The Cure That Creates The Illness

The Times is having a stopped clock moment:

The mistreatment of children at the Tavistock’s gender identity clinic ranks as one of the gravest medical scandals in recent history. By the time the NHS-run service was permanently closed last March, it had become a matter of routine for its clinicians to prescribe trans-identified children with drugs that arrested the onset of puberty. Though misleadingly presented as a consequence-free intervention, in reality the majority of the thousands of children given puberty blockers advanced to cross-sex hormones, and some to brutalising and medically-unnecessary surgeries.

What makes the scandal at the Tavistock all the more shocking is that its excesses were no accident: they were the predictable result of implementing the mistaken ideology that some children are born into the wrong sex. Taking this pernicious but fashionable belief at face value led doctors to abandon an array of professional norms and standards of good practice with alarming zeal.

As Dr Hilary Cass’s landmark 2024 report into the NHS’s gender services concluded, the rationale for the use of puberty blockers on children remains “unclear”, with only “remarkably weak evidence” available as to their long-term effects. Yet perversely, Dr Cass’s accurate highlighting of the scant evidence base for the experimental treatments used at the Tavistock is now poised to set in train a process that is all but certain to see more children harmed. On Friday the NHS announced plans to launch a £10.7 million clinical trial looking into the drugs’ effects, with trans-identified children once again to be used as the human guinea pigs. This study cannot be allowed to proceed.

Within days of becoming health secretary last year, Wes Streeting announced an emergency ban on puberty blockers in the NHS. In December there followed a ban on private prescriptions. Both steps were entirely justified. Though there is little high-quality evidence about puberty-blockers’ longitudinal effects on children, there is strong prima facie reason to think their side-effects dangerous and any supposed benefits negligible. Originally developed to treat prostate cancer, and occasionally used in the chemical castration of male sex offenders, puberty blockers act on the pituitary gland to shut off the natural production of sex hormones. They have never been licensed for use by children suffering feelings of cross-sex identification, but little in the way of medical expertise is needed to imagine their potential harms.

Puberty is not an optional extra in a healthy human being’s biological life plan. It is a extended physiological process involving a range of fundamental cognitive and psychological changes. Suppressing it is a disaster for the individual concerned. The notion that an ethical trial should be undertaken to establish the possible downsides of chemically sterilising children is as macabre as it is irrational. That research could be conducted over a long enough time-scale to establish informative results, while remaining experimentally well-controlled, is just as dubious.

Recent data from GP records suggests the number of children diagnosed with gender dysphoria has increased 50-fold over ten years. That trend, however, bears all the hallmarks of a social contagion, one aided and abetted by social media. Confronting such developments, adults, not least doctors, have a responsibility to prevent, rather than collude in, the mistaken choices children are liable to make about their own best interest.

And Victoria Smith writes:

The NHS has this week announced its £10.7 million clinical trial into care for gender-distressed children, following the recommendations of the Cass Review last year. Including the prescription of puberty-blocking drugs — currently banned in the UK — the trial has been christened Pathways. As if there are multiple ways of becoming an adult in a sexed body, as opposed to just one.

Dr Hilary Cass herself has welcomed the news, but there are many who had hoped it would never take place. In another world, the Cass Review would have offered a route — tentative at first — to undoing what is a medical scandal of epic proportions. For the past decade, more and more children have been subjected to damaging treatments based on the lie that one can be born in the wrong body. The pertinent question should be “How did this happen?”, not “How damaging is it, really? And if we’re careful and ask the right questions, can we still make it look okay?”

Perhaps we should not be surprised that things have progressed in this way. When it comes to “gender-affirming care”, it is hard to acknowledge that so many people have been complicit in doing so much harm. It is natural that many will want to keep insisting that this is an incredibly complex area where more data is needed. After all, “Let’s do more research” feels, on the face of it, much more reasonable than “This has always been a terrible idea and anyone could have seen this from the outset.” But the latter position is the correct one.

There is already plenty of evidence that puberty blockers have a negative impact on bone density and brain development, and that almost all of those who are prescribed them end up taking cross-sex hormones. Even if that were not the case, seeking to press pause on an essential life stage is intrinsically damaging in social and emotional terms. Blockers do not create a neutral space for learning the truth about one’s “real” self, free from the onslaught of adolescent hormones and the stress of a changing body. As the detransitioner Keira Bell told the Beyond Gender podcast this week: “the trope that [blockers] buy you more time is a complete lie, because your body’s in shutdown”.

The limited scope of the Pathways trial, not least its proposal to monitor participants for just two years, creates the uncomfortable impression that the aim is not to find better data. Instead, it is to find a way of justifying what is already, self-evidently, wrong. Regular brain scans may or may not show damage within the two-year window, but as the psychotherapist and Tavistock whistleblower Marcus Evans has tweeted, “the consequences won’t be evident in two years, when individuals may still be caught in the euphoria of having seemingly triumphed over their biological development. The real reckoning will come in twenty years, after prolonged use of puberty blockers, cross-sex hormones, and surgical interventions”.

Puberty blockers are the cure that creates the illness. The very existence of the Pathways trial implies that halting puberty, rather than supporting a distressed child through it, is not in and of itself a form of abuse. It implies that, unless there are specific negative effects unrelated to the glaring one of pausing a child’s development, the treatment is justified. It is like deciding cutting is not harmful if septicaemia can be avoided, or rubber-stamping bulimia as a coping mechanism providing the cost to tooth enamel is lower than assumed.

It is missing the bigger picture. No one knows, two, three, four years after going through puberty, whether it was “worth it”. This is not a meaningful question. You grow and change, even when it hurts, because that’s what being human is. No £10.7 million trial is going to prove otherwise. Simply, it should not be taking place.