A friend recently told me she spent four years of her childhood living as a boy. ‘I hated dresses, cut my hair, gelled it and spiked it,’ she says. ‘From aged eight, I thought I was meant to be a boy. I remember going into a swimming pool changing room in board shorts and the girls shrieking: “It’s a boy!”’
It wasn’t until my friend hit puberty that she began to feel more comfortable in her gender. By her mid-teens she was living happily as female. Now she’s a married mother of three who looks back on her tomboy phase with an air of amusement. Yet she shudders to imagine what might have happened if she’d been a child going through the same thing today.
Over the past 30 years, our attitudes towards gender and transgenderism have shifted dramatically. A greater acceptance of LGBT equality means that more adults are now living as a gender different to their birth sex. But what approach should we take to children who exhibit so-called ‘gender-nonconforming’ behaviours? Should we be so ready to accept a child’s declaration that they want to live as the opposite gender? And should we grant them access to medical treatments (such as puberty-blocking drugs) which would enable that in the future?
Some think so. In the past few decades, the number of children being referred to specialist gender services has increased dramatically. Referrals to the Tavistock Gender Identity Development Services (GIDS) — the NHS’s only gender identity service for children — have jumped 1,000 per cent since 2012 (up to 2,590 this year). Of those referred, nearly half will go on to have medical intervention, which can include puberty blockers which are intended to give them time to mull over their decision. A Dutch study suggests that almost all of those who take blockers progress to hormone treatment, which leads towards surgery at 18.
But is the rise down to a more accepting attitude towards all things transgender, or is something more worrying at play? Over the past year, senior medical professionals have come forward to express their concerns that an over-readiness to recognise young people as transgender could be leading to vulnerable children — and in particular young girls — being wrongly referred for life-changing treatments. They worry that clinicians are wrongly interpreting signs of complex conditions, such as depression and autism, as evidence that a child could be transgender.
In February, Dr Marcus Evans, an NHS psychoanalyst, resigned from his position as governor of the NHS Trust which runs GIDS, warning that too many clinicians were looking for ‘quick solutions’ to so-called gender-nonconforming children. His resignation followed a report into the service, compiled by the Trust’s then staff governor, branding it ‘not fit for purpose’. The report stated that ‘children’s needs are being met in a woeful, inadequate manner and some will live on with the damaging consequences’. It also revealed that many children were being referred from GIDS for medical intervention after just a handful of consultations (in some cases, only a single meeting).
‘This is one of the most complicated clinical areas of mental health and clinicians are often put under huge pressure to refer individuals, who believe this will solve their dysphoria, on for medical interventions,’ Dr Evans says. ‘Adolescence involves biological, psychological and sociological changes, and feelings of anxiety and confusion about their role required by society, and experimentation. I’m not saying no to gender transition, but services should resist the pull towards a quick solution that bypasses thoughtful exploration. How an adolescent feels now may not be how they feel in ten years’ time.’
He’s not the only practitioner to think so. Professor Carl Heneghan, who heads the Centre for Evidence Based Medicine at Oxford University, has called for a change in tack, stating there is no conclusive data for making an informed decision about the long-term benefits or cost of treatment. Others point out that 80 per cent of the children referred to specialist clinics will abandon intervention and live in their original gender — although not until after they have begun potentially disruptive treatments.
A senior psychoanalyst (like many I contacted, they asked to remain anonymous) told me ‘children are being seriously damaged’. ‘Gender dysphoria is being treated like an aesthetic,’ he said. ‘How can you consent for a 12-year-old? They’ll be infertile, on medical treatment for life, and if you cut out a piece of their gut to turn into a vagina, you’re not really making them into a woman. There should be a distinction between what someone wants and what is good for them.’
What has gone wrong? Some point to the influence of campaigners pushing a new approach to transgenderism: one based on self-identification (where an individual has the absolute right to decide their gender) and where medical professionals, as well as parents and teachers, are expected to affirm rather than scrutinise a child’s decision. The rise of this approach means that practitioners are being discouraged from applying adequate scrutiny to suspected cases of gender dysphoria in children.
Similar concerns are being raised within the education establishment. Last year, Stephanie Davies-Arai, a mother of four and teacher trainer, founded an organisation called Transgender Trend, with the aim of countering the wave of new teaching resources which she says are pushing an oversimplified view of transgender identity. Davies-Arai believes schools are key to helping children with gender dysphoria, but is concerned teachers are being encouraged to cast aside their ‘usual professional eye and understanding of child development in a political exploitation of the most vulnerable children’. Her view is that by adopting what she terms a ‘trans-affirmative’ approach, schools are endorsing the child’s confusion about their gender, ‘solving’ complex developmental issues with an ‘identity badge’ and setting children on a path towards medical transition.
Davies-Arai highlights one well-circulated pack which advises science teachers labelling the genitals to ‘make it clear that most, rather than all, boys have a penis and testicles and most, rather than all, girls have a vulva and vagina’. This, she believes, is evidence that schools are being encouraged to take an ideological approach to transgender issues, which focuses on the abstract concept of gender identity at the expense of biological differences between the sexes. ‘Recognition of biological facts is not bigotry,’ she said, adding that the Education Act 1996 requires both views to be given on any controversial political point.
She’s concerned, too, about safeguarding. Statutory guidelines advise teachers never to promise confidentiality to a child. Yet some trans resources — and the schools I have spoken to — encourage teachers to uphold a child’s confidentiality in all circumstances, including withholding information from their parents. The guidance also advises trans pupils to use the toilets that correspond with their gender identity, and to confront worried pupils about their transphobia. Davies-Arai says this should be a red flag: statutory guidance is for single-sex toilets after the age of eight. Protecting the trans student is paramount too — any approach should be with the awareness that potential side-effects of medical intervention on brain and bone development are not yet known.
What is the correct approach for schools? Evidently an understanding of transgender issues is important for a school to carry out many of its pastoral duties, not least combating bullying and ensuring an inclusive and welcoming environment. It’s relevant, too, to a school’s mental health procedures: suicidal thoughts are known to be high among young people identifying as transgender (estimates say as high as 41 per cent). So it’s more than understandable that more schools are taking a proactive approach. But these policies need to be balanced against those which protect the rights of other students: for example, the use of single-sex toilets and changing facilities.
Dr Evans stresses schools need to take time to understand the factors which might influence a child’s behaviour. Some 35 per cent of children referred to GIDS have autism spectrum disorder, many have suffered trauma, or are merely struggling to meet social media ideals of their biological gender. There has been particular concern, for example, that young girls with autism may exhibit stereotypically ‘male’ interests and be referred to gender services (around 70 per cent of current referrals are girls).
Adolescence is a time when we try on various looks and throw them off again — 80 per cent of childhood gender dysphoria resolves during this phase. A 1,000 per cent increase in six years after decades of static figures is abnormal. And if we hurtle headlong into affirming every Jess who wants to be James largely due to fear of being branded transphobic, we’re treating this generation of children as guinea pigs in a dangerous experiment.