Who Trolled Amber? - The Tavistock - Episode 7: Gender GP

Episode Date: September 18, 2023

Polly Curtis returns to investigate the world of private trans healthcare, and speaks to Gender GP and its founder Helen Webberley, labelled by one newspaper as one of Britain’s most controversial doctors. Listen to the full series today. For the premium Tortoise listening experience, curated by our journalists, download the free Tortoise audio app. For early and ad-free access to all our investigative series and daily and weekly shows, subscribe to Tortoise+ on Apple Podcasts.If you’d like to further support slow journalism and help us build a different kind of newsroom, do consider donating to Tortoise at tortoisemedia.com/support-us. Your contributions allow us to investigate, campaign and explore, and to build a newsroom that is responsible and sustainable. Hosted on Acast. See acast.com/privacy for more information.

ACAST powers the world's best podcasts. Here's a show of glamour and scandal and political intrigue and a battle for the soul of a nation. Hollywood Exiles, from CBC Podcasts and the BBC World Service. Find it wherever you get your podcasts. ACAST helps creators launch, grow, and monetize their podcasts everywhere. Acast.com The story of the Tavistock's Gender Identity Development Service

is the story of an institution operating in an evidence vacuum and engulfed by a culture war. First, the clinic stood accused by trans rights activists of being too slow to treat young people with puberty blockers and hormones. Then it stood accused by some of its own clinicians of rushing untested treatments. The truth is that both those things happened, depending on the Tavistock clinician you saw. Some prevented treatment people felt they needed, some fast-tracked it too quickly. All were tasked with an impossible judgment. How do you clinically assess whether a young person will still be trans in years to come,

or whether it's just a staging post in their development? Now, as families wait for a new service to replace the old, there's a kind of limbo. And suddenly, a complicating factor in their story has become more important. The role of private medicine. It's always been there

on the margins. It keeps coming up. I tried going privately with my testosterone. It was taking so long I'd looked at going private with gender GP. Often it's just a throwaway line in the conversation. And what happens in practice is people go to a private route. It doesn't stop something from happening. It just stops it from happening in a way that it's actually financially accessible.

What I realised is that as the waiting list grew for the Tavistock, more teenagers were paying for private healthcare. For a while, after the judicial review of the Tavistock service, it became the only route and the Tavistock could only watch on. Their body was starting to mass skin lies and the parents decided to seek treatment privately. So they sought treatment through a private provider because you hadn't referred them we weren't in a position to refer so because of the because of the judicial ruling you know we we i mean i knew the family young person for many years and we had done sort of extended assessment. It had been extended a bit longer because actually I didn't think that the child was sufficiently mature enough, I think, to make a decision. Currently, the Tavistock is taking no new patients

and the first new services aren't due to be up and running until the autumn. Patients can be added to a waiting list, but they'll likely have to wait years before they're seen. So if you're looking for specialist help right now, there is nothing on the NHS, and the private sector is stepping in. I'm not that savvy on the whole business side, but I... You said that you described yourself as a businesswoman. I know, but I'm not. I'm a doctor. At the end of the day, I'm a doctor peddling in business. In the limbo between NHS services,

I wanted to investigate where people are going for help now and how the peddling private sector is stepping in. Most of all, I want to know whether those services are safe. Because when the NHS falls away, who can you trust? What is really happening in the poorly regulated and unscrutinised world of private providers treating young trans people? I'm Polly Curtis. From Tortoise, this is The Tavistock, Episode 7, Private Healthcare, The Wild West. Hello. Hello. One more floor. One more floor. Get our steps in.

That's it. Hi, really nice to see you. Helen Webley is 56 and lives in central Cardiff with her husband and one of their five adult children. Do you want us to leave our shoes here? No, it's fine. Are you sure? She's welcoming, warm and relaxed. and one of their five adult children. She's welcoming, warm and relaxed. My name's Dr Helen Weberley.

I'm a GP and a gender specialist. I live in Wales and I'm the very proud founder of GenderGP. I expect her to be more wary of journalists, given some of the highly public and contentious battles she's fought. Over the course of our four hour long conversation she is open and passionate rather than guarded in her telling of her story. I love being the kind of person that will sit on the edge of the bed and hold that person's hand and say I understand this is really scary for you and I'm going to do all I can to help you and your family. Helen Webley trained as a GP but was always more interested in how people felt than in complex diagnoses. She says she always has

to look up the right prescription but she can read her patients like a book. She had no specialism in gender. It all started for her in 2015 when a patient walked into her surgery in Blanau in the valleys of South Wales. One day a person came in who looked to all intents and purposes like a man and we chatted and then they came back another week later and I noticed well this time I noticed that they were wearing a bra and they had pink nail varnish on and we chatted. And then next time there was a few more female attributes that they presented with. And I was like, so you want to take female hormones like to grow breasts and things like that? And she was like, yes, that's what I want to do. And I was like, wow, that that's just wow.

I was like, that's just goodness. I couldn't kind of get my head around it, that that would be something that I could possibly do or that somebody, or that would be right, really. She did the research and learnt about the adult service at the Tavistock. But looking at her patient, who'd never left Wales before, she thought they couldn't manage the journey to London, let alone repeat visits. So I said, I'll do it. I said, I'll do it. It's fine. I just knew it't manage the journey to London, let alone repeat visits. So I said, let's, I'll do it. I said, I'll do it. It's fine. I just knew it was the right thing to

do. So I did it. And it really helped her. As I talked to Helen Webley, I'm struck by how she's so sure her instincts are correct, that she just knew it was the right thing to do. Even early on, when she knew so little about treating gender dysphoria, she's a million times more certain than the director of the Tavistock Clinic, Polly Carmichael, who told me much of their job was about managing uncertainty. The service was and continues to be about, which is a sort of genuine curiosity and not having all the answers and managing the uncertainty about the outcomes for these young people. Helen Webley prescribed cross-sex hormones for her patient. Did it feel like an important moment in your life?

Definitely. I'll never forget her. I'll never forget the gratitude. I'll never forget her. Never forget the gratitude. I'll never forget the way something so small that I could give this person would mean so much and make such a difference. Helen Webley strikes me as a restless soul. She's always looking for something new to get her teeth into. She also says that she has an entrepreneurial streak. And over the years, you know, I've tried all kinds of things. I bought some commercial properties and there was a cafe in one of them and I'm like, okay, I'm going to run a cafe. And then there was one time I was like, okay, I'm going to buy some brown furniture on eBay and I'm going to do it up and sell it for loads of money. I bought a camper

van and I made a little website called Hire Me. If I look back back i was waiting for some kind of idea that would come through helen webley tells me she loves new technology and in 2015 she's drawn to telemedicine and the burgeoning world of private online practice so she builds a website to share her medical knowledge she adds diagrams and information to help people better understand a whole range of conditions. There's a page about HRT and then she adds a page for transgender healthcare based on what she's learned from that first patient. The way it feels like in my head is that I made it on that day and then when I woke up the next day it's like oh my goodness it's almost like it's like a massive snowball has just rolled down the hill and now it's huge. It's like a massive snowball has just rolled down the hill and now it's huge.

By luck or algorithmic design, that page starts to rank very highly on Google. Search for trans healthcare and it's the first thing that came up. It's getting thousands of hits. People were emailing me and reading the stuff that I was writing. So I took this page off there and I made a new website specifically for transgender information and care and called it Gender GP. And that's how Gender GP is born. A trick of an algorithm just at the point where there's a huge surge in the numbers of young people seeking help for gender dysphoria. As the emails pour in Dr Webley starts consulting privately with them

and prescribing the hormones they say they need. There were no alarm bells going off in your head, thinking, is this right? Not at all. It just felt fine. It felt, I'm a doctor, I have a medical degree, I have a licence to practice medicine. Was it exciting? Tremendously exciting. To have people say, oh my God, you're the first person that's ever understood me.

The first person who's ever listened to me. I've been to see so many people and you're the first person that's ever made me cry with happiness rather than cry with sadness. And all my patients were telling me that. And what I was noticing with these transgender patients is it was just immensely rewarding. The fear at the beginning of the consultation and then the joy at the end of the consultation when they're just like crying with relief. I mean just amazing job satisfaction. It sounds like an almost intoxicating experience for Dr. Webberley. She was hooked. Initially, she only sees adult patients, but that changes in late 2016.

Can you remember the first child who came to you? A hundred percent. It's like these marker moments, isn't it? And I was in a taxi on my way to the theatre with my sister. We were going to see an amateur dramatics production in Manchester at the theatre. And I checked my phone for my emails and there was an email from a 16-year-old. And he said, hello, Dr. Webley, I'm transgender and I know that you help people. And I know that I'm only 16 and I wonder whether you'd help me. And I was like, oh, my God god now what am I going to do I remember and I showed my sister and I said oh and she's a school teacher actually and she was like oh Helen you can't she said that's that's just taking it too far

that these are children these are young people you know that's just too much you can't do that but Helen Webley is not one to shy away from a challenge. In fact, she runs towards it. So I saw him in my clinic and I was like, yeah, you're a boy. You know, OK, you've got a few girly attributes going on there, but you're a boy in and out. She prescribes the testosterone he and his mother are asking for. These transmasculine people who've got a female oestrogen hormone profile

and you give them the testosterone profile that their body is craving for and it just unleashes life like you've never seen it. That idea that someone's body might crave the hormones of the opposite gender is highly contested. Their emotions start matching their identity and then when they get their first crack in their voice or their first hair on their chin it's just like Christmas all at once. It's truly phenomenal to watch it develop as a doctor. When I was talking to the staff at the Tavistock, they told me that they start by accepting that what a young person is feeling is real

rather than questioning it. That's what they mean by an affirmative approach. It seemed to me that, at least in theory, this was a tactic designed to build trust with a young person before taking them on a more exploratory therapeutic journey which might last several years before the start of any medication. Of course the reality at the Tavistock was that things varied enormously. Some clinicians accepted their patient's gender identity at face value. Others were more probing.

At Gender GP it's clearly very different. She says she never doubts what her patients say to her. She won't question their experience. Counselors, psychologists, therapists are all vital parts of this. But I saw that they were being used to do the assessment, the assessment of whether you are transgender or not. And I'm like, that's such a waste. Why don't we believe that they are transgender and then use those psychologists and counsellors and therapists to help somebody in their journey? And if in that helping somebody

in their journey, it actually becomes clear that they're not transgender at all. We haven't lost anything. We haven't cut anything off or changed anything. We're just working through it. And actually, that's never happened. Helen tells me this a few times, that nobody who's been treated by Gender GP has ever changed their mind, that circumstances change, but identity doesn't. We've never had anybody who hasn't been transgender. There've been people who have said I can't do this I'm going to stop. Never had someone who's changed

their mind you know that horrific thing that people are so scared about I've just not seen it. So when you talked about that first teenager who came to you and when you first met them your response was you're a boy was that an assessment it's a belief it's a confirmation she's telling me that at gender gp diagnoses are made on belief rather than clinical judgment the first teenager dr webley saw was 16 but the child who changed everything for her was 12 and came to be known as Patient A. Patient A was referred to Helen Webley by Susie Green, who at the time was chief executive at the trans young people charity Mermaids. Today, Susie Green works in fundraising for GenderGP, raising money for people who can't afford treatment.

Patient A was born biologically a girl and had a twin who was also a girl. But for as long as everyone could recall, Patient A had presented as a boy. Patient A was already being treated by the Tavistock and had been prescribed puberty blockers. already being treated by the Tavistock and had been prescribed puberty blockers. But under their rules, they would have to wait until they were 16 to get the cross-sex hormones to start their puberty as a boy. And this 12-year-old sitting in front of me was the most boy thing I've ever seen, if you like. And he was saying, when can I have my puberty? When can I have my puberty? And Jizz was saying, when you're 16, not until you're 16, definitely not until you're 16. I was like, I can't wait that long.

That's why they came to see me as soon as I saw him. I'm like, I've never seen a more obvious kid that needs to start puberty now. The most boy thing I've ever seen. Is that enough? It feels flimsy to me to diagnose someone in this way. that enough? It feels flimsy to me to diagnose someone in this way. It also assumes rigid gender stereotypes in which girls are girly and boys are boyish. Otherwise, when? 13, 14, 15, 16, what's going to happen? This kid would not have made it. He definitely wouldn't have made it. You know, mum was saying that he would, she didn't think that he would make it properly, like suicide make it if we didn't do something, and I believed her.

And so we treated, so I treated him. I knew it was a brave thing to do. I knew it was an unusual thing to do, but it felt absolutely the right thing to do. But it was the one that started all the trouble. The trouble came thick and fast. In 2017, Helen Webley was prevented from practising medicine by the General Medical Council, the GMC,

over her treatment of patient A and two others. In 2018, she got a criminal conviction for operating a medical practice without a licence. So GenderGP moved its registered office to Hong Kong to escape UK regulations. It's now registered in Singapore. In 2022, her husband, Dr Michael Webley, was struck off by the GMC

for what they described as a catalogue of failings over how he treated young people and prescribed puberty blockers and cross-sex hormones. The GMC also found he'd failed to adequately assess patients. Then, in March this year, the High Court rejected a previous ruling against Helen Webley which had found that she'd failed to give proper advice to a patient about the impact of hormonal treatment on their future fertility. In that judgment,

Mr Justice Kaye was clear that his decision was in no way a verdict or endorsement of the work of Gender GP. The sole focus of this appeal has been the quality of the appellant's clinical practice in relation to one patient, patient C. This appeal does not raise any wider issues about the wisdom or otherwise of administering puberty blockers to the younger age group who wish to undergo interventions for gender reassignment with full parental agreement. Throughout the GMC battle, Gender GP has been operating without Helen Webley, using remote therapists and doctors to carry out consultations. But now she is free to practice again. ACAS powers the world's best podcasts. Here's a show that we recommend.

Hi, I'm Una Chaplin, and I'm the host of a new podcast called Hollywood Exiles. It tells the story of how my grandfather, Charlie Chaplin, and many others were caught up in a campaign to root out communism in Hollywood. and the others were caught up in a campaign to root out communism in Hollywood. It's a story of glamour and scandal and political intrigue and a battle for the soul of the nation. Hollywood Exiles, from CBC Podcasts and the BBC World Service. Find it wherever you get your podcasts. ACAST helps creators launch, grow, and monetize their podcasts everywhere. ACAST.com I think what I've seen is more and more young people who've been accessing treatment through the private sector.

The arrival of GenderGP back in 2015 was felt inside the Tavistock. I'm just trying to think when it first became more aware. I mean, it seemed to begin around 2015, 2016 sort of time. I mean, that was when GenderGP launched. Was that apparent to you that that was happening? Yeah, yeah. We were aware of that. Was there a conversation internally about that? I think the conversation around that was, is this provider working within the agreed guidance? And if they were working within that guidance,

I suppose that sort of led us to think about, well, what were they doing? What were the assessments? James Barkley is a senior clinician at the Tavistock Clinic. He's always struck me as a measured and honest voice in this story. So measured that he's careful about how he responds to questions about the more troubling elements of private trans healthcare. We have our model of work.

It can kind of cut across that, I suppose, because I think we like to take quite an exploratory assessment and evaluative approach, quite a steady approach, and private advice have a different model, really. And I think there's a bit of a worry about, is sufficient time given to that sort of approach to really exploring things? There's so much ground to cover, I would say, in the work. I suppose I'd ask how doesn't another clinician

reach an informed view, a safe view, that this is an appropriate step to take. As the waiting list for the Tavistock grew, James Barkley was seeing something new. Patients arriving already on medication obtained privately. Suddenly the Tavistock wasn't the only route to puberty blockers in town. Which is quite a tricky situation to navigate because the family are coming with good intentions. They're trying to do their very best for their young person. You know, what they'll say is they've exhausted all the attempts and trying to support the young person, keep the young person going. It's usually a sign of how desperate I think people feel. it's usually a sign of how desperate I think that people feel. Gender GP can't or won't tell me how many patients they've treated since they started.

They confirmed there are currently nearly 10,000 patients on their list. More than a thousand of those are below the age of 18. Their website promises a multidisciplinary team approach. There are information gathering sessions, follow-up, discovery sessions and optional counselling, all of which is done online. Doctors working for gender GP prescribe the medication privately but they do sometimes work with NHS GPs to advise on drug regimes. Pharmacists can decline to honour private prescriptions, but GenderGP says it has a network of providers willing to work with them. Getting hold of the medication isn't the only challenge for private patients.

Some need to find someone to give them injections, or they need to learn to do it themselves. And all need regular blood tests to monitor for side effects. Then there are the costs. I've got their price list up on my screen. So it starts with a £195 setup fee. There's a monthly subscription of £30 and then sessions range from £30 to £65 an hour. and then sessions range from £30 to £65 an hour. Remember, GenderGP has around 10,000 patients on its books right now, so if they were all to pay that monthly subscription, that's a monthly revenue of £300,000.

Then there are the prescription costs. Those range from £28 for three months' supply of oestrogel to £40 for one month supply of testogel. Puberty blocking injections come at about £270 for a three month supply. Helen Webley says she's never had a complaint from anyone she's treated. I've spoken with parents who have accessed drugs privately and watched as their children's bodies changed over months and they felt relieved and happy for them. But others are worried about what's happening. Mother's Day last year, she'd just turned 17

and we were at a cafe having breakfast together with me and my son. Sarah's child is one of those who has used gender GP. Sarah is not her real name and she's voiced by an actor. Then she hit me with this on trans thing and my preferred name is Jack but you don't have to call me that until you feel ready and my pronouns are he and I just kind of I didn't know what to think, and I just kind of, I didn't know what to think, really. I just kind of looked at her and I said, well, OK, thank you for telling me, and I can see that you're quite nervous about telling me, that's OK, but you need to give me time, and I've got questions that I'd like to ask you about later.

Sarah's instinct at that breakfast was to stay calm, process the news and work out how she felt but more importantly how her child really felt. It turns out that she didn't have the luxury of that time. What I didn't know is that about three days after that she went with her dad onto Gender GP online and she would have known about that appointment. She didn't tell me anything about it and her dad didn't tell me anything and that would have been planned for weeks. Sarah had been separated from her children's father for a while by that point and their estrangement made it even more complicated.

So they hadn't done blood tests, they hadn't, you know, they hadn't done anything except for the fact that she just got onto this gender GP appointment on Teams and spoke to a counsellor who, after an hour, told her she had gender dysphoria and that she could have testosterone. That private prescription for testosterone followed and although Sarah only found out about it later, by April last year, her child has started regularly applying the hormone gel. Sarah doesn't support this treatment route and it's led to a breakdown in her relationship with her child. I feel really bereft. I think about her and I wonder what she's doing with her day and where she is and what she's going to be doing and what colour her hair is because she was forever changing it to different colours

and and how she's feeling mentally and then that turns into frustration because I can't do anything to help her and unquestionably she's suffering and that frustration then rolls into anger towards gender GP for what they've done to her and how they've manipulated. I can't even go there. I'm just completely enraged. They've been instrumental in me losing my child, losing my young woman and physically and mentally they've damaged her. and physically and mentally they've damaged her. It's clear that Helen Webley is proud of the work of GenderGP. But to me, the service she describes is hormones on demand, not by any form of assessment.

When the reality is that for some young people, they will develop differently in the future. To not have any system to help them think through how they are feeling, that feels wrong. People always ask me well how many do you turn away and I'm like it's not like that. They can't get to you quick enough. You know they've done all their soul searching, they've done all the questioning, they've done all their fighting at home. They're so ready for the next step. Even if they're teenagers when so much can change. They don't change though.

The only thing that changes is their desperation and desire to be confirmed and affirmed in their identity. That's the thing that changes. Their identity doesn't change. Helen Webley is so sure that the young people she sees have gender dysphoria, a diagnosis that means extreme unease because the gender they identify with doesn't match their biological sex. But everything I've learned tells me it's such a hard call to make. How can you be

so confident, particularly when the treatment involves hormones which cause irreversible changes to growing bodies. For Helen Webley, whatever the arguments, it's a risk worth taking. Maybe for some of them it was wrong. Maybe they went back and lived in their birth gender. Maybe they weren't transgender at all. But what we mustn't do is make every single transgender person in the world suffer just so that we cis people are not protecting ourselves, thinking, oh my goodness, what if we made a stake on one of them? In her mind, Helen Webley is not providing an alternative to the NHS. Gender GP is the service for this patient group.

I mean, we've been doing their work, basically. Gender GP has been doing the work that the NHS Tabasco Clinic should have done. But it's also been treating the patients that JIDS felt shouldn't be treated. Yes. Well, they've been treating the patients that JIDS should have treated, and they've been treating the people that are waiting for JIDS to decide on whether they will treat or not. She insists that her service is safe despite the lack of evidence of the long-term impact of the drugs or whether young people who medically transition might come to regret it later. The narrative is that there's no research. There's plenty of research out there to show that gender affirming care in young people is the right thing to do that social transition gives young children a better opportunity at school this research is

all there but there are no long-term studies to follow people up it's still too new so i think what what i'm struggling with is how you can be so sure that this is right for the vast majority of your patients. You can hear my frustration here, but this debate about evidence is frustrating and misleading too. When Helen Webley says there's plenty of research, there are small-scale studies, but none that look at the long-term impact on young people, simply because they haven't been around long enough to do that research. What we do know is if you say no, that child gets worse, it gets more distressed and more distressed and more distressed. And then when you see them at 13, the knives have started coming out

and the cuts have started coming out and they've stopped going to school and they haven't got any friends anymore because they've left their social groups and the family's being torn apart by this distressed child. Or you look at the ones that you say, yes, I'm going to believe you and I'm going to give you an injection which stops your puberty to give us some time. And those kids carry on going to school and they do well and the family unit survives and the knives don't come out. That's what we know. I can't square what Helen Webley is saying with everything else I've learned about this story, which is that not all children who struggle with their gender identity are trans, but some are. not true for that things happened in other ways and they did desist or um they did decide that there were actually other bigger issues in their life that needed tackling first to let them

understand themselves and i can't understand why you're only seeing those patients who do persist and i can't understand why you're only seeing one type of young person. I don't know why I'm not seeing the others. Is it because they... How do you know you're not? How do you know you're getting it right? Because the stories that we... The stories that we... The history, as you call it in medicine,

that we take at that information-gathering stage and then the follow-ups, they are of people who have successfully gone through this process. The best answer I got from the Tavistock, which remember is now very much discredited, was that what they were looking for is that young people are consistent and persistent over a long period of time about their gender identity. Everything I'm learning about gender GP is that there is no time to even assess this because the young people move to medical treatment so rapidly.

In July 2022, the then Health Secretary Sajid Javid said that the Tavistock's Gender Identity Development Service would shut by spring this year. But it hasn't proved easy to do. A new national service is on its way but it's been a struggle to find hospitals willing to take on the NHS's most controversial clinic and the staff to work there. The only people with any real clinical experience are those currently working at the Tavistock Centre. Many see them as tainted. The staff don't exist at the moment, was what one person involved in the new services told me. It's taken months to even settle on a new service specification. Those are the rules the new service will operate under. That specification was finally published this month.

It's likely to lead to a reduction in the number of young people who are prescribed puberty blockers because to do so they will have to be part of a new clinical trial which is expected to have a narrower definition of who should qualify for it. The first new clinic, the Southern Hub, led by Great Ormond Street Hospital in London, is expected to take its first patients in the autumn. The Northern Hub, led by Alder Hey Children's Hospital in Liverpool, will launch next year.

Clinical leads with paediatric rather than gender backgrounds have been appointed. No new young people are being seen on the NHS at the moment, but 250 are being added to the waiting list every month. The waiting list currently stands at around 8,000. People involved in setting up the new service say it could take five years to clear the backlog. Their modelling suggests that they'd need 600 staff to service the patient group properly. That's the size of a small hospital. The hubs are expected to start with around 50 each.

The only way to make it manageable, those close to the new services have told me, is to manage the waiting list differently and to make sure that young people with other diagnoses are getting treatment for those first, be it mental health problems or autism, which are common among the patient group. But all of that means young people are not and will not get the treatment they want when they want it. Helen Webley tells me GenderGP is scaling its operation for even more referrals. But you don't even need an online private GP like Helen Webley's service. You can also buy testosterone online without any medical advice at all. online, without any medical advice at all.

For Faith, and again, that's not her real name, we're using an actor to voice her words, her child's transition took the family by surprise. Really, the whole thing came out of the blue when she was 13. Her behaviour changed very dramatically, and at first we didn't know why she started to cut her hair and then she asked for school trousers and and all of that was okay that's fine we didn't have and don't have any issue with her being gender non-conforming at all. What was actually happening was that she was getting her friends to call her Matthew behind our backs. Faith only learnt of this when a teacher rang to ask her about the name change,

but it was already having a big impact on her child's life at school. All the friends that had previously been not very interested in her and even some who'd been a bit mean girl they were all of a sudden all over her. Everybody was like oh Matthew, Matthew, Matthew. Everybody wanted a piece of her and I do remember seeing that and thinking oh my god they're loving it. You know, these girls that I really couldn't give her the time of day before, they're all over her. One day, Faith is in her child's bedroom and finds a small bottle marked up with a label saying beard oil. And I thought, well, that is strange.

What would she want beard oil for? And then I did think, oh my my god I hope it's not testosterone. She sent a photo to her online support group. They said don't believe it don't believe what the label says because apparently there are things called stealth labels. Apparently if you buy testosterone online there's a drop down menu that gives you a choice of these fake stealth labels. So if anyone finds it, it won't arouse suspicion. Then, Faith found the needles.

When you find syringes, it just makes your blood run cold. Because you know the idea that they're going to be injecting something. that they're going to be injecting something, it crosses a certain barrier, a threshold really, of what you would be prepared to do to your body. Her father, she's very close to her father, and her father, he snapped the needles in front of her with his hand shaking, and we begged her to never do anything like this,

and that if she still felt like this when she was older, that if she must do it, if this this then she should do it through the nhs but never never on the black market like this and and she said she wouldn't but then a few months later we found more faith's child had been nowhere near the nhs or the private sector they hadn't even been online themselves. The testosterone was from a drug dealer. What happens is there's as well as the normal kind of drugs that you might expect, so ketamine, weed and all the rest. There's also a huge range of prescription drugs as well and of course you can get other prescription drugs. I don't know how they get them but they do. Then testosterone and oestrogen are just part of that. So it's so easy. So, so easy.

James Barkley recalls similar cases in his clinic. It poses huge ethical dilemmas for the NHS. I think with the online things, I think it's just not safe for me anyway. It's not really up for negotiation. Actually, this is not safe. You need to stop. What steps do we need to do that? Do you ever at that point say, okay, we'll do the referral now so that at least you're transferred into an NHS trusted service and having all the monitoring and the wraparound healthcare alongside it? The endocrinology team absolutely absolutely would agree with them would not

accept referral like that without without an assessment so this is the type the sort of dilemma you're working with where you want to bring them into to a much safer context but their referral wouldn't be accepted without proper psychosocial assessment by by this commission so and and i suppose there's a bit of a, as an aside really, is this sort of queue jumping as well, in a sense, because word will get out very quickly as well. In the end, Faith thinks her child was on testosterone for three or four months, but now says there are signs that her gender dysphoria might not persist after all.

Her child stopped wearing a breast binder. And then, last summer... The scene was very calm and it was really sunny and beautiful and it was just me and her. And this is after years of her being very prickly. Me reaching out to her all the time and being rejected. Sorry. That's okay.

So just the fact she had agreed to come paddleboarding with me was very special. And when we were far out, all of a sudden she said to me, do you mind if I take my top off? And I said, of course not. And then she took her top off. And enjoyed the sun on her skin. Sorry. It's okay.

And I was so pleased for her. Sorry. I thought, my God, she's comfortable enough with her breasts that she can enjoy the sun on them. I mean, you know, she's comfortable enough with her breasts that she can enjoy the sun on them. You know, that's huge. It's just huge. And it was so lovely to behold. She was young and perfect and, most importantly, at ease with herself,

happy with her natural body, and that was a beautiful thing. With the new NHS service in limbo, the Tavistock's reputation in tatters and the verdict still very much out on its replacement, the private sector will inevitably step in to fill that void even more. I keep thinking about what it must be like to be a parent faced with a child in distress and questioning their gender, and trying to navigate some help and support for them at this moment in time. Who do you trust?

All the institutions, you know, I don't trust any of them now. None of them. of them now, none of them. It's like the Wild West in my head now. I'm on my own, you know, firing guns left, right and centre. And my husband, we are firing guns and we've got our child in the middle and we're just trying to protect her. I asked James Barkley what the uninitiated parent facing this right now should do to help their child. I'd probably be talking to my doctor. I'd probably be wanting perhaps to see if I could access any sort of counselling, perhaps through school or college. I would try and keep it proportional. I would very much emphasise the talking about things. You might want to do a bit of detective work about what the, you know, what's on offer

out there in terms of local counsellors or LGBT support. You know, the vast majority of people don't go down a medical pathway. The vast majority of people just want to explore stuff and make sense of who they are and how their gender experience fits with who they are going forward. So I'd be very much wanting to kind of almost keep people out of a service like mine, if at all possible. His answer basically confirms that there is a void left behind in this whole saga. But I know I wouldn't trust online services operating on the edge.

I'm not that savvy on the whole business side, but I... You said that you described yourself as a business woman. I know, but I'm not. I'm a doctor at the end of the edge. I'm not that savvy on the whole business side, but I'm heavily involved. You said that you described yourself as a business woman. I know, but I'm not. I'm a doctor at the end of the day. I'm a doctor peddling in business. I would want to trust the NHS, but there's nothing to trust at the moment. And when the service is open,

they will be operating with the same pressures that the Tavistock faced. Too little evidence in a heightened atmosphere. That every step will be scrutinized by parents, by patients, the press and politicians who all hold strong and conflicting views on what it should do. The delicate work of rebuilding trust will face challenges at every turn. The almost impossible question of how to care for young people with gender dysphoria, when there's no consensus on what it is or how to treat it, mustn't be left to Dr. Webley, the dark web, or drug dealers

willing to offer medication on demand. This episode was written and reported by me, Polly Curtis, and by Katie Gunning, who was also the producer. The sound designer was Tom Birchall. The editor is Jasper Corbett. For more information about all of our investigative series, follow Tortoise Investigates wherever you get your podcasts. For the best Tortoise listening experience curated by our journalists and with additional episodes and content, download the Tortoise audio app. Or if you just want early and ad-free access to our podcasts, you can subscribe to Tortoise Plus on Apple Podcasts.