Modern Wisdom - #611 - Hannah Barnes -The Collapse Of The UK’s Gender Identity Clinic

Episode Date: April 6, 2023

Hannah Barnes is an award-winning investigative journalist, and an author. Finding your place in the world can be hard. However, some interventions for struggling children may cause more harm than good. Britain's Gender Identity Development Service at The Tavistock Clinic has recently been shut down after controversial use of puberty blockers and Hannah's investigation uncovers exactly what happened. Expect to learn why there was a huge increase in the number of children being referred for puberty blockers, just how ideological this institution was, whether the effects of puberty blockers can be reversed, whether children can consent to life altering medication, just who is to blame, how these treatments can put children on a one-way-ticket to much more serious procedures and much more… Sponsors: Get 10% discount on Marek Health’s comprehensive blood panels at https://marekhealth.com/modernwisdom (use code: MODERNWISDOM) Get 15% discount on Bon Charge’s red light therapy devices at https://boncharge.com/modernwisdom (use code: MW15) Get a Free Sample Pack of all LMNT Flavours with your first box at https://www.drinklmnt.com/modernwisdom (automatically applied at checkout) Extra Stuff: Buy Time To Think - https://amzn.to/3GkjIRX  Get my free Reading List of 100 books to read before you die → https://chriswillx.com/books/ To support me on Patreon (thank you): https://www.patreon.com/modernwisdom - Get in touch. Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx YouTube: https://www.youtube.com/modernwisdompodcast Email: https://chriswillx.com/contact/  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello friends, welcome back to the show. My guest today is Hannah Barnes, she's an award-winning investigative journalist and an author. Finding your place in the world can be hard, however some interventions for struggling children may cause more harm than good. Britain's gender identity development service at the Tavistock Clinic has recently been shut down after controversial use of puberty blockers and Hannah's investigation uncovers exactly what happened. Expect to learn why there was a huge increase

in the number of children being referred for puberty blockers, just how ideological this institution was, whether the effects of puberty blockers can be reversed, whether children can consent to life altering medication, just who is to blame, how these treatments can put children on a one-way ticket to much more serious procedures, and much more. A very spicy, probably quite hotly contested topic today, however, Hannah is unbelievably measured in the way that she puts this across. It's evident that she is really trying hard to be objective, to not try and trigger tribal responses.

The work that she's done here is super, super impressive. I really hope that you enjoy this one. In other news, this episode is brought to you by Marik Health. I wanted to get a full blood panel done a couple of months ago and after asking around Marik Health came back as the most highly recommended and most premium service that you can get. I loved it so much that I actually reached out to the owner and said I want to partner with you on the show. I think that there is so much potential upside that you can have for your performance and your health by getting a proper high quality blood panel and then a ton of recommendations, not just for your lifestyle and books and dietary

requirements, but supplementation and pharmacological interventions as well. You can stop guessing when it comes to your health. Marick Health is a telemedicine company that uses blood work to provide valuable insight into how your body is functioning and what might need to be changed to improve performance and longevity. With Marik's comprehensive lab tests, you'll receive biomarker feedback with actionable steps to improve your metabolism, libido, mood, cognitive health and more. Once you get your labs done, you will have the choice to meet with a medical provider to discuss potential treatment options. So, if you want to stop guessing when it comes to your health, if you want to work out what is going on inside of your body, and if you want the highest quality recommendations

from the best service that I've found, go to marichhealth.com slash modern wisdom that M-A-R-E-K health.com slash modern wisdom and use the code modern wisdom, a checkout to get 10% off your first lab order. In other, other news, this episode is brought to you by Bon Charge. Bon Charge is a holistic wellness brand with a huge range of evidence-based products to optimize your life in every way. Founded on science and inspired by nature, all Bon Charge products adapt ancestral ways of living into our modern-day world.

I am a massive fan of their red light therapy devices. I'm actually using mine for about 10 to 20 minutes, most mornings whilst I'm meditating. And the reason that I love it is it's both near infrared light and red light therapy all in one. It just feels fantastic. I feel more energized. I definitely feel more awake.

I'm a massive fan. Also, you can get a 15% discount if you go to boncharge.com slash modern wisdom and use the code mw15 at checkout. That's boncharrge.com slash modern wisdom and the code mw15 at checkout. And in final news, this episode is brought to you by Element. Element contains a signed back electrolyte ratio of sodium potassium and magnesium with no junk, no sugar, no coloring, no artificial ingredients, no gluten, no fillers, and no BS. It plays a critical role in reducing muscle cramps and fatigue, while optimizing brain health,

regulating appetite, and curving cravings. But most of all, it just tastes good. It is a salty, sweet, fruity drink. First thing in the morning, the orange flavor is phenomenal. It means that you don't need to have a coffee upon waking. It's optimizing your adrenal system. It's making you more hydrated. It means that you're going to sleep better on a night time. They're the exclusive hydration partner to team your say weightlifting and the special forces and Navy SEAL teams and FBI sniper teams and a bunch of other tech leaders and everyday athletes around the world. Plus they have a no BS, no questions asked refund policy. So you can buy it 100% risk free. And if you don't like it, they'll give you your money back

and you don't even need to return the box. Head to drinklmnt.com slash modern wisdom to get a free sample pack of all eight flavors with your first box. That's drinklmnt.com slash modern wisdom. But now ladies and gentlemen please welcome Hannah Barnes. bonds. How did you feel before releasing this book and during the research? What did you think the sort of response was going to be like upon revealing your investigation and what it actually been like since it's come out? I think the weeks and months prior to publication were the worst. I was very, very nervous

and it had been years of work and it's a bit like, it was a bit like a third baby really, I've got two kids and you take your baby out into the world and you want people to love it. Obviously not the way that you do and I love my children more than my work, but I was really nervous about how it would be received and the response that I would get as well. And I have to say, I've been so pleasantly surprised in that the response has been overwhelmingly

positive. I mean, there have been favorable reviews on the left, on the right of British politics. I've spoken with public service radio in Australia the first time the ABC have really looked at this topic, acknowledging that people do have concerns about the evidence base in particular or are spoken to NPR over there in the States. And I think when you get favorable reviews for your British viewers, from the Guardian newspaper, from the Observer, from the New Statesman, but also from the Telegraph, the Mail on Sunday, the Sunday Times, the Times, you know, it really speaks to what I was trying to do with this book, which is this is a health story. It's not an ideological story. I'm not a cultural warrior in any way. It's about whether

the best care was always provided to each and every one of the young people being seen at that gender clinic. It seems like for the very well-meaning people who are trying to raise well-meaning concerns around the ability to consent, the effectiveness of different treatments, the confusion, both on both sides of the consultant desk around how this stuff works, that because it is so ideologically heated, it's incredibly difficult. And also, I would actually say that some of the people on the right have made this a more difficult conversation to have because of how inflammatory and how reactionary some of their conversations have been, because it's very easy to lambast anyone who decides to criticize this. Oh, you must be one of those reactionary far-right people.

You just want all trans people to die. You go, well, I can see why treading carefully, as it seems like you have done, has hopefully managed to even out the balance between left and right. I think so, but also, I mean, just the way that I've approached the story and that we approached it at News Night where this started has always been, you know, we've tried to be calm. We've never questioned people's identities or the right to transition. It's not ever been about that. It's about, as I say, about the standard of care. And I think sometimes, as you mentioned, the language used when this or related issues

are discussed is really unfortunate. And what I've tried to keep in mind the whole time while writing was, you know, we're talking about children and young people. And we need to, you know, be really careful in our our language and often those young people are really very stressed and it doesn't help to speak in really inflammatory terms. I think it's far more heated in the States than it is here. Obviously, it's very divisive here as well, but we don't have, you know, you mentioned sort of the evangelical right and the hard right who want to who deny the existence of trans people and perhaps want to take away all care. And I don't think we have that here in the UK. No, I would agree.

For the people that are just in the UK and think that this is a very heated topic, turn that volume up by 10 times. And that's what you've got over here in the US Okay, so what is the story of kids? Wow, where to start well, it started off as a It was the brain child if you like of a Child and adolescent Psychiatrist called Domenico to Chely and he was really moved by a single example, a young person he was seeing in the early 1980s, who was female born, but strongly identified as male and was very distressed about being in this female body.

And that example, and a couple of others that he saw in his work as a psychiatrist in Croydon, sort of South London, gave him this idea that there had to be a specialist service for these young people who had this, what he called a very rare condition where there was this mismatch potentially between biological sex and how they identified. And he succeeded in opening this service in 1989 at a South London hospital called St. George's. And then it moved to its current home, the Tavastok and Portman in 1994. And really for quite a long time, the numbers were very small. The service was about talking therapies, about trying to help those children and young people explore their gender identity, to understand it, to

reduce their distress, to help them manage uncertainty. There was also, they did some work in schools about sort of trying to break down stigma. And what he noticed, even in those very early days, was that often young people would obviously, they'd have their gender-related distress, but they'd also sort of have quite a few other difficulties as well. And while it was never the aim of the service to try and change someone's gender identity, or to sort of push them one way or the other. He noticed that sometimes by exploring someone's gender and kind of trying to help the distress being brought by the other conditions, perhaps sort of depression, anxiety or what have you, then it might actually relieve that gender related distress at the same time.

So it was a very cautious, slow approach, and what we know as colloquially as puberty blockers, they were available in the 1990s but to 16-year-olds only. So you pretty much had to have gone through puberty by the time you could have them. And the idea was that they would help to prepare the body for those who wanted to transition, prepare the body for the administering of cross-sex hormones or gender-affirming hormones. And it was acknowledged at the time that adolescents, well, it's acknowledged by professionals who work with young people, adolescents is a great time of fluidity, and that gender, incongruence in children was not quite the same as it is in adults, in that it might not be fixed,

and actually in some guidelines that Domenico to Chely wrote in the late 90s, it actually stated that professionals working with these young people should be mindful that strength of feeling might not indicate permanence, if you like, you know, that it was still even if someone felt very, very strongly, it might not be that they would feel that way forever. And then the service sort of remained quite small and in the 2000s it became under increasing pressure to provide

those medications to younger aged people and that was essentially because a team in the Netherlands had started doing that and Jid's was the second is the second oldest gender clinic for for children and young people just after the Netherlands. Second oldest in the world? Yeah, in the world, yeah. Wow. So I think that the Dutch opened in 87, I believe, and yeah, Gids opened in 89. And there weren't very many people working in this field.

And as we went through the 2000s, pressure grew on the service. It appeared, there was some very early data coming back from the Dutch team and it appeared that there was something here that would help this very small group of young people who were very, very distressed, who had their gender incongruence from early childhood and it had persisted and was consistent throughout and had intensified with the onset of puberty. And it's a misnomer that pressure solely came from young people and families and perhaps sort of trans-friendly groups. It came from all quarters, it came from them certainly, but it also came from other clinicians working in this field. It came from those working in adult gender clinics who said that we deal

with those adults who have had to go through puberty and it's really distressing in some cases. And it came from endocrinologists as well. And so they took, they still had concerns, like the concerns that they had at the time was what impact blocking puberty at the younger age could have on bones because puberty is the time where our bone mineral density is increasing. It's fastest rate. So if you stop that, what's the impact going to be longer term? And we still don't really know that. We know it's not good to stop it, but when you reintroduce hormones to the body, whether that's our naturally occurring ones

or synthetic ones, it does increase again, but we don't know whether you actually ever hit the peak that you would have had you not interrupted it. We don't know that yet. And they were concerned about what impact it might have on development, your sexual identity, on brain, all these other things.

And those concerns didn't go away, but they were under pressure. And actually, there was an ethical argument that here is a treatment that might be very beneficial to this group of young people. Let's proceed on a cautious basis. We want to try and add to this evidence base because there aren't much data. So let's try and monitor a selected group of young people and see what the results are.

So that's what they set out to do in 2011. And they ran this research study. They recruited 44 young people from the age of 12 over the next three years and then sort of quite strikingly, rather than wait for that data to come back. In 2014, just after they had recruited the last young person to study, so they'd only just started the blocker. They they rolled out early intervention as it became known as policy across the service. How young is early intervention? Well, at that point it was 12, but what they did in 2014 was not just roll it out and make it to anyone who fitted certain criteria, but as not part of a study, but they actually did away with that younger age limit altogether. So they moved from what was called an age approach to a stage approach.

So providing someone had reached what they call Tana Stage 2 of puberty, which is pretty early puberty. So for girls, you could be in Tana Stage 2, for example, but have not started your periods. It's that early. And provided you had been reached Tana Stage 2, you could potentially go onto puberty blockers. So for example, in girls in particular, who tend to start puberty earlier, that could be as young as nine or 10. And certainly, data that Jidts have presented publicly

has shown that they've referred a nine-year-old for puberty blockers and 10-year olds have started on Pupiti blockers. Not many, but they have. Okay, so that's 2014. Yes. And then what happens is, at the same time that the Pupiti blockers have become more widely available, this coincided with a really quite rapid increase in the number of young people being referred.

And we saw this rise in absolute numbers. So from 2009 or 910, the financial year, 97 referrals to jids. It didn't, sorry, had that been relatively flat throughout the 2000s? Well, it had grown but not quite steadily. Well, when the end of the year started. And some years he went up and so it wasn't huge.

It had gone up. It did double one year, which year was it? From memory, I think it might have been about 2005, potentially, went from 20 something to 50 odd, but it was relatively small. And so we had this 97 in 2009, 10. And then it went up 50% per annum until 2015 where it doubled.

And that was beyond anybody's expectations. So what number does 2015 get us to? How many people is that? So it was 1,400 and something. And so not only did they see this really quite rapid increase in referrals, but there had been a really dramatic shift in the demographics of the referrals at the same time. So whereas previously, the demographics of the referrals at the same time. So where has

previously the majority of those referred had been boys, biological males, who had often had sort of lifelong gender dysphoria or gender incongruence. What happened over that five year period or so is that the girls then equaled for the first time around 2011 and then massively overtook the boys. So by 2015, it was two thirds female in terms of referrals and they tended to be girls who didn't have this sense of lifelong gender incongruence, but really their gender related distress had started after the onset of puberty in adolescence. And they often were contending with quite serious other problems as well, like eating disorders, suicidal ideation, depression, anxiety, some had suicidal ideation, depression, anxiety, some had suffered physical or sexual abuse. So they were really quite complicated young people. And this is really when clinicians working there started to worry because the evidence base for using the Pupiti blockers

was limited anyway. That's why they set out to do the study in the first place to try to add to it because we didn't really have much data. There was a bit more by this point from the Dutch, but it's still one gender clinic. But what Jid's was now doing was applying a medical treatment for which had a low evidence base to start with to a completely different cohort of young people for whom there really was no evidence that it worked. And actually the leaders of the service were quite open about that. And they spoke to the UK Parliament in 2015 and in their evidence they said we have extended

the use of physical interventions to those for whom there isn't a robust evidence base. We're not seeing the young people that are in the Dutch study, but we think it will benefit them. Now, it was well intentioned, but it wasn't evidence-based at that point. And the evidence really never came to support the widespread use of puberty blockers for this cohort of young people. And we haven't really seen that from other gender clinics either. And a year later, 2016,

some the initial data started to come back from that study which showed that at that point every single one of the young people who'd gone on the blocker and who was eligible to go on to cross-sex hormones the next stage of a medical transition had done so and for some you know, as one clinician in the book says, that was their holy fuck moment, because it exploded this idea that they were telling families and that they had been led to believe themselves that the blocker was providing time and space to think, which made a perfect sense. Like the idea that someone is very distressed about their developing body, that's not the gender they identify with, so if you pause

the body's development, then that made sense that you would pause the distress and allow time to think. But some people started to question, well, you know, what are the odds of adolescence in particular, having time to think, but then all thinking the same way. Like generally, that's not something we see. And moreover, when young people were approved for the blocker, that they were given no space to think either by the service because rather than increase the amount of time they spent talking with professionals

and using that time. In fact, the frequency of appointments went down and they saw the service less often. So for some, it just totally changed the way they practiced. They saw that actually their decision to refer someone for puberty blockers, and I say refer because Jid's doesn't prescribe. They refer and then some endocrinologists at two other hospitals do the prescribing. That decision became much, much more serious, because if it was the case, as it appeared to be, that those young people would almost inevitably go on to cross-sex hormones. Then, sayations needed to be had before you started the blocker, about what transition might look like,

what someone should expect from physical transition, the irreversibility of cross-sex hormones, what was known, what was not known, and so this was a real turning point. It seems like the puberty blockers become much more of a one-way street or a set of train tracks that once somebody gets put on them, it's rare that they're going to deviate. Well, it's really difficult to know for sure because what we don't know is that we don't know that going on the puberty blocker in some way causes someone to stay fixed in their identity and therefore to go on to the next stage. And we don't know that because of the way the studies are designed, we can't infer cause and effect. But that is certainly what clinicians believe that it might be.

And you can't really say any more than might, but it might be that somehow pausing development or blocking puberty might in some way lock in an identity and stop it from changing where it might have. And it might not have in all people. And I think it's really important to stress that for any group of children and young people who have gender and congruence from the studies that exist in the past, there have always been some that went on to transition as adults and no one was ever questioning that but there have always been a group that happened as well and that's tended to be the larger group. But the concern actually initially about blocking puberty earlier, was this, whether you would somehow lock in an identity that might have

changed if you didn't do it. And that was something that was acknowledged by the Dutch team that pioneered this approach. They talked about sort of slightly unfortunate phrase, but they talked about something they're called false positives. Then if you blocked earlier, you might end up with these false positives. IE people who wouldn't have transitioned to had they not gone on the blocker. It's quite a euphemistic way of putting it, but so it was always acknowledged that this might happen. We don't know whether that is what's happening and Jid would say, well, look, it's not surprising that all those young people went on to cross-sex hormones because we really carefully screamed them and

we judged, we only for that study, referred those for whom we thought were most likely to persist and become trans adults and transition because they'd had this this lifelong gender and congruence and we're just really good at this and that's why we got the results that we had and I think there are a couple of problems there in that we got the results that we had and I think there are a couple of problems there in that there are named professionals who took part in some of those assessments who say actually our assessments weren't that good and I did assessments that weren't that good and it's not very common for human beings to admit they made mistakes and I think when people appear to their name for it there seems to be no incentive for someone to do that, other than it being true. And I think the second difficulty is that while that may have been the case

for that small group of 44 young people, although as I've said, clinicians who took part in those assessments have challenged that. But even if you accept it for those 44, it seems to be the case that the vast majority of young people period go on to take cross-sex hormones, and these were not the young people who were carefully screened and had lifelong incongruence and what have you. So there are a couple of difficulties there. Have you got any idea of how many patients were arriving at GIDs versus how many were being given puberty blockers? It's really, really difficult to put a number on it and this is,

I have tried very, very hard as I have many other people to ask GIDs and the endocrinologists at both people to ask Gids and the endocrinologists at both University College London hospitals and leads teaching hospitals where the endocrinologists are based. How many young people have been referred and then prescribed puberty blockers? The honest answer is we don't know. From what is in the public domain, it would seem about, I put it about 17, 1800. We know that in 2017, in response to a freedom of information request, Jid said that they had referred 1,261. So that was 2017.

Now there was a period where not much happened at all because of legal disputes. There was a paper published last summer which gave some more figures for 2017 to 19 and adding those up together with some data that I received back from one of the hospitals. I would say it was sort of, yeah, minimum 17, 1800, which might not sound like across all of them. Across since 2011, or potentially since it was nationally commissioned in 2009, but really there was so few in those early years anyway, because they weren't available. That might not sound very many.

So we think they've seen in that time about 10,000. So it's about about 20%, but I think it's quite misleading to look at it that way. And because it's, I think it's more fruitful potentially, and this is what Gids haven't really answered, is to look at, well, how many of the people that were eligible will refer? Because there's one graph in the book. And this is kind of the best data we have, which is really kind of poor in itself. And this is from 2018.

And it shows the proportion of young people who had been referred to the clinic between 2010 and 2013, who by 2017 had been referred to endocrinology, so for peopety blockers. And what you can see very clearly is sort of a belt, a classic bell curve, that both ends of the age distribution, the very young and the very old, you have quite low proportions. So, you know, the three, four, five-year-olds who were referred during that time, they weren't have been eligible basically because they hadn't started puberty. So that kind of rules them out. Sixteen and seventeen-year-olds, the seventeen-year-olds in particular, very low proportion because there's not really much point going on a puberty block and you can go straight onto adult services and have hormones direct.

So, and that's, clinicians say that happened quite a lot. The older ones would say, because the rules here, not in the States, but the rules here were, even if you were 15, 16, 17, you had to go on puberty blockers for a year before you could go on hormones. You could never go straight onto hormones. So lots of people just waited for adult services. But what you see in the middle, these kind of adolescent years, is very high proportions of young people who were referred between the ages of 11 and 15 were then referred the ages of 11 and 15 were then referred for blockers. And those who were referred in that time period, 2010 to 13, who were 14, in fact about about 70% of them did. So, Afrogees can be very misleading. And, you know, for years, Gids put out a figure in the public

domain, they gave it in loads and loads of interviews, they said about 40% of the young people are referred for puberty blockers. And of those who we see who are referred under 12, it's about 20 to 25%, which you don't have to be a mathematical genius to work out, well, if the average overall is about 40%, and the under 12 is about 20, then it sort of implies that the over 12 is about 60, you know, just basic maths. And those proportions have come down, but really, without the actual proper data in the public domain, all we can can summarize, these are my best estimates. Isn't this place run by the NHS? Yeah.

Is that not owned? But I mean, how is this not freedom of information? I could literally be owned by the British government. Well, yeah, it's not owned by the British government, I know what you're saying. I mean, there have been countless freedom of information requests asking for this data, and the response is we don't have it, or we have it, but it would take far too long for us to get it because that information...

That's a reason NHS absolutely screams NHS. Well, this is the individual trust. So they've been asked on, or many, and occasionally they've given us bits of data like that, that 1261, that came from us bits of data like that, that 1261, that came from a freedom of information request. And I have personally, FOI'd the trust and the end of chronology hospitals, and they haven't provided it.

They must have it. And it is in those patient records, obviously, if a young person has been referred. But I think also concentrating solely on the physical interventions only tells a fraction of the story. I mean, you know, we don't know what's happened to those who weren't referred for them. While it jits, we don't know whether the gender distress resolved and if so how and what they're doing now, we don't know how many went on to adult services, we don't know how many people are happy, we don't know how many people are not happy. We don't know much at all. Given that this is an incredibly serious intervention that has lifelong repercussions, This is the sort of thing that tracking

would have been pretty useful for just how effective is this sort of intervention? Just how effective is it to not intervene? Can we do talk therapy? Can we do other things that don't lock in this set of train tracks down? Okay, so I'm gonna write in saying that kids only all that they did was refer for puberty blockers.

They weren't referring for surgery, they weren't referring for anything else, was the sole thing that they did refer for puberty blockers? Yeah, they had absolutely nothing to do with surgery. So everybody they saw was under 18 and while I believe that you can get double mastectomy is now at 17, they have nothing to do with that, that's solely adult services. So they would refer for pubety blockers and this is the key thing that from around 2014 also when they became in their own words an assessment service, there was no other treatment pathway that they offered. So they didn't they they weren't offering extended ongoing talking therapy, like you say. They would

assess for suitability for physical interventions, and that's not to imply that the majority were referred onto that, but they weren't offered anything else really either. Our puberty block is reversible, Because that's something that I've heard claimed. The honest answer is we don't know. I mean, physically, they are, well, the honest answer is we don't know. The official NHS guidance is little is known about the long-term side effects of using puberty blockers to treat this condition because they function very differently when used in gender distress

young people than they do in the treatment of prococious puberty for which they are licensed. Because in prococious puberty where a child startsupity very, very early, like way before they're ready. They take the Pupity blocker, it pauses the development, and then they stop, and then they go through their body's biological puberty. In generally speaking, as we've already mentioned, when a young person experienced in distress about their gender takes the puberty blocker, they don't stop. They take it and their body never goes through their biological puberty, they will then go on to cross-sex hormones and hormones will return to their body and their bones will start strengthening again, but it's not their body's natural, naturally occurring hormones.

strengthening again, but it's not their body's natural, naturally occurring hormones. So systematic reviews of the evidence base have been undertaken here in England by nice, the National Institute for Care and Health Excellence in Sweden, in Finland, and I believe Norway now as well, by the respected health bodies, the official health bodies. And in all those cases where they've undertaken a systematic review, they've found the evidence-based wanting on the efficacy of using both puberty blockers and cross-sex hormones in this area of health care. But physically, they are reversible in that if you stop, then yes, puberty resumes. But what we don't know and what's acknowledged by the NHS and its official guidance is we don't know what long-term impact blocking puberty might have on brain development, on cognitive development, on sexuality,

on the development of other identities, so we don't know any of that because the long term data doesn't exist and interestingly there's a case study in the book a young trans man called Jacob who took the block of four years from 12 to 16 was not very well on them at all and you know The argument is yes, they're physically reversible and puberty resumes. Well, he didn't get his periods for two years after coming off the blocker. And even now, he's 19, they're not regular. And surprisingly, he's not being monitored at all.

There's been no follow-up since he chose to leave the care of jits. So, the statement is made that they're physically reversible, but in fact, when used to treat this condition, we really don't know. So few people come off and then they're not followed that we don't know and we don't have a long-term data. What about the effectiveness of puberty blockers for helping with suffering and suicidality in youngsters? Well, again, the data are really quite poor. The original Dutch studies argued that there was a psychological benefit to going on the puberty blockers.

And then they didn't actually measure the sole impact of cross sex hormones it was hormones and surgery and they said the whole pathway was was beneficial but but when jids tried to replicate the dutch with in that study we didn't get those data back until well very late 2020 in a pre-print, but officially published in 2021. And actually, when using quantitative measures, proper measurable stuff, they found no psychological benefit to the young people on puberty blockers. And in fact, even by the subjective,

quantitative measures, the self-reports from those young people, it was a really mixed bag as well. So the researchers, the team reported that the majority had a positive experience and obviously none wanted to come off, but actually the data is not really that strong and even in those qualitative measures, when you look at those who've been taking them more than a year, it's about equal proportions. Some, in terms of about 30% reported, or just under 30% reported positive mood changes, and 30% said negative mood changes.

And what's so interesting is that actually they had data that showed that as far back as 2016 or 2015 even, that for some people, well, there was no improvement and actually for some people they appear to get worse. So there really isn't strong data, certainly from the UK that supports the argument that puberty blockers improve mental health or reduce suicidality. I know that there are studies in the states that come out of the states that claim to show that, but actually they're pretty methodologically flawed and they have been quite heavily critiqued and often don't actually show what they claim to show higher up in the paper when you look at the data. So yeah, it's pretty weak.

It stacks up a very serious body of evidence here. You have an intervention which may not you have an intervention which may not impact people in the way that it should do in the short term. It may not have the reversibility that would make it less of a big deal in the medium term. It may not fix the problems that are concerning in the long term and it may also lock these individuals into a trajectory that they can't get out of on the life long term. That seems like an incredibly big decision to make. It should be one that's incredibly heavily scrutinized. It's one that should take a very long time to get to. And I understand that when this intervention or these interventions were first being rolled out, you don't know what you don't know.

You don't know just how don't know, you don't know just how serious it is, etc, etc. I presume that the unknown and knowns and the gaps in knowledge are precisely where a lot of the holes, like people fell through these holes, both in terms of the clinicians, the consultants and the patients. Yeah, and I think it's really important to acknowledge that there are consequences to not acting as well. And you know, I've spoken to people for the book who are very happily transitioned and they describe puberty blockers as as life-saving. So that is some people's experience. And there is an argument that that some in the trans community and trans allies will put forward that they're not meant

to be anti-depressants or anything. They blocked puberty and they prevent a young person going through changes that they can never reverse if they choose to transition as adults. But I think, which is true. Like that is one rationale given for the blocker is that it prevents future surgery and it makes particularly for biological males, it makes it easier to pass as adults if they choose to transition.

I think the difficulty is that these various other rationales, sort of the time and space to think and the improvements in mental health and the reduction in distress, have been given as the rationale for using the book by researchers and by gender clinics. And so there's sort of shifting goalposts as to what we're measuring and you know it's almost as if when the data doesn't support the original hypothesis then the hypothesis changes perhaps. And I think you're right with the unknown unknowns and I think when this started, it was a perfectly, it was trying to help a very small number of people with a very sort of specific difficulty.

And they proceeded with caution and they tried to add to data, they tried to add to the evidence base. But when data came back that didn't, that wasn't consistent, that didn't support what they believed, that didn't give pause for thought, and that's what's quite striking. So it wasn't, and it may well be that blockers, as I say, I've spoken to people for whom they've been life-saving, but it seems that when they're applied to a completely different cohort of young people who never met the criteria of the Dutch study, they weren't psychologically stable, they didn't live in supportive, necessarily, you know, stable home environments,

and they didn't have lifelong gender and congruence. It's not really that surprising that you don't get the same results. And the surprising thing is to roll out one intervention to a massive group of people and not think that perhaps something else might be needed in some of those cases, and it's not to say that some won't benefit from them. But I think the evidence base hasn't really advanced much in 20 years. Yeah, it doesn't seem that way. Given the fact that this, that the puberty blockers aren't reversible, even if they were reversible, I don't know if this, if it changes this concern, if it changes this concern,

how can it be argued that it is ethical to allow an individual who is not old enough to buy a lottery ticket, buy a red bull, vote, drive a car with a teacher in the seat next to you, have sex, watch porn, how is it possible for that kind of person to be allowed to consent to any kind of procedure which could have lifelong implications? Well the argument that one of the women who led Gids for a decade, she retired in 2020, Bernadette Ren wrote, was that from its outset, Gids was not just a therapeutic project, it was a justice project, and it was about extending the rights to live one's life, personal autonomy, if you like, to this group of children,

and respecting their identity. It wasn't about challenging who they were, and the argument is that young people know who they are, and it would be cruel to deny them the chance to live as the person they identify and who they strongly feel themselves to be. I mean, that's the argument. How many of these young people are just gay? Well, I can't answer that definitively. What I can say is that from the very limited data that exists, many of the young people referred to gender clinics, well certainly to jits, Our same sex attracted or or bisexual. So what we know is that actually so the 70 young people in the Netherlands who form who who were part of those these two Dutch study

were one Dutch study really but two tranches which forms the basis of all gender-affirming medical care for children. All of the girls in that study, all of the biological females were same sex attracted or bisexual, none were opposite sex attracted and one of the boys was, which is quite striking. The data that we have from JIDS is that of those referred in 2012, so you know more than a decade ago now, of the older young people that referred so 12 and up for whom they had data which was about a hundred, just under a hundred. So again

not not not great. Around 90% of the girls were same-sex attracted or bisexual and about 80% of the boys, roughly. And the only more recent data we have from Jids, but we haven't seen any sort of breakdown, it's just on their websites from about 2015, so we don't know what the numbers are, but this puts it about 70% combined for the girls, either same sex attracted or bisexual, and about 60% for the boys. So it's still very, very high. And this was a concern that many, many clinicians had, and I want to be clear that it is not the soul,

it's not solely coming from those clinicians who are themselves gay or there's been or bisexual. It was so widely seen. And I think some of those clinicians say that the charge was put to them, well you're too close to it because you're gay and therefore you can't be subjective about this. Now, Jid's would deny that that happened, but actually when I put that to them, when I spoke to them for the book, one clinician and a heart says she said, look, look at the data. We weren't seeing something that wasn't there. And okay, the data aren't great. We only have a couple of years, but we saw this on a daily basis. Young people, mainly girls, but the boys as well, sitting in front of us, talking about how they had a relationship

with someone of the same sex, been home experience homophobic bullying, and then came to identify as trans. And it wasn't that they were saying that none of those people could be trans or they didn't know themselves in any way, they were saying we need to think about this and we need to explore sexuality as we need to explore gender, because it's noteworthy that in many of the cases someone was not just a transition, wouldn't just change their gender, it would also change their sexuality. And they were just saying this is something we really need to think about and that they were worried about.

And it's another example really in this story of where knowledge seems to get forgotten as time goes on and the clinic became busier. Because the old data tended to show that when you had a group of young people who were distressed around their gender, some would grow on to be trans adults, but the majority wouldn't, and the majority of them would grow up to be gay. And that seemed to be forgotten as time went on. And clinicians said, look, these behaviors that many of us are taking as indicators that someone might be trans, they equally apply to kids that might grow up to be gay. Like they're really similar.

So that's something we need to bear in mind. It wasn't that they were dream of telling a young person, know your identities, not what you think it is your gay. It wasn't like that. And of course, no one was intending to, this is awful, like converting gay kids. It's, no, there was no intention, but what they were saying is we really need to think

about this and at the moment we're not. How many other mental health complications were the young people coming into this clinic suffering with? There were complicated young people. There were complicated young people with complicated lives. I mean several clinicians said they didn't see a single young person for whom everything was fine, apart from their gender identity. You know, others disputed that and they said, for some, you could, you just knew and there was nothing else it could be and so therefore three sessions is fine and you know that's that's fine. But but but many said that these were the most complicated distress and traumatising young

people they'd ever worked with and some of these were very very experienced mental health professionals who'd worked in numerous other services And that's why they were so worried because there appeared to be so much else going on. And even if some of those young people were trans and would benefit from transitioning, and I'm sure some of those young people have, they were saying they're not in the right place to do it safely. And some of those other issues need to be solved first. It wasn't that they were denying their identity or that it could be the right path for them,

but it just wasn't safe to do it at that moment in time with so much else going on. And equally, it could be that the primary difficulty was not the gender, and that if you solved something else. I mean, I don't want to wish to imply that this was the majority of cases, but there were several cases that documented in the book where a trans-identification came quite quickly after a young person had suffered a traumatic event or had potentially been, you know, sexually assaulted or sexually abused. Now, what clinicians say is that it's quite easy to understand why someone might feel distressed about their body and particular parts of their body. If they've been, you know,

horrifically violated, usually by people you trust in those parts of the body. And therefore, you'd want to change it. And what they were saying was, that needs to be worked through first. Again, it's not as black and white as someone's had a traumatic childhood, therefore they can't be trans and can't transition. They were saying in those circumstances that trauma has to be worked through so that we make sure that we get this right. And they were saying that too often it didn't happen. Well, fundamentally, the question here, I think, is are young people distressed because they're trans and aren't fully living

out their desired gender identity, or they're trans because they're mentally distressed and haven't dealt with the underlying problem. Yeah, and it could well be both, depending on which young person you're talking about. But it's not through... Taking someone through CBT, or taking them to an anxiety counselor or a trauma therapist or whatever psychotherapy is significantly more reversible than putting them on puberty blockers. Yes, I guess the counter-argument would be if you miss the relevant time window, then

for someone who will identify as trans for life, then those changes to their body are very damaging and irreversible too. So, but yes, I mean, I wonder if the more ideologically bound would even see removing some of the, let's say that there is a non-zero number of people within this cohort for whom autism, OCD, trauma, etc., etc. are precursors to a gender identity crisis. And if the precursors were removed, that the gender identity thing would fall away. I can imagine the more ardent trans activists here in the US saying that that would be something which is unethical as well, that by getting rid of the precursor, this is denying somebody's transness out into the world.

Oh, yeah. And that's what happened at JIDS in that clinicians say that they were discouraged from providing what you might call a differential diagnosis. So to even suggest that someone's distress might be as a result of something else other than being trans was discouraged and seen as transphobic. So yes, I mean that is the view of some people.

Didn't you you had a story about a boy who was showering five times a day and wouldn't leave his room? What was that story? Oh, it was an absolutely heartbreaking story. So this is a young teenage boy. Was it openly gay? And yeah, I was coming home showering as soon as you got home from school and his mum didn't really think that much of it.

She just thought, oh wow, I'm blessed with a really high genic teenage boy. And it became very, very serious and she quickly realized that he had quite, he had very severe, obsessive, compulsive disorder and sought help from local, what we call camps here in the UK, so child and adolescent mental health services. And not long after he was seen at CAMS, he blurted out to his mother, you don't understand, I'm trans, you've been misgendering me my entire life, and put it into perspective, he was six feet, big, big, very tall, you know, size 13 feet, what have you, as I say, openly gay and happy today.

And his mum was just like, what, you know, and it was 2014, it wasn't, she didn't even know what it meant really. And from the moment that he'd said that, cams would affirm him as female and set about referring him to gender specialists, to jids, and his mum was like, hang on. He's really unwell. Like, even if this is true, he's in no state whatsoever. And his mental health deteriorated very, very rapidly. He got to the point where he couldn't leave the

house, he couldn't go to school, he the floor of his bedroom had to have plastic sheets on it, his bathroom would be flooded because he was going to the toilet so much he couldn't keep clean and then the toilet would flood and it was absolutely, I mean, talking to his mum, you know, eight years after the event, she was in tears and it was very, very distressing. And he was so ill that he couldn't actually attend his appointments at Jids. And rather than take that as a sign that perhaps he wasn't well enough to transition, or to consider transitioning, a very senior Jids clinician traveled to his home instead, well, to near by his home, several hours. And his mum claims that at that very first appointment,

not he wasn't offered blockers, but the subject was brought up and she just couldn't believe it. And ultimately she took him out and he had private therapy. She lost all faith in NHS clinicians and said, this is just mad, basically. My son is really, really ill and no one's helping him. And then after several years, he didn't identify his trans anymore and he's happily gay and has a partner and their relationship isn't very good.

He still has mental health problems. But it was just extraordinary that someone who cannot leave their own home, who wanted to cut off their own penis and saw things crawling up the walls to even consider that they would be in a state ready to transition. You said that less than 2% of children in the UK have an autism spectrum disorder and it jids more than a third of the referrals had autistic traits. Yeah, yeah, and that's something that worried clinicians too, because they're like, well, that seems to be very high.

I mean, the 2% thing, I mean, that may well be an underrepresentation. I mean, this debate's had all the time, the data on autistic spectrum to sort of not fantastic, but yeah, I mean, that's the best we've got. And again, it wasn't they were saying that no one who's autistic could be trans, it's just with this really high proportion exhibiting moderate to severe traits, might we be medicating unnecessarily autistic kids, and they were really worried about that, because what we know about autism is that not just on gender, but on other things as well. Autistic people can think very black and white terms, and it seemed to those clinicians who were sitting in the room

with those kids and their families that it was potentially a way of making sense of their world rather than a true identity. And they just wanted to be as careful as they could be. What have you come to believe about why this 2015-16 period just saw an insane increase in the number of admissions? What do you think is going on there? And also, what were the downstream implications for what happened inside of GIDs? Okay, so the first part of the question, I think there are lots of things that explain it. I don't think I can give a definitive answer, but I would say there's a load of factors. So GIDs themselves would put this rise

down to increased acceptance of trans people, increased visibility, and it being easier to come out and put a name to something. I think that might be true for some people. So, for example, there's a young trans guy in the book called Jack Jack and for him, that kind of fits him really. He, for his entire life since childhood, didn't feel like a girl. And really, when he came across the idea of trans around sort of 2010, he said, yeah, that's me. So, that might be the case for some people, but it really, it doesn't explain the full picture. And all I can really say is what clinicians have told me and what young, both trans and de-transitioned people

have told me, which is a variety of things. So for some people, and actually WPath, the world professional association of transgender health, which is based out there in the States, and is very affirmative, even they accept that for some young people there will be a social influence to this, to their trans identity, and that we have to bear that in mind. And for one of the young people in the book, Harriet,

that was certainly a factor for her, the fact that many of her friends were also identifying as trans or non-binary, and it was quite trendy at that time. For her, she also was having some quite severe mental health problems, and she had had a same sex relationship and been made to feel quite ashamed about that and she didn't want to be a lesbian. And the combination of these things, and she was a really heavy social media user. And in her own words, she saw trans identity as a way of understanding, of jumping ship, but also of making sense of who she was. And for a while, she was much, much happier. She was.

She went through this honeymoon period for several years. It wasn't a fleeting identity. And in that time, you know, she took to South Australia and had a double mistake to me, and now regrets that. But, so I think, so I think that's the host of other factors and I think particularly for girls, it's quite hard being a teenage girl. I mean puberty is quite difficult anyway. But I think now we have, you know, hardcore porn is quite ubiquitous and I think it's probably difficult being a teenage girl when there are certain expectations of you sexually and perhaps having your first sexual

experience with boys who have consumed that kind of material. And I think it's hard for some girls who don't perhaps feel that they don't live up to the, they don't feel uber feminine, perhaps they don't fit what they see as girls should be, you know, that they're not doing girlhood properly. I think it can be a really difficult time, and I think all these things perhaps explain why a different identity might be the answer. That was also coincide. We were talking about this flip almost, that it was mostly biological men, at males, and then you get this, this big sort of lift off. So you're okay, well, what's happening to just the girls? Advent of social media, ubiquitous, you have online porn,

expectations or I guess a back end of a sexual liberation movement that perhaps makes sex at younger ages more common, you know, British TV series like skins and stuff like that, you know, British TV series like Skins and stuff like that, you know, it really does put relationships at the forefront of a 14, 15, 16 year old's life. So it doesn't surprise me. No, and clinicians, you know, these are not my sort of ideas, this come from professionals, but you know, clinicians would also say that girls in particular, and they've noticed this in their professional careers, I mean, girls have a tendency to express distress through their bodies. So whether that's eating disorders, cutting, that tends to you know, tends to affect girls in greater proportions than boys for some reason.

I remember her. But also, you know, I do want to say that, sorry, just very, very briefly, that I talked about Jack. You know, some of the number may well be that, you know, some of these, some of these, we'll, we'll, they'll identify that because they'll grow up to be trans. So I want to sort of acknowledge that as well. Yeah, I remember hearing a story, two really interesting stories, recently actually, the first one was a girl who overrate, it well, well into adulthood. And after a turn of therapy, it turned out that she'd been sexually abused when she was younger.

And what it seems was happening was this woman was making herself into as unsexual of an object as possible by gaining weight. So she was using weight, not only physically to create a barrier around her that made her feel safer, but also figuratively, symbolically so that she wasn't seen in that same kind of sexual light. Okay, well, that's interesting. And then this other one, the YouTube channel called Kidology. She's a British YouTuber, 100 and something thousand subs. So it's an interesting channel. And there is a common subculture on the internet at the moment that there's no such thing as a female in-sale that basically any woman would be able to get sex, it might not be the sex that they want, but it's sex. And for men, there are men who want sex and can't get it, therefore there is no such thing as a female in-sale. And she really changed my opinion on this because

she spoke about the fact that she had gone through some trauma, not in terms of a sexual assault, but just in terms of like an unpleasant, but just in terms of an unpleasant and enjoyable experience that had left her feeling incredibly averse to sex. So even if she likes a guy, even if she wants to get intimate with a guy, she can't bring herself to do it. And I thought, holy fuck, like that, that type of dynamic that could cause someone to want to be intimate, but be unable to bring themselves psychologically to do it. Like, that takes all of the boxes of in-cell as far as I can see. And both of those, just very interesting, obviously, as much as I can try to understand the female psyche, much smarter people than me have done it and

failed. But both of those, I found it really interesting and insightful around, you know, some of the challenges that I think are unique to the way the females' minds work. Yeah, I mean, I don't know if I can add anything. That's such a fantastic story. So, okay, one of the elephants in the room I suppose, especially for the people that are listening from America, especially for the people that are listening to this, coming out of the culture war, raging left versus right thing is how much of a role did ideology play when it came to the behaviour of and policies at Gids. I think it's really complicated. I think it absolutely did play a role, but it's not as blatant as some would want to believe and talk about. So there were certain groups, you know, trans groups, trans support groups who were very active and their presence was certainly felt by clinicians at GIDS.

And I mean pretty much everyone I spoke to, I mean it depends what period of time you're talking about, but the period of time where the referrals were going up through the roof and the pressure was absolutely immense to get through the numbers. There was a particular group called Mermaids, but there have also been others, and more recent years, gendered intelligence is probably the most influential group. But their presence was felt, and clinicians say, even though they weren't in the room, they were in the room. They were in our minds. We had this pressure from Mermaids all the time, and Mermaids were

a charity which supports gender diverse as they put it and trans children and their families, and they're very much in favour of a medical model. And they lobbied Jids for years, both to introduce the blocker at a younger age, so in the 2000s, and then to reduce the age at which hormones could be given and to relax the criteria whereby a young person had to go on the blocker before going on hormones. Now, the reason I said it's complicated is because they didn't get everything that they wanted. So those two later things didn't really happen. So there wasn't a big reduction in the age at which hormones could be given. It came down a little bit to around 16 as opposed to a hard 16 and so you could be you know 15 and 8 months, 9 months or what have you, but it didn't really shift significantly.

But they were influential. We know that the head of that charity would make requests on behalf of families for a young person's clinicians to be switched if they weren't getting a referral for blockers as quickly as they wanted. And on occasion, I don't know how often this happened, I'm not suggesting it happened often, but it did happen and those requests were granted. We know that senior people in the wider trust, which housed Jids, asked wanted to coordinate the content of Jids' website with that of Mermaids and make sure that they were consistent and get approval for that from Mermaids. And I think there's probably a more subtle influence that they had,

which is is it appears that when new information came to light during the course of the work, whether that's information on the blocker and how it was working, you know, this, everybody going on to cross-sex hormones or the vast majority, or other things that came known, for example, the risks to biological males who had their puberty blocked too early, who then went on to transition. Actually, if you block too early, it can make it very, very difficult to perform certain surgeries. When information came to light,

it wasn't routinely passed on and it wasn't written down. And the suggestion from clinicians I've spoken to is that that was because there was some kind of fear of a backlash from these groups. If that information was codified because it was scary to tell a young male who identifies as female, that surgery could be very difficult for you if we blocked it early. It's probably not something they want to hear. And it also makes it much more real, doesn't it? You're talking about many, many years in the future. So I think they were influential. They weren't running the show, but clinicians were definitely aware of them and potentially changed their practice because of them because they were in their heads. And I think it prevented Jids from changing direction

when perhaps it could and should have over over the years because the relationship was too close. And what clinicians have said is that who've worked in other places where you know you have patient groups and sometimes patient groups come into conflict with medical professionals because they might want something that actually is not clinically indicated. And what professionals said was that in other places we saw the service be able to hold a proper boundary and they didn't see that happening at Jids. Again, the service disputed, but it came up with pretty much everyone I spoke to. Even those who spoke favourably about the service, they said that mermaids were very influential. But what I didn't find and why I'd say it's more complicated when you ask about ideology, I didn't find that the vast majority of people working there were ideologues in any way.

I mean, there were some, but it was the minority. Most, which is caring, thoughtful professionals who wanted to do the very best for the young people sitting in front of them. And so I don't think it was staffed by a load of ideologues, but it's quite telling that one of the people in charge of leading that service said, you know, described as a justice project as well as a therapeutic project. Yes, the energy, the vibe, the culture trickles down from top to bottom, right?

Yeah. You have somebody leading at the top, that essentially everyone else is responsible to culpable to answers to. So, I mean, you can say it's not a bunch of card carrying, flag waving, ideologues with foam fingers saying that we want to trans the kids and all the rest of it. But it does seem like there is a pretty big laundry list of errors that occurred.

It seems like I have no idea how malpracticy, how calling into dispute someone's medical ethics and whatnot this is. But we can definitely say that it was a suboptimal, like clinical environment, I think. Who's to blame? And why did this be allowed to happen? Especially in the UK as well, just for the people that don't, that are maybe from the US, you know, to get interventions, you know, to get prescribed, you can't get

prescribed melatonin in the UK, right? You can buy 10 milligram tabs on Amazon over here in the US. The general patient, doctor, relationship in the UK is starkly different to the way that it is in the US and they're not incentivized to typically intervene. You'll Number of times I've gone into the doctor. I'm sure it's been the same for you as well You they'll print off a single sheet of paper Give it to you and say like well, you know, give this a read and try good not using your phone before you go to bed or or you know Stop eating so much kale or whatever the like whatever the thing is and then they'll say, well, I get on your way you go.

By point being that they seem to be reticent when it comes to interventions and most people enter this, I've turned to friends with the doctors and work in the medical industry. I don't think that they would want to go into do anything to damage people. And yet it seems like there's been massive litany of problems. Why did they occur? Is there someone that's having the finger pointed at them? Why are there so many holes in this system? Big questions. I think it starts in a way from the previous answer and I think where ideology did trump medical evidence here. It may have been, I'd like to believe it was well-intentioned, that there was a desire to help distressed young people. But by expanding the group for which you refer young, for puberty blockers, that was a decision that may were helping someone fulfill

meet their true identity. It wasn't evidence-based. There was no evidence to support that, and actually, data came back that actually challenged that, and they didn't change practice and that's what's so sort of difficult to understand. So I think you know that that is where you can certainly say that ideology influenced because this was a belief system really, it wasn't based on evidence, it was a belief that they were helping. And as one clinician put it you know things can be well-intentioned but And as one clinician put it, you know, things can be well-intentioned, but ill-informed. Who's to blame? Lots of people are to blame. The leadership of Jeds is to blame, and they should take responsibility for the decisions they did and didn't make. The leadership of the Tavastok Trust are to blame for not taking seriously enough the concerns that were brought to them by a

sizeable number of staff working in that service who were not transphobic, who were relaying clinical concerns, safeguarding concerns, safety concerns, and potentially child protection concerns about the young people they were caring for. And really to have taken those concerns seriously would have needed huge change. And for whatever reason, the leadership of the trust didn't do that. NHS England is to blame. They did not provide adequate oversight. Why did they allow the rolling out of the early blocking of puberty without seeing any

robust data at all? Why did they not step in earlier? Why when the referrals were going through the roof and that they saw that these were very complicated young people, did they think it was sensible to staff the service with predominantly junior inexperienced members of staff, which is what happened, and why when it was clear that wasn't working, did they not change direction? Why did they not act until 2021 in asking someone to undertake a thorough review, an independent review of this service, or this area of care, when they'd heard concerns for many years, and at least as back as 2018,

if not before. All those people are to blame. So are the media who for many years did not scrutinise this in the way they probably should have. So are the politicians who have heard about these concerns for many years and nothing has changed. And so are the healthcare regulators who, until our work at BBC News Night showed them some of these very, very serious concerns that were related to the trust during an official review, hadn't inspected it for since 2016 and then did go in and rate it inadequate. So, so many people are to blame. It's systemic failure on quite a large scale.

Why did this happen? Well, again, I don't think it's something that I can answer definitively. I think it's something I mentioned before that, you know, why didn't they change direction? We've talked about this when it was quite clear that it probably wouldn't be the right pathway for all of the young people. Well, it's very hard, isn't it, to admit we've made mistakes. It's not something that is in our nature, really, as human beings. And I think Anna Hutchinson puts it this way when she was talking to the medical director of the trash. She said, for someone to have been recommending or referring for a potentially life-changing medical intervention

for a decade or so, what are the implications of admitting that you may have got that wrong? It's quite intolerable, actually, potentially. So it may well be that some of it is explained to the fact that it's too hard for some people to admit that this might not have been the right thing to do in each and every one of those young people's cases. I think what clinicians told me on many occasions was this was just not a service that operated according to the normal rules that you'd expect in the NHS and they said that the word gender because it was there in this, it muddied the waters.

It meant that it wasn't subject to the normal oversight that you'd expect. And this is something that Dr Hilary Cass has pointed out in her interim findings, that it hasn't been subject to the normal oversight that one would expect of a service that refers for innovative treatments for children. And the usual checks and balances, the usual data collection. It's just not been there. You know, one very senior clinician said to me, it's almost like for NHS England, there was this cloak of mystery created by a gender service,

and it was assumed that we were the experts, and it was so special that, and we knew what we were doing. So, and so the oversight wasn't there. And I think there were practical reasons that explain it as well. Jid's was part of what's known as specialist commissioning in the NHS. It's a specialist service. And there were hundreds of them. And I think for a while it was really small, it didn't come

across their radar. And I think some health insiders that I was voting to admit they were far too slow to act. But I think for many years it just didn't figure. And you know, that's not good enough. That's not an excuse and it doesn't. But maybe, yeah, it's, you know, there's no grand conspiracy, but maybe it just fell through the cracks. That the fact that there are so many different parties who through fear, habit, negligence, busyness, distraction, whatever, for a whole host of reasons, and the fact that there is no single hooded figure with a long hook nose and a staff, you know, that's coordinating all of this is so much more banal and less conspiratorially impressive than I think a lot of people might have considered.

But the problem with it, and it's the same way that intelligence services work, right? By compartmentalizing information, you limit any one person from being able to work out what's going on. But by compartmentalizing inefficiency, what you do is you stop any one person from being able to fix it, because there are numbers of different vectors, all of these different angles. Well, this person's shit, this person's shit and this person's shit and you know, when you pilot all together, it's not one big mound of shit. It's multiple spokes of shit all pointing at the same thing. And yeah, I, I think that business point you

make is really important actually. I think sometimes they just was no time to think through what they were doing. What's happened to kids now? So, so Jid's is still open. It's, it has lost a lot of staff recently and I was talking to a parent of someone being seen there at the moment who has said this has been quite difficult because it's made continuity of care really quite tricky being having lots of different clinicians. So they've lost a lot of staff. They're still open. The NHS has announced last summer it's planned to close it and it's going to be replaced by

regional services in England, to start with, but then the idea is that there'll be maybe seven or eight. And that will hopefully address sort of the busyness issue, which is you can't have one clinic attending to all the children of one country, it's crazy. But also there is a very different approach that's been signalled that these new services will take. So gone is any mention of a time limited assessment, whereas the current document that guides GIDs talks about three to six sessions that an assessment will be carried out. There's just no mention of that. The primary focus is going to be psychosocial and psychological, so talking.

It's going to be the primary aim is reducing distress. It's going to be far more holistic, much more mental health support for young people, expertise in all these other factors that we've talked about in autism, in other neurodiverse conditions, safeguarding expertise. And now what they have said is that these gaps in the evidence base, which have been identified by the systematic evidence review, they've got to be plugged. We can't just continue with no long-term data or a really clear view on who benefits from this treatment and who might not benefit and what the long-term impact might be. So what they've said is that physical transition and access to

puberty blockers probably will still be available, but young people will be expected to enroll on to a research program. So that some of that data can start to be collected. And actually, on the point of data, as we've discussed, these new services are going to have routine and consistent data collection, which doesn't appear to have been the case over the last 30 plus years. But in the meantime, there are at least seven and a half thousand young people waiting on a waiting list for help, some of them waiting for years,

in distress, and with nothing, and that's awful. One of the reframes that I'm going to take away from your work is that when we talk about that, when we talk about seven and a half thousand young people that are struggling with what they are saying is gender identity and for some of them very well, maybe, they require trained counseling and interventions to help them work out what's going on. That this could be from all manner of different places. And the reason that I think that's such an important takeaway is that that's politically neutral,

ideologically, it should be relatively neutral. Look, there are lots of contra-indic indicators and precursors to what can manifest and present as a gender identity problem. That should be treated. Regardless of what it, like, okay, so you're not going to treat, you know, even the most hard-carrying evangelical, like, hard-writing, well, you don't want to treat a kid that's got ADHD or OCD or autism, like, of course not, like, to be an idiot. So I think that that's got ADHD or OCD or autism, like of course not, like to be an idiot. So I think that that's that's very important to think about it that way as in look there are a suite of things going on here. It is important that we give people, even if you know and I'm

sure teenagers belligerent coming in saying that they know what the problem is and they've read it on TikTok or on Reddit or whatever. Even if what ends up happening is that OCD autism spectrum disorder etc. counseling is couched within a gender care world, gender care treatment, which will perhaps encourage teenagers who wouldn't have gone for this kind of treatment because they adamant that it's one issue and it may be something else. Even if you do frame it within that, that very well may make them more open to it. And go, okay, and then perhaps over time, if some of these issues, mental health issues, which are perhaps upstream from this problem. If they do get relieved, you go, that's another way, perhaps, of dealing with this. And, again, the massive influx that we've seen, and you mentioned it earlier on, that there

are pockets of sort of gender issues that occur. It's five girls in one class in one school. Well, I mean, what's going on here? Like, that seems to push against the, it's simply the fact that people are seeing that they can live their true selves because they're less, you know, there are role models out there in the world.

They go, well, if that was the case, there would be completely evenly distributed. If there was no sense of a psychological influence, a psychological contagion effect, like some sort of mimetic thing that's going on, it would be exclusively distributed randomly and evenly. But it's not. It happens in particular towns, in particular cities, in particular schools, in particular

classrooms. I'm sure that if you mapped the place that these kids sit at the lunch table where they sit in class, you're also going to see that it happens within friend groups. So given that you have this massive increase, I actually think, you know, if the UK is able to enact what it is that you're talking about, I actually think that that's quite reassuring. I think that, you know, all of the different propositions, care, security, safety, holistic model, focusing on talk therapy, etc. etc. That, to me, seems like a pretty unobjectionable good approach to this issue.

Yeah, I mean, the mood music is very positive. I think the problem is we're quite a long way from that actually being realised, but I think it's interesting that of the countries that have looked at the evidence base, they've all started to proceed slightly more cautiously when it comes to medical transition. They haven't ruled it out, but Sweden, Finland, Norway, potentially here in England as well. There's a sort of rowing back from affirmation only and medical approach only. And it's talking therapies first and not rolling it out to those for whom it will still be the right answer, but not the only answer for all of the young people coming forward.

Yeah. I really appreciate how gentle you are with this discussion. That's the best word that I can come up with for. I think it incredibly measured, which I think is very important. If you want to try and change people's opinions, if you want to try and slide through a very divisive and sort of ideologically fuel topic, I think that you're going about the right way. Very, very impressed with the way that you present your stuff. So if the people that are listening want to find out more about you and the work that you do, why should they go?

Well, I work at the BBC, so I don't have my own website or anything. But yeah, find me on Twitter, I'm at Hannah SB, so Hannah, and then SBW. The book's called Time to Think, it's on, in the States you can get it on Amazon, I don't have a US publisher, so if there's anyone listening and wants to publish it, then please do get in touch. But you can buy it on Amazon on Kindle or Hard Copy, it will be sent from the UK. Yeah, that's me really. I appreciate you. Thank you for today. Thanks so much for your time. Thanks for having me. Thank you very much for tuning in some worrying statistics coming out of that, but also reassuring, I suppose, that a clinic

that was evidently no longer capable to deal with the problems it was facing has actually been shut down, and that there are people like Hanuk who can go and do investigative work and actually uncover what went on. Anyway, thank you very much for tuning in. I'll see you next time. went on. Anyway, thank you very much for tuning in. I'll see you next time.