TRIGGERnometry - Gender Clinic SHUT DOWN: Journalist Breaks Down Investigation - Hannah Barnes

Episode Date: August 20, 2023

Hannah Barnes is an award-winning journalist based in London. She is Investigations Producer at the BBC's flagship news and current affairs programme, Newsnight. Having led Newsnight’s investigative coverage of the controversial clinic, Barnes went on to write ‘Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children’ - available here: https://www.amazon.co.uk/dp/1800751117 SPONSORED BY: Shopify - Go to https://www.shopify.co.uk/trigger/ to sign up for a £1/month trial period and take your business to the next level today! Join our exclusive TRIGGERnometry community on Locals! https://triggernometry.locals.com/ OR Support TRIGGERnometry Here: Bitcoin: bc1qm6vvhduc6s3rvy8u76sllmrfpynfv94qw8p8d5 Music by: Music by: Xentric | [e-mail] | https://www.xentricapc.com/ YouTube:  @xentricapc   Buy Merch Here: https://www.triggerpod.co.uk/shop/ Advertise on TRIGGERnometry: [e-mail] Join the Mailing List: https://www.triggerpod.co.uk/sign-up/ Find TRIGGERnometry on Social Media:  https://twitter.com/triggerpod https://www.facebook.com/triggerpod/ https://www.instagram.com/triggerpod/ About TRIGGERnometry:  Stand-up comedians Konstantin Kisin (@konstantinkisin) and Francis Foster (@francisjfoster) make sense of politics, economics, free speech, AI, drug policy and WW3 with the help of presidential advisors, renowned economists, award-winning journalists, controversial writers, leading scientists and notorious comedians. Learn more about your ad choices. Visit megaphone.fm/adchoices

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who undertook these assessments, who referred some of those young people, that they themselves fear that they've been part of a major medical scandal. Some people say there was pressure to refer quickly because it freed up their time as clinicians. Because the waiting list was growing. And once you referred a young person to endocrinology, you saw them less frequently.

So it freed up some clinical time. Were you into, I mean... That's horrifying. Yeah. Anyway. Perhaps you get to the point that you can't. You can't change direction. Because what does that mean?

What does that mean for you as a human being to go, oh my God, I might have got this wrong and I might have got it wrong for some of the most vulnerable young people there are. How do we get from a handful to thousands? That's a $64 million question, isn't it?

If I'm an ordinary person watching this, based on every time we've gone down one of these cul-de-sacs, we always end up with, there was not enough data, they stopped collecting it. I'm thinking cover-up. Hello, and welcome to Trigonometry. I'm Francis Foster. I'm Constantine Kissen.

And this is a show for you, if you want honest conversations with fascinating. people. Our terrific guest today is an author and journalist's latest book called Time to Think is about the demise of the Tamestock Gender Clinic here in the UK Hannah Barnes. Welcome to Trigonometry. Thanks for having me. It's a pleasure. We've been trying to make this happen for a while. We had COVID. You had COVID. Didn't happen. Here you are finally. Before we get into your book, and it's a very important book, who are you? How are you where you are? What has been the journey through life that leads you to be here, Siddon, talking to us? Journey Through Life? Well, I've been a journalist at the BBC for 15 years.

Before that, I worked in commercial radio. It's a news reader and reporter. I'm a mum of two kids, young kids. I grew up in the suburbs of London, had a pretty normal childhood. I went to Oxford and did the degree of politicians, PPE, and obviously by most people's standards, I'm a massive failure because I'm not prime minister.

And they went into journalism from there. And you mentioned your B.B. BBC journalist. I saw you a couple of days ago at News Night, actually. But if I may say, so I hope it's not an unfair representation, but I feel like the issue of transgenderism and some of the issues to do with trans ideology and so on, it sort of was the coverage of that was led from the new media and older media took some time to get there. I don't know if that's a fair characterization. Do you, you don't agree? I would agree and disagree. So I think I think at Newsnight, we were really ahead of the curve.

And actually, much of the stuff that we know is because of the reporting that I did with my former colleague, Deb Cohen. So, you know, we started doing that in 2019. At that point, there really wasn't much around. We were doing it in 2018, but you're fine. No, sure. But, you know, Janice Turner was writing in The Times. And there was some stuff in print media. But I think it wasn't really till, you know, I think our reporting directly,

led the CQC to inspect the Gender Identity Development Service at the Tavistock. I think we did have a big impact. Oh, sorry. I feel like I've opened the interview by what appears me having a massive go at you, even though you're one of the people that's done well. Where I was trying to get to is, why do you think, unlike you, that's maybe the way I should have phrased it, many people took a long time to get to this point where this conversation was even being had?

Because I think the media just reflects all these other organisations that have taken a huge amount of time to get to the point that we're at today. So, you know, you could clump politicians with that, the regulators, the NHS, the central NHS. I mean, the way that several clinicians at the Tavistock put it to me was that this word gender in some way muddied the waters and sort of the usual checks and balances, if you like, that you'd expect in medicine. and particularly when you're caring for children and young people just weren't there. People were frightened that in some way asking the same questions or raising the same concerns that you would in any other part of caring for young people. When you did that in this space, there was a fear of being branded transphobic, whereas actually all they were saying was, we're not sure this is safe.

And another said, everybody assumed that we knew what we were doing, that we were the specialists and somehow it must be really complicated and there was this cloak of mystery. So that's the only explanation that I think potentially explains why so many people looked away for so long. And as Hillary Cass has said, this hasn't been subject to the normal oversight you'd expect, especially when we're talking about children

and drugs that are being used off-label, about which we don't know the long-term impact. And before we get into the book, the question that I really asked you is what motivated you to write this book? What motivated you to go into the eye of the storm? And it is a storm and it is possibly the most toxic issue of our time.

Well, I got to the point that we'd done sort of four films at Newsnight. We also did a radio documentary. But with all, always with journalism, there's so much more that you know that you can never put on screen. I mean, not at all that we were, blocked in any way we were enormously supported by by news night but I knew so much more and you know

I've lost sleep over it and I was really worried by some of the stuff I heard and I just thought this is a story that has to be told because unless this is in the public domain we can't have a adult calm evidence-based discussion about how best to care for this group of often very vulnerable children and young people. I didn't think it was my job to provide answers. I don't think that I'm not a campaigning journalist. I felt there needed to be a lasting record of what has happened because I think it's undeniable. Things have gone wrong. Some things have gone well as well. And some clinicians, not all, wanted their story told. And this conversation had to come out of the gender clinics and into wider society, because the welfare of children really is kind of everyone's

business. I agree with you. And what were the things that you lost sleep over, Hannah? Well, that potentially very vulnerable children might have been harmed. And, you know, documents from the clinic, transcripts of interviews that Gid's clinicians gave to the medical director in, well, across 2018, they were deeply upsetting. Those clinicians talked about the young people they were seeing, not all of them, but some being some of the most vulnerable children they've ever seen, and being in really quite a terrible state. And in some cases, and again, not very many,

but in some cases they were referred for quite a major physical intervention after an hour or two, or even three or four, which was allowed. But the levels of trauma that some of those children had suffered, prior to that that didn't seem to be being explored, it's upsetting. You know, and I became a mum in 2016 and it just changes your outlook, I suppose. Of course it does. I mean, when we, you say major interventions, because there's going to be people who are listening to this

who won't know what that means, and you were talking about major trauma. So let's explore a little bit what those terms mean. What does it mean major trauma and what do major interventions mean? So trauma, so some of these young people, had suffered physical or sexual abuse. Some had lost a parent very young through bereavement or, you know, had suffered family breakdown.

A small but sizable proportion were living in care, which sort of implies that there had been the difficult circumstances leading up to that. Some were living in quite a risky way in terms of their sexual behaviour, those are all traumatic. Some had parents that were abusing alcohol or drugs or who had mental breakdown,

and that's not those parents' fault, but that's quite traumatic for a child to grow up in that living environment as well. So all those kind of things that would put together in a broad umbrella under trauma. In terms of major interventions, I mean, people would dispute this, but I'm talking about the first intervention

and sort of the primary one that JIDS would refer to, well, would refer young people for, is colloquially puberty blockers. And it would seem from the very poor, but in limited data that we have, that once on puberty blockers, the vast, vast majority of those young people would then go on to hormones,

so either synthetic testosterone or estrogen, depending on your sex. And, you know, with those, came lots of physical potential risks, particularly if you block puberty early and you go straight onto hormones, you will be sterile, for example. Not so much if you go on later,

then there's chances to preserve fertility. But, you know, all sorts of things. And to even those who are very happy as trans adults, and for them it was the right and only path, they will tell you that it's not always easy living as a trans man or woman. You have to take medication for the rest of your life. If you medically transition, you may have several intrusive surgeries. So to go through that and it not be the right path is,

is awful. And Hannah, I want to go back to the core of this issue with the Tavistock and for you to explain a little bit more at a more basic level for people who we've got a big audience around the world. But before we do, there is a, and forgive me for asking this question, but I actually do think it's important. The way you talk about it, there's a kind, I feel like there's a tension within you because on the other one, on the one hand, I think you want to communicate about

these issues that you truly care about. On the other hand, I think you feel like you have to be very careful as well. Or maybe I'm imposing that on you. I don't know. The reason I'm asking this is it feels to me like if 20 years ago a story had come out about some children being harmed by medical malpractice, a journalist at BBC News Night would be like, this is the biggest story. I'm going to get the scoop. I'm going to go out and cover this, which you've done. I don't know that they would have had the same sort of feeling.

that this is a landmine issue. Why is that? Why is a medical malpractice on children an issue about which you have to be so careful? Excema is unpredictable, but you can flare less with ebbglis, a once-monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about four in ten people taking ebbglis achieved itch relief and clear or almost clear skin at 16 weeks, and most of those people maintain skin that's still more clear at one year with monthly dosing. Ebglis, Lebrichizumab, LBKZ. A 250 milligram per 2 milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis that is not well

controlled with prescription therapies used on the skin or topicals or who cannot use topical topical corticosteroids. Don't use if you're allergic to ebbglis. Allergic reactions can occur that can be severe, eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine. when treated with Epgless. Before starting Epglois, tell your doctor if you have a parasitic infection. Ask your doctor about Ebglis and visit ebglis.lis.lily.com or call 1-800 LilyRx or 1-800 545-97579. I think there's lots of different aspects to what you've said there. So I think, well, generally, when you're talking about medical malpractice, as you put it, it's a question of, you know, a botched medical

procedure, isn't it? But what's happening here is it's so intertwined with someone's sense of themselves, an identity. I don't think you have that in other stories. Now, I am cautious because I think, you know, there are lots of people out there commenting on this. So, and do so probably in much stronger terms than I do. But what I've done and why I think the book has been received so well is I'm not telling people what to think. I've laid out the evidence and everything, you know, I think there's 70 pages of references in the best way that I can, in the fairest way I can, and for people then to make up their own minds. Because, partly because I work for the BBC and we're absolutely committed to impartiality, but I just think there are lots of people out there

who will express their opinions. And I think actually what so many people have said to me from reading the book is, I just never knew any of this. And it's trying to be calm. And I think I don't talk about it in the same way I would, as you say, another medical scandal. Because I actually think the only honest thing to say is that we don't really know the scale at the moment.

So I would say, what do we know? We know that some young people have been harmed. And I've spoken to them and their stories are in the book. And we know that other young people, appear to have been helped. They say they've been helped and they're happy. We don't know what the numbers are either way. And those will undoubtedly change over time.

So I think it's really hard to say, well, you know, that's why I'm reluctant to say, this is a major medical scandal. It may well be. At the moment, I just don't think we have enough data to put any sense of scale on it. But what I think and what I felt was so striking is that mental health professionals

who worked at the Tabastock, who undertook these assessments, who referred some of those young people, that they themselves fear that they've been part of a major medical scandal. And let's talk about the medical scandal. I feel bad because it feels like I've been grilling you about your own personal opinions.

But the reason I've asked you about it is I think it kind of shows you how society is around this issue and it's telling, I think. But anyway, let's not delve too far into that. So... No, I mean, you're right. I think...

But I think it's good to be cautious about language as well because actually, I think sometimes we forget that we are talking about children and young people. And I think sometimes the language is really unfortunate. And actually, different people like different terms and what have you, but I just think it's important to have some compassion as well. Oh, 100%.

100%. But I suppose the argument might be that if you recognize the damage that's being done, then the compassionate thing to do is to scream about it from every rooftop. Some people would argue, too. And that's the debate, I think. I think you've done a great job of actually laying out the fact. So let's talk about the fact. The Tavistock was a clinic here in the UK. And give us some of the numbers. What sort of numbers are we talking about how many people were coming through? How many people would have been referred for? blockers, what other things did you find that sort of people should know about? Well, in the early days, so that the unit, the gender identity development unit as it originally was, started off at another London hospital in South London, St. George's,

and I think the first year, two children were referred. It moves to the Tavistock and Portman NHS Foundation Trust in the mid-90s, and it still was about a dozen a year. It grows, you know, it ticks up. And then fast forward to 2009, we've got 97 referrals. 2019, another decade, and we've got 2.5,000. And the last year we have numbers force, which is 21, 22, more than 5,000. So we've had quite a big increase.

Yeah, that's so sure. You know, you look at it, it's that classic hockey stick. graph. And from 2009 to 15, the referrals go up at 50% per annum, and then in 2015-16, they double. And at the same time, you have this really quite radical shift in the demographics of the young people being referred. So initially, the majority of those referred were boys, birth-registered males, assigned males, whatever language we want to use. 2011 there's parity, equal number of boys and girls referred, and then by 2015, total reversal,

and now we've got two-thirds of the referrals, girls. But not just girls, but girls who actually, their gender distress only started in adolescence after the onset of puberty, which was completely different to the traditional presentation, if you like, which was sort of lifelong since early childhood gender incongruence. And lots of these girls, not all of them, but lots had really quite serious and distressing other difficulties that they were also contending with.

So no one doubted that they were distressed about their gender, but loads of them had other associated difficulties as well, like anxiety, depression, perhaps they were self-harming, eating disorders. Maybe they'd had a traumatic child. all these things. In terms of how many were referred for puberty blockers, we don't know, because every time someone has asked,

either the Tavistock and Portman or one of the two trusts that prescribed the puberty blockers, so either University College London hospitals or Leeds teaching hospitals, they've not provided an answer. So best estimates from what is in the public domain, at least 1,500, I would say.

I mean, a freedom of information request said that by 2017, there'd been over 1,200, so I don't think it's unreasonable to think. We're in excess of 1,500, but the answer is we don't know. And I think that's one of the things that is so striking about this story is the lack of data and how a clinic that's been running now for close to 35 years is really not able to tell the public at least really, anything meaningful about the thousands of young people that they've seen. That's shocking.

The fact that they didn't even keep records. What is either one or two things, they either didn't keep the records or they're refusing to disclose them. I don't know which is worse. Yeah. Either of those two options are, I mean, that's horrific. Well, this is a thing that has really sort of shocked clinicians as well who worked there because they say, well, look, we had a research team.

We collected loads and loads of data, so where is it? Now, as you say, it's either there, but not somehow collatable in a meaningful way, or they collected the wrong data, you know, stuff that doesn't matter. I don't know. But we don't know it. And for example, and one example of this is that for years, they said 40% of young people referred to us are then referred on to, for puberty blockers. Subsequently, that's come down,

but they were consistent about that for many, many years, in the press and everything like that. They put this figure in an academic paper, and then they explained where it had come from. And the Tavistot were asked, well, through freedom of information, could they give the actual numbers behind this graph, which put, of referral and the proportion of which had gone on to endocrinology. And they said, no, we don't

have it. The lead author is a professional at UCLA, asked them, and the person that did the number crunching, if you like, doesn't work here. They were a research doctoral assistant. So UCLA were asked that same question. You've got this graph. Can we just have the data behind it? We don't have it. please go back to the Tavistock. Now, the Tavistock then said, we've done a search and we don't have it. Now, one of several things is true then. Either they do have those numbers,

but don't want to release them for whatever reason, or they don't have them. And it's like, well, what does that tell you? So this is their core treatment pathway, referral of young people for puberty blockers, They have this really quite important data, their data, but they've not kept it. And they've not continued that either. It's, I mean, it's baffling.

I don't know which of those is true. But either way, it would be helpful to know. That's such a British way of putting it. That is the most BBC way of putting it. Hannah, so thousands of young people are referred to this clinic. Can you describe to us as a kind of as a customer of this thing or whatever the right term is, as a patient, whatever it is. What is your experience like? So you're a child, let's say you're, I don't know, what would be a sort of median age?

11, 12. So you're 11, 12. You may be coming from care. You may be coming from a dysfunctional family. You may have been abused. You get there. What happens to you? I'll answer that.

I just wanted to stress, not all kids. were like that. Yeah. And I just want to say, like, so many of these young people, you know, they had loving families and they just didn't know what to do. There's nothing worse,

is there than seeing your children in pain. So I just want to put that. And they were going to the professionals to ask for help. Well, quite. And as a parent, I think actually, you know, this is sometimes where people go,

why do people care so much about this issue? It's not that many people and whatever. But you mentioned yourself becoming a mother and as a parent now myself, I think for a lot of parents, their big fear is that, hey, and we'll get on to this, where do young people, particularly young girls, get the idea that this is the right thing for them, number one.

Let's say your child has that, and then you go to the professionals, and you're like, look, I'm just a parent, I don't know what's going on, can you please help me? And then after a couple of hours, they're on the pathway to help, right? That's, I think, where parents' concerns are. So, but tell me more. So let's...

So any given young person's experience, to be frank, will be completely different depending on who you and your family happen to be assigned to, like which pair of clinicians you see. That's reassuring. And this is part of the difficulty and something that was absolutely highlighted by Hilary Cass and by the CQC when they inspected Jids. So on the one hand, you had assessments that could be, and the CQC found this, that say two appointments, so that's two hours.

on another hand at the absolute extreme there could be 50 sessions so that's therefore you're talking years in the latter a couple of hours in the former now the experience that that young person and their family have is so worlds apart in those two things now it could have been in the 50 session assessment which is rare was rare it could be that that person was then referred for puberty blockers but having gone through years

of talking therapy and everybody being as sure as they could be, because there's never certainty, but as sure as they could be and fully informed and making that decision along with their professionals. That is a very different kind of relationship and, you know, care offering than the young person who's seen two, three, four times. And so this was part of the difficulty.

And there was no agreement amongst the staff group about how best to care for these young people. And I think this is really important to stress that actually globally, there is not clinical agreement on how to best care for this group of young people. And that might mean, and it probably does mean, there won't be one way either. It might well be that what works for some just won't work for others because kids are different. And just as there are different ways that someone might get to their gender dysphoria

or gender incongruence, there's probably going to be different ways out of it as well. So there is disagreement amongst people, even at working in gender clinics today about how we best do this. But fundamentally, that makes the service really difficult because there was no agreement on what, what it was that they were treating in the loosest possible sense,

you know, not to pathologise these young people, but if you can't agree on what it is you're treating and how best to treat it, how can there ever be a sort of consistent assessment and consistent care? And there wasn't. If you believe that gender dysphoria equals being trans and therefore that is a stable, lifelong identity,

then of course you would refer. for physical interventions. If you believe that actually gender dysphoria might lead to a trans outcome, but equally it might be related to something else that's causing you distress in your life, then you might not, or you'd be far more cautious about doing that.

And that was the difficulty. I mean, I was really struck by... There was a clinician who's in the book, Dr. Kirsty Nwistle, who worked up in the Leeds site for Jid's, which doesn't really get a huge amount of attention. And she's very worried pretty much as soon as she joins. And she has a massive difference of opinion

with the clinician that she's working with about a couple of cases. Now, the solution of the managers of the Leeds Gid site is that Kirsty Entwistle and this other clinician just won't ever work together again. And one of their... colleagues told me, well, that was the only sensible solution because they were so poles apart that they couldn't work with families. Now, what are the implications of that? That you have two people working in the same NHS service whose views are so opposed and their

opinions on how to care for the patients that they can't work together. It's quite extraordinary. So it's a very long-winded answer because, so it depends who you sort of. It depends who you saw. However, I take it from what you're saying is there was variation in how different patients were treated and some would have had a long time to think about and go through the process. But I also take it that there were some people who would have turned up, had a couple of sessions and onto the puberty block as they went. Is that accurate? Yes. Yeah. And how did that happen exactly? Why was that? Why was that? Why was that allowed?

Well, I think in the earlier years, so puberty blockers became available as sort of standardized practice at these younger ages from 2014 after they'd, well, they hadn't really completed, but after an initial attempt at a study. And at that stage, 2014-15, although some of the clinicians didn't understand

perhaps why you might refer, even after six sessions, which was the kind of the assessment model. They didn't, they weren't overly concerned because in their eyes at that time, what they were constantly being told and there was nothing to suggest to the contrary was that what the puberty blockers did was they provided time to think and there were no long-term effects and they were completely reversible. And actually what so many of those young people needed was time to think. They were very, very distressed. And the rationale of the blocker makes perfect sense, that you've got this mismatch between your biological sex and the gender identity that you, you know, that you perceive. You stop your body going through the puberty

of your biological sex and then you can hopefully take away some of that distress and then think about things. Now, it was only really when So in those years, 2015-ish, lots of clinicians told me that pretty much any young person that wanted the blocker could have it during quite a quick assessment. And actually, as long as they met the criteria for gender dysphoria, which pretty much all of them did because they're silly and most teenagers would meet them, they would be referred for puberty blockers. What were the criteria for gender dysphoria that you say were silly? Well, they think, I mean, I mean, at one area, this is a rare moment of agreement from both those who are very pro-medical intervention and those who are very against is that, you know, they're steeped in gender stereotypes. So it would be things like playing with toys that are typically associated with the opposite sex, having friends that are mostly of the opposite sex, wanting to be. The opposite. You know, they're just...

So if I were a girl who was a bit of a tomboy, quote unquote, and I felt some sort of distress, puberty blockers, off you go. Well, yeah, you have to have the distress, and it has to be for more than six months. But six months is not a huge amount of time. No. It's not a huge amount of time. And actually, the small amount of data that we do have kind of bears out,

that in those years, sort of 2014, 15, 16, 16, lots of people, well, proportionally, lots of people were referred. Like this data that I mentioned before that they didn't release because apparently no one has it, but there's a graph, it's the only graph in the book. And it actually shows that, you know, of those who were referred in adolescence, the majority went on to be referred for puberty blockers. And the peak is at about 14. And I turned into absolute Uber geek, and I actually blew this thing up

and I'm measuring it. And I'm like, oh, one millimeter is this. And so I do actually get their numbers. And it's about 70% of 14-year-olds during this particular time period. And now you get an average of a minority, 40%, because the really young ones obviously aren't eligible to be referred. And so it's the classic, the average, the mean. The mean is meaningless because it hides what's going on in the middle.

So there was that, that they didn't think, it made, sense. There was also the fact that some people say there was pressure to refer quickly because it freed up their time as clinicians because the waiting list was growing. As we've already mentioned, the referrals were going through the roof. They breached their 18-week waiting target for the first time in sort of autumn 2015 and they never met it again. And once you referred a young person to endocrinology, you saw them less frequently. So it freed up some clinical time. Hannah, we interviewed, I mean... That's horrifying.

Yeah, anyway. Hannah, we interviewed Marcus Evans, who was one of the whistleblowers on this show two years ago, and he said something to sit on that interview, which has always stuck with me, which he was said that some of the people who were working at the Tavistock were motivated more by ideology than patient care. Was that your experience when you were doing your studies,

and you were actually looking into this case, or did you find something else? I think it's a bit more complicated than putting it that way, in my view. I don't think that the majority of people that worked at Jid's were ideologues. They were just hard-working, caring professionals who wanted to help kids, like the vast majority. And that's why, and they became concerned when the reality didn't, really match the theory, if you like.

Where I think ideology really impacted on JIDs is that there seemed to be this inability to stand up to some of the trans charities and groups. And, you know, it was lobbying in part, not totally, absolutely not, but pressure from those groups that helped lower the age at which. puberty blockers could be available in the first place. There was a real big push for that. But there was pressure from elsewhere too and in the medical community.

But I think there was this almost, clinicians have described to me, there was this fear of sort of upsetting those groups, groups like mermaids, which people have probably heard of, and gyres, that when data became available that challenged what they thought they knew

and that perhaps, showed that actually puberty blockers weren't working in the way they thought and had been telling families, they didn't change direction. And some people told me, some clinicians told me that they felt that that was because there was a fear of how some of the groups might respond. And similarly, you know, as more information came out, nothing was codified, nothing was written down. So in all fairness to some of these clinicians who didn't pass on information, you could only passed on something that you know. You can't pass on what you don't know. And, you know, there's a, there's a meeting in the book. And it was an absolute turning point for lots of people, but they

have a visit. The Jid staff have a visit from a surgeon who performs vaginoplasties on trans women. So taking a penis and surgically constructing a vagina. And he tells the Jid staff, he said, look, there's a problem. If you block puberty too, you. early in males, there isn't enough penile tissue to do that surgery in the safest and most effective way. You can still do it, but it's riskier and you know, you might have to have subsequent surgery. To everybody listening to that, that I spoke to, they, from that moment on, passed that on to all of the relevant families. So no one questions that. But it was never written down, despite the efforts of one clinician who wrote a leaflet,

had it approved by that surgeon and one of the members of the leadership, but it was never signed off. So I spoke to clinicians who joined the service subsequent to that, so that was in 2016, who never knew that. So they couldn't pass it on. And I'm told by people who work in adult services that you can see that in some notes, that some trans women who, you know,

when they were boys and looking to transition, were not told that when they started the blocker, and some were. But again, it's this lottery. So to go back to your question, I don't think most of the people working there were ideologues. I think there was a, but I think the service became, if not captured, then frightened to stand up to ideology when evidence became available that showed actually this intervention was not working for some people. So effectively, these charities,

and push back if you think my language is too inflammatory, but I'm trying to be as accurate as I possibly can be. These clinics were essentially bullied by these charities because they were intimidated by what could happen or how essentially if they didn't adhere to what these charities felt was best. And as a result of that, patient care was compromised. I'm not sure I'd say they were bullied, because in all fairness to...

charities and lobby groups, that's what they're there for, right? They're there to put forward their view of what they feel is the best treatment for the people they represent. So you can't, you can't blame them. Why they didn't stand up to them, I don't know. What's the worst that could have happened? These are all hypothetical questions. I mean, it's, but it's striking.

I think it's very easy to understand why the medical pathway was introduced. and why the age was lowered originally and why they wanted to do more research. I think it's much harder to understand why there was no change in direction or at least pausing to reflect when data came back, which suggested their original assumptions were not the case.

So that being the case, we have this situation, which is awful, absolutely awful. When was the moment that the medical community and people like Marcus Evans started to go, there's something very wrong going on here. I think it happened for different people at different times.

So Marcus is married to Sue Evans, who was the first whistleblower, if you like. And she had concerns as far back as 2005 that some young people were being referred to quickly. And bearing in mind, you had to be 16 at that point. But she, you know, she saw some colleagues, refer young people after four appointments and she felt that was too quick in all cases. So Marcus Evans had lived through that experience, if you like, and then there was a sort of a

quite a big gap between Sue leaving in around 2007 and then lots of people taking their concerns to Dr David Bell, who was a very senior psychiatrist in the adult service of the Taverstock, but also at that time, the staff governor. So he was the representative on the board of governors who kind of spoke for staff across the trust. And essentially 10 members of Jid's staff who had tried repeatedly, and there's a paper trail that shows this to raise their concerns within JIDS and within the trust to very, very senior board members, nothing changed. And so they took the concerns to David Bell and then it all came in the public. And that's when Marcus, you know, he resigned over the fact that he didn't feel that those concerns were being taken seriously enough by the trust.

And equally, that Dr. Bell had been treated very poorly. But the clinicians themselves, who are working at that point, I mean, they each had different moments. But there was several, it was really when the first bit of data came back from this study that had begun, which challenged all the assumptions they had about puberty blockers. Because what this showed was that of those who had become old enough by that point, every single one of them had gone from the puberty blocker to cross-sex hormones. But also that there'd been no psychological benefit to being on the puberty blocker. And so for Dr. Anna Hutchinson, she describes learning that as her holy,

fuck moment. Because it exploded everything that they were doing. She said, you know, what are the chances of being given time to think? And all children and young people thinking the same way, she's like, that just doesn't happen. It doesn't happen in psychology. And also, even if we gave them time to, that this is what they did do, there was no space to think in the Tabastok model anyway, in the Jid's model. Because when you went on the blocker, you didn't have more talking.

less. You got seen every three to six months. And so, and actually, these young people weren't feeling better. In some cases, both psychologically and physically, they were getting worse. And so at that point, quite a sizable number of clinicians just went, this isn't safe, what we're doing. And they became much more cautious. And they extended their assessments. And that's probably how we got to, you know, the 50, although very rare, but, you know, because they felt, as one clinician puts it to me in the book, like, that knowledge that pretty much everybody that started the blocker went onto cross-sex hormones totally changed the way I practiced, because if I didn't think that a young person should go on hormones, I wasn't going to put them

on the blocker because you had to do the work then. It was far too late once they were on the blocker because the other thing that they noticed was that actually a young person tended to shut down once they got on the medication. They got what they wanted. They weren't at all open to talking. Hannah, and I'm curious about what happened prior to that discovery, when people went and raised concerns and they were not taken seriously. Do we have a sense of why that happened? Because I think that's a question a lot of people would be asking. And I think you've got a very measure. take on all of this and that you're really looking at an organization like any organization in which lots of busy people and they don't have the time and blah blah blah blah blah

blah is that what happened was there was there people at the board level who felt that this is the path that they must proceed down why did those concerns not getting taken seriously prior to this discovery i think there are different reasons why these concerns weren't acted on one appears to be that certain people in the trust just believed that this was the right thing to do. Like this is a vulnerable group of young people, trans people are marginalised and stigmatised and we're helping them. And any concern is transphobic. I think some people perhaps didn't raise concerns as robustly as they might have. In hindsight, because there was this really, I don't know how unique it is,

but I wouldn't say it existed in the BBC, for example. I mean, I like my colleagues, but people at Jid's describe it as a family, and they were encouraged to think that way, at least for a time, before it became absolutely enormous. And when concerns were raised about clinical practice, it was made to appear to the rest of the team that, you were criticising the leadership, or you were criticising a person. And yet these were people that we cared about and, you know, you don't criticise your family.

And then arguments would come back, well, we're doing it better than everybody else. Or, you know, the private sector would be worse. And they said, but that's not good enough. Like what we're doing is not good enough. We can't just say, well, other people would be worse. Some people have suggested that the concerns weren't taken seriously enough because over time, the contribution that Jid's made to the overall income of the trust was quite significant. So it went from around 2015 being about 5% of income that came into the trust to about 13% at its peak.

And when you combined that with the adult service, which the Tavistock took on 2017-18, it was a quarter of the entire income. And no one suggested that there was anything sort of really malicious about that. But so many people just said it had to be a factor, even unconsciously, that there was so much, you know, the financial stability and viability of the trust depended on this income. Dr. David Bell said to me, perhaps it wasn't taken seriously, because to really listen to what those clinicians were saying, you couldn't put a sticky plaster on it. It just required a complete overhaul, a radical rethink of exactly what they were doing. But hold on a second, Hannah.

These are kids' lives that are being irreversibly damaged their bodies. And not saying, obviously, but they're putting the system ahead of that. That, to me, it's apparent. As I say, I don't think anyone, no one has suggested to me that, I don't think anyone is, was intentionally harming children. Agreed. I don't think there's any evidence for that. Have children been harmed?

Yes, they have. So, and I think what's so interesting about the people that spoke to me for the book and put their names on record is that it's very rare for us as human beings to say, do you know what, I've done something really wrong. Yeah, that's true. And they did do that. And Anna Hutchinson puts it, you know, why weren't the concerns taken seriously?

She says it might be that those people at the top of the service who have been there four years, well over a decade, referring young people for puberty blockers, perhaps you get to the point that you can't, you can't change direction. Because what does that mean? What does that mean for you as a human being to go, oh my God, I might have got this wrong

and I might have got it wrong for some of the most vulnerable young people there are. And perhaps that's intolerable and perhaps that explains in part why they didn't change direction. I don't like... Yeah, absolutely. Yeah, look, it's a very, very good point. The thing that I always struggle with this issue,

and this is someone who was a teacher for many years and I taught autistic kids, is that no one picked up the link between autism and especially autistic girls. I think the number, or the stat that I get, keep remembering is 40% of these girls who were referred had autism. And they were dealing with mental health professionals. Why did someone not jump on this sooner and go, hang on?

There's a very real link here between autism, gender dysphoria. Something else is happening here. Do you see what I mean? Well, I think they did spot that. So, I mean, their own research showed that I think it's 35% of boys and girls that were referred had autistic traits. So they spotted that and it's what you do with it. And seemingly, it didn't change anything. And this is another theme, if you like, that whether it's that you realize that over a third of your referrals are autistic compared to 1, 2%, nationally,

whether it's new knowledge on surgery, whether it's new knowledge on how the blocker might be working, clinicians use this phrase like everything changed, but nothing changed. So practice just never changed. So they knew that, they knew. And the CQC picked up that, I think, of the sample of records that they looked at,

50% were autistic, of the ones that had been referred for the blockers. but they weren't collecting that data. And when Kira Bell, who was seen at Jid's and transitioned and has now detransitioned, when she took the case to the High Court, in the original judgment, the judges remarked that they were surprised in characteristically understated British language. Jiz didn't have that data. How many of the people you refer are autistic, they didn't know.

And it's also the element of how many of these kids, who are going through this process, they're just gay. They're just gay kids. I mean, whenever I, you know, because the show has got quite big now, the people who come up to me, I get quite a lot of gay men and gay women

wanting to talk to me about this. And I remember talking to this gay lady, makes me sound like I'm from the 1950s when I say that, but a few weeks ago, and we were talking about this, she approached me and we were having a nice conversation. And she just looked to me and she went, thank God that I'm in my late 20s.

Because if this had been around when I was 12, I would have transitioned. And I would have screamed the house down until, you know, there was medical intervention because that's how upset it was at the fact that I was gay or I am gay. I think this is the part of the story which people particularly in, you know, liberal metropolitan cities find the hardest to accept. And certainly that's like the reaction that I've had to the work.

Like, it just can't be true, you know. And clinicians themselves, they would get young people coming in and using these vile homophobic slurs that, you know, that we had at school in the, I think we're probably a similar age, you know, the 80s and 90s. And hearing that, I kind of, I thought we were done with that. thought it just wasn't a thing anymore for people to think it's not okay to be gay, but it is. And it's not me saying that.

Like every clinician I spoke to said that so many of those young people were same-sex attracted, even those that spoke really favourably about the work edges and particularly the girls. And actually, when those clinicians who were gay themselves raised those concerns, they say they were accused of being too close to the work that they were seeing something. that wasn't there. And what they've turned around and says, look, they say, look at the data.

Like, it's really rubbish. Like, we don't have much of it, but what we do have absolutely bears that out. So Jid's data from every single young person that was referred to them in 2012, of the ones they have data for, which is the older ones, they didn't ask the very young kids,

what is it? I think 90% of the girls identified as either same. sex attracted as well or bisexual and 80% of the boys and then in slightly more recent stats those come down to about 70% and 60% respectively but they're still incredibly high so they're saying we weren't seeing something that wasn't there and I've spoken to young people themselves there's a there's a case in the book Harriet who said I was a lesbian and it was so obvious I went into my jid's assessment and I talked about the first relationship I'd had with a girl and I felt really

ashamed about it because she wouldn't talk to me in public. And I've never been attracted to a boy. And all that was ignored. So it's not, the data, the personal experiences, the experiences, the clinicians, it's there. And I have to stress that of the people I spoke to for the book, not all of whom are named or quoted, but collectively they've worked with thousands of young people directly sitting in a room like we are now face to face. It's not. it's just, I don't think it's credible to pretend that the overwhelming number of people who might be affected by this are gay, bisexual or lesbian. I mean, and that has always been the case. So every study we have in this field is quite rubbish, but all of them highlighted that.

And when Domenico de Chaley opened Jids back in 89, he always made that point that of any group of kids, some would grow up to be trans, but there would be the minority, the majority wouldn't, and the majority of them would be gay. And somehow this gets lost over the years, even though it was in the clinical presentations,

and even though their own data showed them that. And it wasn't, I don't know, it was just not seen as a thing, like the gender identity was what mattered. So I described it as medical malpractice earlier, and I appreciate your commitment to impartiality, and it's very strong. But if I'm reading between the lines, and you don't have to commit to my way of saying it,

but this was a situation which due to a number of structural and other failures, autistic and gay children, who were overwhelmingly the majority of the cases, if you put those two categories together, were essentially treated for autism and homosexuality with puberty blockers or in some way. Is that overstating it? Well, I mean, I'm not sure you need to treat homosexuality.

Well, I wasn't there doing it. No, no, no, no. I mean, that's what I'm saying. Yeah, I mean, that was certainly the fear. with mental health issues, autism and homosexuality, were treated as if they need this medical intervention. Yeah, I mean, several things. One is, like, you know,

not everybody was referred for puberty blockers, which I think we've clearly established. But yeah, that was, and that was discussed. I mean, you know, this, and the medical director, various people were told this. You know, they would have discussions. I mean, it wasn't that discussion was shut down in that they talked all the time.

The fact is they just talked, but nothing changed. So that was the problem. But they would have staff meetings and, you know, really worried clinicians would say, maybe we're medicating gay kids. Maybe we're medicating autistic kids. And if we are, we're doing something quite dangerous. And it was that those fears couldn't be responded to adequately. And that's why ultimately people left because they felt that the risks in the work

weren't being adequately acknowledged or minimised even. There will always be a risk because every single clinician I've spoken to said you can never tell for sure who's going to benefit and who's not. But there are ways of minimising that and they felt that that isn't what was happening. But yes, I mean, if you go right back

to where this started with a team in the Netherlands, they acknowledge right, right at the beginning that the risk of blocking puberty earlier, pre-16, was that you would get something which they referred to as, rather euphemistically, as false positives.

i.e., in your attempts to help those who would grow up to be trans adults, you would probably, the risk was, you would also include people who, had they not had their puberty blocked earlier, would not have transitioned and would have somehow come to either accept or their distress would have been released,

without physical interventions. And all the data suggests that those false positives are most likely gay, lesbian and bisexual people. And Hannah, one thing I wanted to ask you as well is, given the rapid increase in the number of referrals over the years and the decades, as you described, where does that come from? Because gay people have always existed.

Autistic people have always existed. How do we get from a handful to thousands, to thousands. That's a $64 million question, isn't it? I think there are lots of... So there are clinicians who are much better at hypothesising about that than I am, so I'll just steal their ideas.

But I think there are lots of reasons. And I was talking to someone recently said, oh, it's either social contagion or it's greater social acceptance. I don't think that. I think it's both and. So I think... I think for some people, and I've spoken to them,

I think greater visibility of trans people and more social acceptance, I think that probably was the case for them. And I think there will be different things for different people, but I spoke to people in the book who were like, I always felt this way. But I didn't know what it was called. And it's not for me to question their story.

I think for some people it's absolutely, whether we use the word contagion or not, but there's certainly influence of friends and peer groups, and even W-Path, the World Professional Association for Transgender Healthcare acknowledges that in their most recent standards of care, that for some, there will be that influence, because why wouldn't there be?

There is for everything. Like, we've all been teenagers. And again, I've spoken to people for whom that was definitely a factor, where all their group of friends were either trans or non-binary, and it was trendy and made them fit in. I think for the girls in particular, there are additional factors. I think right now it's really quite tough

to be a teenage girl. We live in this quite hyper-sexualized world. Two jids clinicians, Anna Hutchinson and Melissa Midging, call it the pornification, you know, this and pinkification. And I think if, I think for some young women, if they don't feel that they are,

or present in a way that is seen as typically uber feminine, whatever that means, it's nonsense, then you can look for another way that explains why you feel that you don't fit in. I think for some people, even for those for whom transition hasn't worked, most of them will say that it did for a time. And initially, in the early stages, they felt great

because it was like, oh, this explains. This explains why I have been unhappy. Not everybody. But if you inject me with testosterone, I'll probably feel great for a while as well. Well, it's a natural antidepressant. That's what I mean. Right.

So when you inject people with drugs, they often feel great. This is not necessarily evidence of that being the right thing to do. And as we've discussed, like internalized homophobia, we'll explain it for other people. So I think there are all kinds of reasons. Can you put some percentages on those things for us?

No. Well, the difficulty is that I agree with you that there's a complex range of explanations. But the problem is that can be used, and I'm not for a second suggesting that's what you're trying to do at all. I'm just trying to get to the truth here. That can be a way to conceal the reality of what's happening. Do you see what I'm saying?

Because if we say, look, there's a reason for this, this, this, this, this, but like one of them is 90% of the entire total. Yeah, but I'll put it back to you, like how could we possibly come up with the percentages? I mean, what would that look like? How would we arrive at that data? I think it's hard to say. One of the things I think we ought to look at it is, I don't know if this has been done, but several years down the line, you go and speak to those people and see how they feel about what happened. Yep. And then you kind of break it down from there. At the very least, we probably would want to know how many people receive treatment that they shouldn't have received. So it seems to me quite a priority here.

Yeah, that would be good to know, wouldn't it? I would think so. But we don't know. And why not? Well, I think there are several reasons we don't know. So one is, if we keep it focused on jids, I think they haven't wanted to find out. They haven't found out. I mean, their own documents, their own information

that they've released under Freedom of Information shows that there was a time when they said, yes, we are going to record both those who changed their minds prior to medication and those who do once they've started either the blocker or hormones. And for a couple of years, 2017-18, they said, yep, we're doing that. And then they suddenly said, no, we're not going to do that. It's really time-consuming. So they never collected that data.

Only they will know why, because that seems quite important data to have. Because in order to benefit, it's why I find the argument, that some people make that we shouldn't talk about, you know, that talk of detransition, so people have gone through a medical transition or surgical transition and then revert back to their natal sex. That doesn't undermine the experience of those for whom a medical transition might work. Actually, I've spoken to, you know, there's a trans researcher in Canada who's doing loads of research on detransition, and he says, we can make treatment better for everybody if we understand those for whom it doesn't work as well. That's equally important

because everybody wants to prevent that happening. So yeah, but we've had no follow-up of Jid's patients. So we don't know where they are. We don't know who's happy, who's unhappy, who's medically transitioned, who hasn't. And it would be equally helpful to know of those who never transitioned, what was it for them that worked or didn't work? I mean, these are all really important questions, which we have no answers to. What we do know from the very limited studies that exist on people who have detransitioned is that the reasons they give for detransitioning and also identifying as trans in the first place, they vary.

But how you ever get to reliable percentages, I just don't know. Yeah. I guess the reason I'm asking you is, again, not trying to put anything on. you, but if I'm an ordinary person watching this, based on every time we've gone down one of these cul-de-sacs, we always end up with there was not enough data, they stopped collecting it, I'm thinking cover-up. That's what I'm hearing. Now, that is quite, I mean, I watched Chernobyl the other day. You kind of see elements of how people, particularly in stressful situations, where there's a lot of fear, where they know they've done something wrong, but they don't want to admit it, you kind of

can see how even often well-meaning people will end up doing things that are bad and then not wanting those things to be revealed. But it's just, it sort of feels like every time we go down one of these paths, we always end up where they stopped collecting the data, they stopped, didn't look into it, they didn't want to know this. That's sort of what it feels like here to me. It may be. I don't know. I mean, I would, one of the people I spoke to the book, Dr. Juliet singer, so she's a child and adolescent psychiatrist. She also happened to be a governor at the Tavistock. And she felt she was constantly asking for data as soon as she arrived. And she felt, and certainly others feel, that it wasn't just that it wasn't a priority, which is strange

in a clinical service, but it wasn't just that it wasn't, she felt that they didn't want to find out. And that might be the case. Only they will know for sure. But she also made the point that if you don't have the data, if you don't know your patient population, you don't know how many are autistic or gay or have anxiety, depression. If you don't know that, you don't know the long-term outcomes of the treatment. You don't know how many people are satisfied or unsatisfied by the treatment. How can you be experts?

Because what are you experts in? Now, those are questions posed by people who work at the trust. I don't, you know, it won't surprise to say, I'm not going to say it's a cover-up, but certainly the question has been raised by those who are close to it. And just finishing off with these detransitioners, their bodies have been irreversibly changed. What are they experiencing?

What in what physical state are they left in now as a result of these puberty blockers, the surgeries, the hormones, do we know? I think different people are in different situations. So a young, I mean, your body from puberty blockers, that's not, you're not going to be permanently altered. But what I would say is that I'm still in touch with them. A young, still identifies as trans, a young trans man, he's 20 now.

So he was on blockers for four years between the ages of 12 and 6. And he's chosen not to take testosterone, but it still identifies as male. Now, he broke four bones while on the blocker. And the talk that it's physically completely reversible, well, do we know that? Because so few people come off the blocker that we don't really know. And when he came off the blocker, no one from either UCLA or the Tavistock ever followed up on him. So he came off at 16. It wasn't until 18, two years later that he got his periods.

And even now, another two years later, they're not regular. He feels left behind, I suppose, cognitively and emotionally from his peers. Is that to do with the blocker? Well, we don't know. There are no studies. There's no follow-up. So we don't know. In terms of detransitioners, I think people handle it in different ways.

I mean, Harriet, who I spoke to for the book, when I caught up with her again recently after it was published, she's actually doing really well, which is great, and she's much happier. You know, she lives with her voice being a lot lower and obviously sounding masculine, and she's had a double mastectomy. But I think there are also, I think talk of detransition

actually masks lots of things as well, because there are, what does it mean? Like, there are people who have fully surgically transitioned who have had what people in the trans community would call, you know, both top surgery and bottom surgery. They've fully surgically transitioned. Now, and some, and I can't put any numbers on it, some are really unhappy, like desperately unhappy.

And given the chance, again, they would not have done this. Can they detransition? Absolutely not. because what would that look like? The body has been totally changed by hormones. If you've had a hysterectamine, you're female, you're going to have to take some kind of hormone all the time. And if you're federally surgically transitioned,

it doesn't matter how you feel in and of yourself. Society will never perceive you as your birth sex again. That's just a sad reality. So in a way, detransition, it's all a bit more complicated, isn't it? How do you measure it? Absolutely. Hannah, we could talk for hours more and we will on our locals with questions from our supporters. But for now, I'll just remind everybody. The book is time to think.

Thank you for writing it. Before we head on over to locals, two things. We'll ask you our last question. The other thing I should say as well is, I know that this is not an easy issue to cover, mainstream news, non-mainstream news, whatever. So well done for writing this. Thank you. I know, and I can, you know, as I have alluded to repeatedly,

I can see it's not an easy thing to have done necessarily, but it is an important one. So time to think, I hope everybody reads it. What's the one thing we're not talking about as a society that we should be? The standard of maternity care. Tell us more. I think. You've gone BBC mode again.

No, I haven't. I'm actually thinking. I think when you have one of the most developed nations in the world and close to 40% of maternity trusts are inadequate or requiring improvement, I don't think that's a good place to be for women and their partners and their children. Agreed. Head on over to locals where we continue the conversation. What would you say to people who may be watching from other.

countries about, you know, how these things ought to be looked at or handled, what is the right approach.