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Why we need an inquiry into gender treatment for children

Governments need to worry less about upsetting lobby groups and rather more about protecting children

Sajid Javid is right to worry about the way the NHS has treated children who identify as transgender. The Health Secretary is reported to be preparing an urgent inquiry into the issue, and planning an overhaul of how the health service treats young people with gender dysphoria.

He is the Secretary of State for Health and Social Care, so it is his job to be concerned. But for too long ministers have shied away from what future generations may consider to be a scandal of epic proportions.

In England, children presenting with gender dysphoria are referred to a single NHS provider – the Gender Identity Development Service (GIDS) operated by the Tavistock and Portman NHS trust. Dr Hilary Cass is currently undertaking a review of GIDS. In her interim report published in February, she said:

A fundamentally different service model is needed which is more in line with other paediatric provision, to provide timely and appropriate care for children and young people needing support around their gender identity. This must include support for any other clinical presentations that they may have.

Cass Review – Interim Report

Cass was right to highlight the fundamental problem faced by GIDS clinicians. The evidence base is inconclusive, and – perhaps worse – there is not even consensus on the condition they are treating. The report highlights that:

A lack of a conceptual agreement about the meaning of gender dysphoria hampers research, as well as NHS clinical service provision.

Cass Review – Interim Report

As someone who was diagnosed with gender dysphoria as an adult, I am not surprised. Gender dysphoria is not like the measles or the mumps where there are objective tests to support a diagnosis. The only source of evidence is the word of the patient. If you claim to be dysphoric about your gender – whatever that means to you – then you have gender dysphoria. Moreover, the patient then specifies the treatment for the condition. For me that was hormone therapy and gender reassignment surgery. Perhaps my life was improved, perhaps it wasn’t, but my own gender clinic has no clue either way. I was discharged two months after my surgery in 2016, and I’ve had no contact since.

But – arguably – adults are responsible for the choices we make about our own bodies. Cass and Javid are talking about children. Youngsters deemed too immature to consent to a tattoo – presumably because tattoos leave permanent marks – have been put on a course of treatment to stop their normal development during adolescence, with drugs that were never even licensed for that purpose.

Javid is said to be particularly alarmed by Cass’s findings that some non-specialist staff felt ‘under pressure to adopt an unquestioning affirmative approach’ to transitioning and that other mental health issues were ‘overshadowed’ when gender was raised.

This suggests to me that the clinical approach is being driven not by evidence but by ideology – the concept that we all have a mysterious ‘gender identity’ that is somehow more important than our biological sex when society needs to distinguish between men and women.

Recent cases in sport have alerted a wider audience to the impact on women. Female swimmers for example were left to compete for second place when Lia Thomas – a biological male – stepped onto the poolside.

But sporting outrages can be rectified more easily than the arrested development of children. The long-term prognosis for youngsters whose puberty has been blocked is not known because doctors have never before conducted such experiments on adolescents.

Of course, not all children referred to GIDS have been prescribed puberty blockers, and many others are languishing on long waiting lists. However, assuming that their parents have not succumbed to private providers who write prescriptions for a fee, they are left in a state of limbo – thinking that there is a treatment available that would solve all their problems, but out of their reach. What must that do to anyone’s mental health?

Children are suffering now, so Javid is right to step in now with an urgent inquiry, even while we await Cass’s final report. There has been too much dithering, and for too long. Yes, there is likely to be criticism and condemnation from the LGBTQIA+ lobby, but governments need to worry less about upsetting lobby groups and rather more about protecting children.


Debbie Hayton is a teacher and journalist.

* This article was first published by The Spectator on 24 April 2022: Why we need an inquiry into gender treatment for children.

By Debbie Hayton

Physics teacher and trade unionist.

6 replies on “Why we need an inquiry into gender treatment for children”

Sorry Debbie, I seriously disagree with the point “Gender dysphoria is not like the measles or the mumps where there are objective tests to support a diagnosis. The only source of evidence is the word of the patient. If you claim to be dysphoric about your gender – whatever that means to you – then you have gender dysphoria. ‘
What you are citing is the standard trans ideological mantra. Whilst I agree that there are no physical manifestations of gender dysphoria, or transsexualism, there are a number of indicators which an experienced psychiatrist/ psychologist can use in their diagnosis. Why do you think the activists want any medical intervention removed in the Scottish GRA proposals. The TRA’s believe that each individual can determine if they have GD and how to treat it, medically or socially, and as such they can demand whatever hormones, drugs, surgery etc., they deem appropriate.
In Scotland, we have a document published by the NHS, which sets out the pathways. England were supposed to follow suit, but I have never seen anything ratified in the English NHS.

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I’m in the United States, so I don’t know all the details of what is happening n Great Britain, but it seems to me that this is an area in which doing nothing is perhaps the least harmful “treatment” for children. My point of view, however, is unique, as I believe in reincarnation. Children may be remembering a previous life in which they were indeed a different sex. In this life, however, the majority of children need to accept their sex as their gender and proceed accordingly. Even if reincarnation is not a factor, and children are simply confused about their gender because they are “new” human beings who are unfamiliar with the concept, it seems obvious to me that the majority of children will have better life outcomes if they try to identify with the sex of their body. Indeed, up until medical intervention became a possibility, that’s what all children did. I think that it is fair to say that a life of being “cis” is more likely to be a happy life than a life of being “trans”. In the “cis” life, there is no conflict between body and feelings, whereas in the “trans” life the conflict may persist into old age. Furthermore, I just don’t believe that children have the right to choose their gender for the adult yet to come. Changing genders (which isn’t really possible anyway) is an adult decision that must be made once the individual has grown up, even if that means that you must resign yourself to being a six-foot woman.

Before I finish this comment, let me remind readers that there is nothing kooky about the concept of reincarnation. It is integral to several major human religions, most notably Hinduism and Buddhism. It makes a good deal more sense than the Christian concept in which you live one life and then end up in fictional fantasy-lands called “heaven” or “hell” depending on how skillfully you lived that life.

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Very interesting and disturbing article, Debbie, and we certainly do need an inquiry (though I also don’t hold much hope that it’ll see the real issue).

I really think we’ll look back on the current casual acceptance of trans-gender desire (especially in children) and the consequent medical intervention as a tragic cultural folly. I have only a sketchy understanding of the DSM diagnosis, but, reading through the criteria, I’m shocked by how vague the terms are. Unless there is some underpinning of such terms as “clinically significant distress”, “strong desire”, “strong dislike”, in assessors’ training, it’s little wonder service provision is a lottery.

But – as I’ve said before – it’s worse than that. The criteria themselves – such as a boy’s “strong rejection” of certain toys or “rough-and-tumble play”, or certain preferences for clothing choice – are idiotic, the result of cultural miopia and fundamental sexism. Some of the list (of which one needs a score of six to qualify) actually repeat the same point, once relating to children of either sex, then specifically for “boys (assigned gender)” and “girls (assigned gender)”. The list is so silly I wouldn’t be surprised if it included, “In boys (assigned gender), a strong liking for the colour pink.” It actually does include girls not wanting to wear skirts, and boys who like wearing them, or who like playing with dolls, it just puts it in jargon to make it sound reasonable.

It’s hard to find words to express how monstrously idiotic these ideas are. Some of us remember how shocking it was when women began wearing trousers and business suits – but their sex wasn’t seriously questioned; they were exercising their freedom to wear a piece of cloth of a certain shape (and take management positions). We would now see the previous mentality as ridiculous – the idea that women can’t wear trousers!!! Yet we’re blind to our current sexism. It’s just our cultural wallpaper.

We should be encouraging boys to play with dolls. The world needs more nurturing fathers. We should be encouraging girls to play with machines if we’re to get more going into STEM subjects. Neither should have anything to do with their gender. That’s precisely what’s wrong. The DSM even refers blithely to “toys, games, or activities stereotypically used or engaged in by the other gender.” It is the stereotypes that are the problem, and this travesty of medical gobbledygook just reinforces them and takes them seriously as the criteria for diagnosing a very serious clinical condition.

Imagine if height, rather than sex and sexual attractiveness, became the obsession of a culture. Imagine the height dysphoria diagnostic criteria – a strong dislike of the person’s current height, a strong desire to be short/tall (with self-reported “clinically significant distress”, of course) – with a positive result putting us on a waiting list for leg extensions or bone-shortening operations.

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Most Buddhists, including the Dalai Lama, believe in reincarnation. My sister, who was a Buddhist monk for about a decade, gave me similar explanations to what you have given me, but ultimately she believed in reincarnation. The Dalai Lama has been quoted as saying that we live thousands of lives.

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