com/r/detrans/ ) an online community support space for detransitioners which will provide you with an insight into the enormous challenges combined with lack of resources and lack of support that detransitioned people face.
https://www.gccan.org/ is the website for a new organisation led by transgender and detransitioned people in the USA to strive for better understanding of gender dysphoria and better access to high quality, evidence based treatments.
https://rxisk.org/transgender-meds-a-call-for-reports/ the organisation Rxisk is currently calling for reports on adverse side effects from GnRHas and Cross Sex Hormones.
Autism and Gender Dysphoria
It has also been acknowledged that a significant proportion of adolescent females presenting at gender clinics in North America and Northern Europe either have a diagnosis of Autism or have traits associated with Autism. The association between Autism and Gender Dysphoria has not been rigorously investigated and I fear further restrictions on research and clinical practice under the guise of ‘conversion therapy’ will make it even harder for researchers and clinicians to understand this and attune their clinical practice to their particular needs.
Conclusion
I hope I have been able to convey the intensity of my alarm that ‘gender affirming’ clinicians, trans activists, and trans scholars are applying pressure to have restrictions on ‘conversion therapy’ tightened at the same time that we are in the situation of a huge demand on gender clinics across Northern Europe and North America, particularly from adolescent females, without any real understanding of what is driving this increased demand. We are also seeing an emergence of people
across the lifespan speaking up, sometimes after decades of silence, sometimes very soon after medical interventions, about how their gender transition was a mistake and that they now accept their biological sex.
We have much to learn about gender identity, and in particular we need to be able to understand the novel cohort of females with adolescent onset gender dysphoria. I hope that you will enable clinicians and researchers as well as those children and adults with gender dysphoria to have access to the most thorough understanding of their distress and high quality interventions that have a robust evidence base.
We are beginning to see emerging confidence and new perspectives on gender dysphoria and I think it would be terrible for this to be set back. I highly recommend the documentary ‘Trans-Actions’ made by UK trained psychotherapist Silke Steindinger that I believe shows the importance of inviting complexity of thinking on the needs of people with gender dysphoria.
Yours Sincerely,
Dr Kirsty Entwistle, DClinPsy
UK HCPC registered Practitioner Psychologist
Ordem dos Psicologos Portugueses registered Psychologist
References
Ashley, F. Gatekeeping hormone replacement therapy for transgender patients is dehumanisingJournal of Medical Ethics 2019;45:480-482.
Barnes, H. & Cohen, D. (2019) ‘How do I go back to the Debbie I was?’ BBC News https://www.bbc.co.uk/news/health-50548473
Bindel, J. (2007) ‘Mistaken Identity’. The Guardian UK newspaper. https://www.theguardian.com/lifeandstyle/2007/may/23/healthandwellbeing.health
GNC Centric & Thomasin (2019) ‘Internalised Homophobia is More Powerful Than you Know’ https://www.youtube.com/watch?v=k6Xe2P9c5x0&t=1705s
Herbert, J. (2016) ‘Prejudice, not science, wins the day in Toronto’ https://www.psychologytoday.com/gb/blog/hormones-and-the-brain/201602/prejudice-not-science-wins-the-day-in-toronto
Jontry, B. (2018) ‘WPATH and The Advocate aim to suppress new research on adolescent gender dysphoria’ https://4thwavenow.com/2018/02/25/wpath-the-advocate-aim-to-suppress-new-research-on-adolescent-gender-dysphoria/
Keogh, B., Calderwood, C., Ruddle, A., Newell, R., Hawkins, A., Lousada, J., & Weisz, J. (2016). Memorandum of understanding on conversion therapy in the UK.
Make More Noise (2019) ‘The Elephant in the Room: Detransition. The Elephant in the Room. Medical Ethics in the Age of Gender Identity. https://www.youtube.com/watch?v=stBt7_NTT3o
Steindinger, Silke (2018) ‘Trans-Actions: An Exploration of Gender Dysphoria’ https://www.youtube.com/watch?v=5W2lumyt1ac&t=6s
Wright, T., Candy, B. & King, M. Conversion therapies and access to transition related healthcare in transgender people: a narrative systematic review. BMJ Open 2018;8:e022425. doi:10.1136/ bmjopen-2018-022425
Zucker, K., Wood, H., Singh.D & Bradley, S. (2012) A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder, Journal of Homosexuality, 59:3, 369-397, DOI: 10.1080/00918369.2012.653309
Dr Kirsty Entwistle DClinPsy
Clinical Psychologist in Independent Practice
UK Health Care Professions Council registered Practitioner Psychologist
Ordem dos Psicologos Portugueses registered Psychologist
Location: Guimaraes, Portugal
‘in the best interests of the child’
Children to no longer be prescribed puberty blockers, NHS England confirms
The decision comes after an independent review of services for children under 18 and a sharp rise in referrals to the Gender Identity Development Service run by the Tavistock and Portman NHS Foundation Trust, which is closing at the end of March. (It is being forced to close -call a spade a spade)
Tuesday 12 March 2024 18:25, UK
Puberty blockers, which pause the physical changes of puberty such as breast development or facial hair, will now only be available to children as part of clinical research trials.
The government said it welcomed the “landmark decision”, adding it would help ensure care is based on evidence and is in the “best interests of the child”.
In 2021/22, there were more than 5,000 referrals to GIDS, compared to just under 250 a decade earlier.
She also said there was a lack of long-term evidence on what happens to young people prescribed blockers – adding that GIDS had not gathered routine and consistent data, meaning it was “not possible to accurately track the outcomes and pathways that children and young people take through the service”..
The NHS said children attending these clinics will be supported by experts in neurodiversity, paediatrics and mental health, “resulting in a holistic approach to care”. (where were they during the past years of experimenting on children)
Around 5,000 children and young people are currently on the waiting list for referral into the new clinics, with 250 patients expected to be transferred to them when they are open.
Currently there are fewer than 100 children on puberty blockers, who will continue their treatment at Leeds and University College London Hospital. (UCL is or has been very closely connected with the tavistock)
This is among the biggest news events of the day but likely to be missed in the mist of everything else going on in the world. It will be interesting to follow the coverage over the next few days or weeks.
David
New Statesman
24 March 2024
New legal challenge aims to restrict private gender clinics for teenagers
As the Tavistock Centre closes, the battle over young people’s access to gender-affirming medical treatment is intensifying.
By Hannah Barnes
Illustration by Gary Waters / Ikon Images
The only NHS children’s gender clinic in England will close its doors for good next week. The Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (Gids) will be replaced, initially, by two new regional services offering a more therapeutic model of care. Puberty blockers will not be on offer.
As I have written in the New Statesman Easter Special issue, NHS services have been at a standstill for years, and the private sector has inevitably stepped into that void. Gids staff, who haven’t been given jobs in the new gender hubs, have moved to one provider in particular – Gender Plus. It’s run by the clinical psychologist Dr Aidan Kelly, who worked at Gids between 2016 and 2021. At least nine other Gids staff, or those who have provided endocrinology services connected to Gids, are working alongside him. The private service is predominantly aimed at the 16-25 age group and will prescribe hormones from the age of 16.
But this week legal proceedings will be launched which, if successful, could hamper Gender Plus’s business model and stop others hoping to gain approval for prescribing hormones to teenagers.
The psychotherapist Sue Evans, who was the first to raise concerns about Gids when she worked there in 2005, seeks to challenge the Care Quality Commission in the High Court over its decision to license the Gender Plus Hormone Clinic. Official papers, seen by the New Statesman, accuse the CQC of breaching its statutory duties under the Health and Social Care Act 2008: “The Claimant seeks to challenge the lawfulness of the decision of the CQC on or around 9 January 2024 to register… Gender Plus Hormone Clinic to carry out the legally regulated service of ‘Treatment of disease, disorder or injury’.”
“In 20 years of work, I don’t think I’ve ever met a child that in my professional opinion, clinically, I would have said they’re fine to go forward for this treatment pathway after six sessions,” Evans, who now works in private psychotherapy practice, told me. Evans also instigated judicial review proceedings against the Tavistock and Portman trust in 2019, arguing that children could not fully consent to treatment with puberty blockers.
This time it’s hormone treatment not puberty blockers that are the subject of litigation. “I believe that we need to continue to be cautious where children’s lives are concerned,” said Evans. “The kids that I meet – who are 16, 17 – so many of them are still struggling with all sorts of issues; they’re only just finding out who they are and their identity. And so I feel compelled to keep standing up.”
Evans’s new case argues that the CQC have agreed to regulate a treatment that has not been shown to be either safe or clinically effective. In bringing the legal action, Evans and another claimant – the parent of a 15-year-old who is seeking treatment with puberty blockers and hormones – hope to prevent private clinics prescribing to under-18s.
In October 2020, the National Institute for Health and Care Excellence (Nice) undertook a systematic review of the evidence relating to the use of “gender-affirming” hormones in the treatment of young people with gender dysphoria. It concluded: “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.” It found that studies examining the impact of these drugs on under-18s were poorly designed and “subject to bias”, producing findings of “very low certainty”.
The anonymous parent who is launching the legal action alongside Evans is currently involved in litigation in the family courts with her ex-husband, and has obtained an interim order forbidding their child to access hormone treatments outside the UK. The child is now seeking to explore treatment with Gender Plus. The company’s staff have said publicly that they would “definitely” assess 15-year-olds, so that they could start accessing medical treatment at 16.
Paul Conrathe, who is representing both Evans and the parent, described the CQC’s decision to grant Gender Plus’s licence as a “leap in the dark”. “As regulator, the CQC is responsible for ensuring the public and especially the vulnerable and children receive safe and effective medical treatment,” he told the New Statesman. “Concerns for this treatment are particularly serious given the irreversible lifelong consequences and that it is given to a vulnerable group of teenagers.”
In an unexpected development on Thursday 21 March, NHS England quietly announced that new youth gender services will provide masculinising and feminising hormones to children from “around their 16th birthday”. This is a departure from Gids policy, which stipulated that young people could only access hormones at 16 if they had been on puberty blockers for a year. It appears to be at odds with the cautious stance towards medical interventions – evidenced by its decision to no longer prescribe puberty blockers – which underpins the model of care these new hubs are planning to follow.
Somewhat surprisingly, NHS England’s announcement makes no mention of Nice’s 2020 systematic evidence review, instead citing three documents which informed the new policy. One of the three is more than a decade old, and two relate to the treatment of adults only.
In other places, the policy refers to guidelines and documents that no longer exist. For example, the policy states: “The provider must be compliant with the British Society for Paediatric Endocrinology and Diabetes, UK Standards for Paediatric Endocrinology (2010)”. That particular document was last updated in 2019.
Children who are experiencing “psychotic episode[s], drug addiction or self-harming” will be eligible for hormones, as long as the “associated difficulties… are not escalating”, the new policy says. There is no stipulation of how long a young person will have to be seen before being eligible for hormones, with the duration of assessment being “determined by the clinical team as relative to the needs of the individual”.
One safeguarding measure in place is that a team not directly involved with the individual seeking hormones will have to agree that the child is suitable and meets all relevant criteria.
Gender Plus argues that its approach to care is in line with best practice, as demonstrated by NHS England’s new policy.
Conrathe told the New Statesman that the new policy did not change the case being brought against the CQC, as he claimed there remained no robust evidence underpinning the treatment.
Defending its decision to grant registration to the Gender Plus Hormone Clinic, a CQC spokesperson said: “Best practice guidance for gender identity clinics was considered by internal specialist advisers during the registration assessment and the registration was granted subject to the condition that the regulated activity must not be delivered to service users under the age of 16.” The spokesperson added that the CQC had not yet inspected the private gender clinic. “We are not able to comment further on active legal proceedings.”