Alison O’Connor: Trans community collateral damage in social media policing

Keira Bell outside the Royal Courts of Justice in central London, where a landmark case to stop the NHS prescribing "experimental" puberty blockers and cross-sex hormones to children who wish to undergo gender reassignment has reached the High Court. Picture: PA

The blurbs for a book I’ve read recently mention the author’s bravery on a couple of occasions. In book terms, it’s a word often reserved for war reporters, perhaps someone who infiltrated a dangerous crime gang or who overcame a horrendous life experience.

But the way in which this woman, a columnist with the Wall Street Journal, is said to have taken her courage in her hands is to write about the transgender debate in the US in her book Irreversible Damage: The Transgender Craze Seducing Our Daughters. 

In it, Abigail Shrier points out that, until a few years ago gender dysphoria — severe discomfort in one’s biological sex — was rare. It was typically found in the US in less than 0.01% of the population, emerged in early childhood, and afflicted males almost exclusively.

But in the US today, Shrier says, whole groups of female friends in colleges and schools are coming out as transgender. 

Hundreds of interviews

In her research for the book, she conducted nearly two hundred interviews and spoke to over four dozen families of adolescents and repeatedly heard of these girls who had never previously experienced any discomfort in their biological sex.

Shrier spoke with unsuspecting parents who now find their daughters in thrall to YouTube stars and ‘gender-affirming’ educators and therapists, pushing life-changing interventions on young girls.

The experience is not limited to the US. In the UK, there has been a near-30-fold rise in child referrals to the Tavistock and Portman NHS Trust which has run the main gender identity clinic there for the past decade, to around 2,560 last year.

Sources familiar with the situation in Ireland say similar patterns are occurring here, both in terms of growth in numbers of youth referrals and that what used to be a majority of boys presenting as having gender issues has now reversed, with the significant majority now being girls. 

Those involved are extremely reluctant to talk publicly given the reaction to those that have and resources are a long-term, ongoing issue.

UK High Court ruling

Last week, the UK High Court ruled that children under the age of 16 considering gender reassignment are unlikely to be mature enough to give informed consent to be prescribed puberty-blocking drugs. Even in cases involving teenagers under the age of 18, doctors may need to consult the courts for authorisation for medical intervention, it ruled.

Keira Bell, 23, who previously identified as a boy and was given puberty blockers at the age of 16 by the Tavistock clinic, took the case. After three one-hour appointments, she was prescribed puberty blockers before she was put on testosterone. 

As part of her treatment, she had a double mastectomy three years ago. She believed the treatment would help her “achieve happiness”, but said her other mental health issues were not addressed, adding: “It was heartbreaking to realise I’d gone down the wrong path.”

Treatment in Ireland

In Ireland, we have been relying on a satellite clinic from the Tavistock which is held at Our Lady’s Hospital for Sick Children in Crumlin. In 2017, around 35 Irish children were referred there for treatment compared to just one child in 2011. At present, there are fewer than 20 patients attending this Gender Endocrinology Service at Crumlin.

According to Children’s Health Ireland (CHI), the body which governs and delivers acute paediatric services currently at Crumlin, Temple Street, and Tallaght Hospitals, “some of those patients are on GnRH Gonadotropin-releasing hormone”. 

These hormones are more commonly known as puberty blockers. It also stated that based on international guidelines, treatment can only be considered for patients, following extensive multi-disciplinary assessment, “who are at least Tanner Stage 2 puberty”.

Stage 2 of those Tanner guidelines — which outline the sequence of changes that occur in puberty — state that this particular phase for children “marks the beginning of physical development. Hormones begin to send signals throughout the body.”

CHI says the UK High Court ruling “has been escalated to the HSE to evaluate” as commissioners of this service from the Tavistock. There are also plans to meet with the HSE to discuss the service.

Irish court decisions 

Will the Irish courts now decide on the prescription of hormone blockers here? Around 40% of children who present here as gender questioning will qualify for medical intervention.

In actuality, our gender treatment services in Crumlin operate on somewhat of a wing and a prayer. As per the CHI statement, treatment can only be considered for patients post extensive multi-disciplinary assessment. However, the Crumlin team does not include a key member — a consultant psychiatrist in child and adolescent psychiatry who specialises in the area.

A psychiatrist would also assess other issues the children present with, for instance, such as deliberate self-harming, concerns about suicide, depression, or possible autism.

The two psychologists from the Tavistock Clinic have been providing Zoom counselling during the pandemic, but this contract is due to conclude at the end of the year.

An additional endocrinologist who was appointed to work in the transgender service in Crumlin has since left. According to some assessments, there are around 70 children waiting to avail of this psychological service. There is a long waiting time of three years.

Managing transitions

In 2018, the Royal College of Physicians in Ireland made a submission to the Consultation on the Gender Recognition Act 2015. 

In it, Professor Donal O’Shea, a consultant endocrinologist who has treated people with gender issues for 25 years, said that, appropriately managed, the outcome in individuals with true gender dysphoria, transitioning to their identified gender with appropriate support, is extremely positive.

But he warned that outcomes, where transitioning happens without the appropriate planning and supports, can be “disastrous”.

He notes a change in pattern of referrals at the time, with more patients presenting at younger ages, as well as a significant increase in individuals with gender confusion, gender fluidity, and autistic spectrum behaviour.

This, he said, did not impact on the gender issue for the individual but may impact on suitability to progress.

Medical and surgical treatment of an individual with gender confusion or fluidity will be regretted.

An issue with gender is not the same as gender dysphoria requiring gender reassignment, Prof O’Shea stressed.

“In our service, where over 300 patients have attended we had had three individuals who have regretted their gender reassignment post-operatively and several who have stopped their transitioning journey at various points.

“That is not to say they did not have gender issues, rather it was that hormonal and surgical reassignment was not appropriate to their overall situation. 

"This can be as a result of autistic spectrum issues, personality issues or developmental disorders.”

Utter ignorance

Huge strides have been made in the understanding of this area — strides which were necessary given the utter ignorance that used to exist, as well as gross discrimination.

Trans people around the world continue to be subject to the most awful treatment, not to mention serious violence, including murder.

However, this has also — somewhat incredibly — become one of the most toxic and dangerous issues to raise publicly. This is a real disservice to the trans community who often end up as collateral damage in a row that has so much to do with “cancel culture”.

You may attempt to express solidarity and concern for this vulnerable group, but any dissent from the ‘orthodoxy’ is seen by some as heresy. 

There is a vocal, often sustained and sometimes abusive coterie on social media who take it upon themselves to police anything and everything said about the trans issue.

This is cult-like behaviour — no dissent allowed.

How have we ended up here? It certainly harms the prospects of children who are gender questioning if their care cannot be considered in a non-hysterical fashion, or where doctors are afraid to express their opinions.

This issue is multi-faceted. But to help trans people find their proper place in life and society, surely maulings on social media, or of people with a different point of view do substantially more harm than good.