Woman's Hour - Sailor Pip Hare. Children and puberty blockers. Stalking slogans on Valentines Day Cards

Episode Date: February 10, 2021

Pip Hare has been competing in the Vendee Globe race, sailing around the world, solo, non-stop and without assistance. She is on the home straight now and currently 20th place. Pip speaks to Emma from the Atlantic Ocean. Following a ruling by the High Court at the end of last year that children under 16 with gender dysphoria are unlikely to be able to give informed consent to being treated with puberty-blocking drugs, younger children now need a clinician to apply to the Court to be able to access puberty blockers, and all current referrals and appointments have been paused. We hear from Dr David Bell, former staff governor at the Tavistock and Portman NHS Foundation Trust and a consultant adult psychiatrist and get a response from the Trust.There is a stalking genre in valentines cards. Slogans on cards such as: Your stalker wishes you a Happy Valentines Day and stalker is a hard word - I prefer valentine. Katy Bourne, Sussex police and crime commissioner and main spokesperson on stalking for association of police and crime commissioners tells us why she wants them banned.Presenter Emma Barnett Producer Clare Walker.

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme, peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, it's Emma Barnett here. Welcome to the Woman's Hour podcast. Good morning. You may have hoped that the pandemic could have given you a break from Valentine's Day or you may love it and be planning a weekend of love. Either way, there is a genre of card out there

that you may or may not be familiar with or of, because I have to say I hadn't seen this until it was brought to my attention by a woman we're going to hear from shortly. With regards to stalking, there is a stalking genre. It's trying to be funny around Valentine's Day and people loving each other so much. There's cards such as Happy Valentine's from your favourite stalker. I'll give you some more examples and describe how those cards look in a minute. But what I wanted to know from you is, have you seen these? A lot of people, of course, shopping for their cards online this year. They may have already been doing that, but more and more people, you have to,

because of the shops not being open. Although, of course, in some supermarkets you can get cards. Have you seen them? Have you reacted to them? What do you make of them? Do you want them to be banned? Or would you not go that far? Tell us what you make of this and your reaction to that. Because of course, it follows a rise of irreverent cards that perhaps are crossing a line for you and for many others. 84844 is the number you need with regards to text messaging us. Those texts, of course, charged at your standard message rate. You can email us via the website or on social media. We're at BBC Women's Hour.

A couple of messages and reactions already on this. Somebody called Shane says, Oh Emma, I was having a cheery morning looking at Weetabix and Heinz posts until I saw this and I stopped in my tracks. Having been a victim of this, I find it deeply upsetting. Almost 30 years on having been a victim of this, I find it deeply upsetting almost 30 years on. Having been a victim of stalking. Shane, thank you for getting in touch with us on social media. One from David here says, I've not seen these before. I suspect they're meant to be humorous, but they are creepy.

And if sent by somebody you know, maybe they could raise a smile, but I'm not sure a recipient would be too pleased to receive one anonymously. I'm naturally against banning everything we disagree with but these card producers should show better taste. Also today we speak to a former employee of the Tavistock Clinic about his view on children being allowed to take puberty blockers and how is Pip Hare doing? The Vendee Globe solo round the world sailing race is considered to be one of the toughest sporting competitions.

And she's on the home straight. We're hoping we're very much hoping to speak to her live from the Atlantic. We'll keep that towards the end of the programme to make sure we can get that line up, but we'll do our best. So back to this stalking genre genre in Valentine's cards, slogans on cards such as your stalker wishes you a happy Valentine's Day, picturing a male baseball player with a bat, or every breath you take, every move you make, I'll be watching you with two eyes at the bottom of the card, or another one that says stalker is a hard word, I prefer Valentine. Katie Bourne, Sussex Police and Crime Commissioner and the main spokesperson on stalking for the Association of Police and Crime Commissioners, is trying to have these cards banned. Other examples, just to give you more of a flavour, I'd kill for you, your stalker wishes you a happy Valentine's Day, I watch you when you're sleeping.

Or, simply words on a card, if you knew how much I loved you, you'd be terrified. Katie Bourne, good morning. Good morning. Tell us how you first saw these cards. I was searching across the internet to look for a Valentine's card for my husband. The cat's out the bag now, so he knows he's going to get one. And I just happened to come across this particular card that featured the figure from a recent show on Netflix. And I thought, it can't be be because I've seen this program myself. It's all about a stalker and how he eventually kidnaps his victim and then

kills her. And sure enough, it was. And when I looked a bit more deeply into it, I found there were many of these cards across one particular platform and then another platform as well. So I sent out a tweet asking the platform I'd been looking at, Thoughtful, to remove it. In fairness to them, within 24 hours, they apologised publicly and removed it. But then when we did a bit more digging, it's across other platforms as well. Yes, and the one that you mentioned in your tweet,

and I'll mention here now because we have been in touch with them this morning morning is Etsy. And we've got in touch with them for a statement this morning, but we haven't heard back. Well, I mean, how surprising is that? I think it's pretty shocking, actually. And if you go on their website, and you put in stalking and cards, there are over 500 stalking cards available on that website. And I just think it's absolutely appalling in this day and age in the 21st century that we find this sort of thing funny is just so wrong. It trivializes this crime. Stalking is now a crime. You know, it's not a joke anymore. And this is not about a bit of banter. And let's face it, we all know where a bit of banter gets us. It propelled the whole Me Too movement. So really, why are companies like this who have a responsibility, not just to us as customers, but also to their investors?

Why are they allowing themselves to be associated with these cards? Etsy are not here to respond for themselves. And if we get a statement, we'll share it as and when. Perhaps they would say that they have third party suppliers. But the bigger point remains, these cards are available and you can buy them online. And in the run up to Valentine's Day, they may be what some people go for. I mean, this is the thing. Products often only stay in place if they're selling? Who's buying? Well, it beggars belief, quite frankly. I mean, if the whole idea of Valentine's card, Valentine's Day is about sharing love and showing affection for everybody. But I don't find these cards affectionate at all. You have a, I mean, you could feel like this anyway, but you have an additional reason as to why you don't find cards making light and making jokes of stalking funny. I do. When I came into office just over eight years ago, unfortunately, I became the victim of a stalker myself.

It all started online with cyber stalking. And just an interesting statistic for you, 92% of all domestic homicides have cyberstalking in them. So we know what happens when this sort of thing goes wrong. And then it breached into the physical world. This particular individual turned up at a meeting that I was doing and after dinner, speaking engagement and filmed me unbeknown to me and posted it on a well-known channel afterwards and then I did a charity abseil and another one of his friends that he'd incited to come came along and filmed me and unbeknown to me got access to my harness that I was wearing posted it the next day online and somebody else wrote underneath it you should have slit her rope now it was at this point I thought actually I can't ignore this anymore I did what many people

do in the first instance I ignored it and I thought it'll go away don't give them attention but it didn't and it got worse and then it transferred from the online world into the physical world and that's when when I tried to take action. I know that you can't talk too much about the details of that case because it's live and you have taken action. But how did that make you feel? Because you did, as you say, what a lot of people try to do and ignore it. Well, at first, I made the mistake of thinking, well, I'm in public life, so I've got to expect this. But I had friends, some friends say to me, actually, you shouldn't have to put this in public life. This isn't right. And I ignored it for three, maybe four years until it crossed into the physical world. In retrospect, I wish I'd done something sooner.

And I've learned that actually the majority of stalking victims do ignore this when it happens to them. Many of them don't even recognize the stalking behaviors, especially if it's from somebody that they know or they've been in a relationship with. They often don't want to make a fuss because they don't want to get that person into trouble. They might lose their job and so on. But but actually, this sort of fixated, obsessive behaviour just does not stop. And, you know, it's time now for all of us to call it out. Stalking is a crime. And in terms of coming back to these cards, which started our discussion, did you hear the message that I read out from one of our listeners, David,

who said, while these are distasteful, creepy, perhaps if you know someone well enough, could raise a smile if they're not affected by this in any way that you are, or perhaps just don't feel about these cards the way that you do, and many of our other listeners are getting in touch. But he still objects to it being banned, the idea of them being banned.

What would you say to that? I've seen that argument. You know, they hide behind the freedom of speech, but actually stalking is a crime. It's not a joke. It's not a joke. It's not something to be trivialised. If you trivialise it, you undermine what's happening to thousands of victims out there. We know this crime goes underreported.

In Sussex, where I have responsibility for policing in its totality, we've seen a massive increase in the number of victims of stalking coming forwards. During lockdown, just this year alone, we saw a 70 percent increase in victims coming forwards who are being cyber stalked. Now, this is not a trivial matter. And we know desperately what happens when it goes wrong. We've had a very prominent case just four years ago in Sussex where a young 19 yearyear-old woman was murdered by her stalker. So we absolutely have to get this right. The police response as well needs to be improved nationally as well as our criminal justice agencies. What's going wrong with the police and the response to stalking? Because it is relatively recent, as you say, that it's become a crime. Some forces are doing well

on this. And I would say Sussex Police are definitely leading the way in how to respond to stalking. But again, you know, this is all off the back of some really terrible learning that they've had to go through. But other forces are just not recognising the risk involved. They don't understand the difference between stalking and harassment. And because of that, when they arrive and they first meet a victim, if they downplay it to harassment, harassment doesn't carry a prisonable sentence that stalking does, and they won't necessarily put the right safeguarding and protections around that victim.

So massively important the police get it right, but also criminal justice agencies, the Crown Prosecution Service Service are still letting victims down. They're not prosecuting these cases despite the evidence in front of them. Thank you for talking to us this morning. Katie Bourne, Sussex Police and Crime Commissioner, main spokesperson on stalking for the Association of Police and Crime Commissioners, and now campaigner around Valentine's Day cards featuring jokes and inverted commas about stalking. Just to

read this email before we move on from this discussion, but keep your messages coming in. I can come back to them, I hope. I was a victim, Emma, of stalking in the 90s and it was probably the most terrifying experience I've ever been subjected to. My stalker was eventually apprehended by the police and the case went to court. But my young children, who were also victims in the case, remained traumatised for a long time. How any card manufacturer can think these stalker Valentine's cards are amusing just beggars belief. Now much focus has been on whether children should be allowed to take puberty blockers in recent weeks since a seminal court case at the end of last year. In December three high court judges ruled that children under 16 with gender dysphoria are unlikely to be able to give informed consent to being treated with puberty-blocking drugs.

As a result, children under the age of 16 now need a clinician to apply to the High Court. Current referrals and appointments have been paused. Last month, the Tavistock and Portman NHS Foundation Trust, which runs the only NHS gender identity development service for children in England and Wales, was granted permission to appeal against the judgment. Dr David Bell, who you're about to hear an interview with, is a former staff governor at the Tavistock and Portman Trust and consultant adult psychiatrist

and has been named as an intervener at this appeal and will be giving his perspective to the judges. This is because Dr Bell wrote an internal report in 2018 raising serious concerns brought to him by 10 colleagues about the way the Gender Identity Development Service was treating patients. After 24 years working with the Tavistock and Portman Trust, Dr Bell, a former president of the British Psychoanalytic Society, has just retired and decided to speak to us.

We'll hear a statement from the Tavistock and Portman Trust at the end of this interview. Dr Bell's focus is purely on whether children, as he defines it, those below the age of 18, should be allowed to take puberty blockers. I started by asking him why he didn't participate in the initial High Court case brought by Parent A and Keira Bell. The reason for that is quite straightforward. As an employee of the Trust, I was in a compromised position in my ability to give evidence in the original hearing for the judicial review. Now that I've retired, I'm free to intervene. You're going to give your perspective at the appeal. Are you able to tell us that perspective? The reason I've asked to intervene and the reason,

as I understand it, the court had given me permission to intervene, is because my report in 2018 raised very serious concerns about the service both clinical and ethical a number of those areas areas which I dealt with in some detail in the very reason judgment of the judicial review but given that I was involved at this early period and I think my report and the subsequent publicity that was given to that report and subsequent events that have taken place in terms of more and more people from the service coming forward and explaining their concerns about the service in various news programmes and newspapers. So I think that my report is part of the chain of events that ended up with the judicial review. And for people who are not familiar with your concerns, and perhaps even this whole debate, what are your concerns? I first became aware of these very grave concerns about the service when in my position as governor representing academic and clinical staff on the Council of Governors of

the Trust, a large number of people came to talk to me about their concerns. All those people have now left the service and their concerns were both clinical, ethical and also I would call staff concerns in that they felt they were subject to being silenced and being intimidated by managers when they raised those concerns. They felt that the children who were presenting to the service were being motored through quickly, without sufficient clinical engagement and without sufficient understanding of the complex problems that they brought to the service.

These children have multiple problems, such as depression, a very large number on the autistic spectrum. Some estimates were about 35 percent. Some children just lost in the world and alone, the complex family problems, histories of trauma, and that this level of complexity was not being engaged with by the clinical service, which saw itself as an assessment service. In other words, as a kind of conduit to puberty blockers. They felt that these children were therefore, the needs of these children were being very neglected by the service. Further, they were very concerned that there was an elision, and this is quite an important distinction to understand. There's two different things. One is transgender and the other is gender dysphoria. Gender dysphoria describes discomfort which may be mild to extremely severe in the relationship between the self and the gendered or sexual body.

That can have many, many determinations which need to be understood, individual, cultural, social, family, conscious and less conscious and are part of complex the kind of complex problems that i've been just describing transgender is something quite different that's when the decision has been made that the way to manage this complex problem is to regard the child as being on a pathway to changing their gender. But because of the elision between those two, gender dysphoria was being misunderstood as being transgender, being positively affirmed as transgender,

which is a negation, really, of the neutrality that's necessary to a clinician. And this attitude of affirmation was pushing children through onto a pathway which would have irreversible, serious consequences. Furthermore, they felt that these children did not adequately understand and were not in a position to understand the implications of going on that party. A lot to digest there and a lot of allegations about the concerns that you were hearing. Can I ask, in your capacity, did you see any of this yourself?

I'm not a child psychiatrist. I have not seen children presenting with gender dysphoria. I have discussed this with quite a number of young adults who are detransitioners. People have regretted the pathway and regret having had double mastectomies and other forms of surgery and wish it hadn't happened and wished that the service could have explored things in more depth rather than allowing them to go through on this pathway which has caused such damage. But the simple answer to your question is that my position in relation to this was,

as a governor, hearing the testimonies, all of which were very similar from this large number of staff. That's your reaction to it. So you didn't see it firsthand, but 10 people came to you as a governor to present this evidence, all of which you say was similar or very similar in terms of the concerns that they say that they had. If I just put to you what the Tavistock have said to us. Can I just add something before you do that? These concerns were also raised by a group of parents who approached the trust. And there was some publicity to that. And furthermore, these concerns have been largely echoed by the judgment of the judicial review. If I could just put this point to you to try and contextualise perhaps, or maybe you won't see it like that. But the Tavistock say, with regards to children

being rushed through onto puberty blockers, of the 1,648 patients discharged last year, only 16% had accessed physical intervention while in the Tavistock care. These young people have experienced persistent gender dysphoria over a number of years and have had thorough assessments. So we're talking about a couple of hundred children a year who access puberty blockers. What do you say to that as a bit of context to this? Well, I don't actually have access to the number going forward onto puberty blockers. And I think these have changed. When I was first involved, the figure I was given by the Director of Communications was 50% of children were going forward. That may have substantially changed, I do not know.

But I do know that one of the concerns raised by the people who came to me and by the judicial review was that there was inadequate figures. For instance, they didn't know whether any children who were refused puberty blockers because of lack of capacity to consent. They weren't able to say, they weren't able to give any figures about the comorbidities of the children. They weren't able to give any figures

related to how many children went to the opposite sex hormones. So there's that terrible lack of ordinary clinical governance audit and evidence in terms of this service. But just to come back to your point, it isn't only a matter of numbers. It's a matter of whether or not it's an appropriate clinical service for these children. And my view is it is not. I also know that some children decisions were made after only one or two meetings. The service describes four to six meetings over a number of months. I do not believe that is sufficient in order to engage with this degree of complexity

and to embark on a pathway that has irreversible consequences, which are largely not properly understood by the children involved. I should say that in January 2021 of this year, last month, the Gender Identity Development Service at the Tavistock was rated inadequate by the Care Quality Commission after inspectors identified significant concerns. the report found that improvements were needed in providing person-centred care, capacity and consent, safe care, treatment and governance. In addition, vulnerable young people not having their needs met as they were waiting too long for treatment.

That's an interesting counterpoint perhaps into what you were just saying, because the Tavistock would refute what you've just said about there not being enough meetings, but I'll just read that to our listeners. More than 4,600 young people were on the waiting list and some had waited over two years for a first appointment. David, if I could put something else to you. The Hippocratic Oath do no harm. Many children and their parents feel, I say many in the context of this world, that not being able to access a treatment they believe they can consent to, however experimental that treatment is, is doing them great harm. What would you say to those people perhaps still on a waiting list?

Well, I think that's a very good question. And although I was pleased about the judicial review and the outcome, I also am very concerned about these children. Because if you think yourself for a moment what it must be like, you're a child, you're in acute distress. You've been told that the solution to your stress is to go on to puberty blockers and to start on the trans pathway. And we know that 98 percent who go on puberty block has gone opposite sex hormones. So that's the pathway that they're going. And now they're being told that that's not right

because they're not in a position to be able to consent to it. So now they're in the position, it's like a double whammy. They've been told this is the treatment and now they can't have it. And of course, I think that we need to put services into place to help those children. And I think most importantly, there should be funding for local CAMHS services, that's Child and Adolescent Mental Health Services,

to provide care for these children, to help them manage this. I do not think that this can be managed by the Tavistock because the Care Quality Commission, amongst the things that they raised, that staff had serious concerns about the children, felt that their concerns were not listened to and that there was an atmosphere of intimidation. One of the very important areas that your listeners need to understand, that is a significant number of these children, if left alone, there's quite a lot of evidence suggests they would become gay or lesbian.

But what happens is that there's a kind of binary, a stereotypical view. If you're not gender conforming or if your sex object choice is of the same sex, then you're easily misunderstood in the current ideological context for being trans. Now the reason I say that is that some of the people who talk to me raised these problems. They thought there was homophobia in the families, conscious or unconscious, and the children were being pulled into this, wittingly or unwittingly. And when they raised this, they were told not to raise these issues and they were intimidated. And some of them were taken off the cases they were dealing with. And some of them were told they were being angry gay people.

In the interests of accuracy, I need to clarify that the Care Quality Commission did not use the phrase atmosphere of intimidation in their report. What they did say was that staff did not always feel respected, supported and valued. Some said they felt unable to raise concerns without fear of retribution. David, do you believe a child can be trans? I think it's the wrong question, the wrong word. There was a tendency until fairly recently to think children could be born in the wrong body. So I don't think, nor does anyone else I think now, that a child is born in the wrong body. I think to say a child is trans is an error. What we can say is a child has a disturbance in relation to their sexual and gendered body. When I was originally involved in writing the report, one of the

problems was sexuality was not discussed much in the service at all. It was all gender. I think that might have changed a bit now. So it's not helpful to ask, are they trans or not? Because if by saying they are trans, that means putting them on a pathway, which as the judges pointed out, is an experimental pathway for which we have no evidence for the outcomes. And there's certainly evidence to say that it causes irreversible damage. Instead, it is better to think of them as having a disturbance in relationship to their sexual and gender body, which needs thought and understanding, which cannot be achieved by a small number of appointments.

It needs a much longer-term clinical engagement, which the service isn't equipped for. I don't think that it's clear they can't look after 4,000 children on the waiting list. But a deeper question is, why has this been this huge increase in referrals from about 80 in 2009 to 2,700 in 2019-20? And I think it's because of complex cultural transformations that we don't understand. I don't think it's due to suddenly lots of children coming out. And I do think that considerable damage has been done,

both through the affirmation model and through specifically calling children trans. Okay. And while I think the answer that you've just given will have raised a lot of insights for people, there will be people listening to this who fervently disagree, who fervently believe whether they are the relation, the parents, they themselves as a child who view themselves as trans. So while you have that perspective with your experience as a clinician, as a governor of the Tavistock, what do you say to them? Because would it be a fair characterisation to draw the conclusion from what you've just said, that you don't believe any child in this country or anywhere else should be put on puberty blockers or have any intervention to put them on the road to being trans? Yeah, I think what I would say is this,

that these children and families have done a great disservice to the model that's been being used. I think one way of looking at this might be this, is that if you think we have a population of children and young people, and we'll say within that population is Group a and group b group a are children who are gender dysphoric and they persist with that and when they're 18 19 they exactly the same and group b are the children who will desist you might find that what they really are is gay and they can be gender non-conforming and be a gay young man or woman.

And they don't need to have irreversible medical treatments or surgeries to their body. And I think those will be the much, much larger number. You're saying there there's group A, group B. So just to get it clear, you do believe some adults can be trans? Of course. You do? Yes, I'm specifically and only talking about children. And I want to make it very clear that I'm absolutely opposed

to discrimination of any sort against trans people. And of course, trans people, if that's what adults, what they choose to do and what suits them and they're better for, that needs to be respected and they must not be discriminated against. And your point there is that we have no idea when they are children whether they are group A or group B. Yeah, and if we make a sort of blanket pathway, we will be doing irreparable damage. From the way that we've just had our conversation here, it strikes me it's important to ask you,

how has this affected you personally, talking about this and sharing what are your views based on the testimonies of 10 people coming forward, as well as those parents that you mentioned, because it has become a toxic debate for some? Well, it certainly has become a toxic debate. I think because of my seniority and position, and also I felt a duty because of being a governor, I felt able to speak out. But this has obviously brought me into a lot of dispute with the trust, who took disciplinary action against me. I'm pleased to say that they did not stop me from speaking out. And of course, I was legally represented all the way through and ensured that I stayed within what was allowable within my contract.

You say it has been difficult for you. Can you elaborate on that? What do you mean by that? Yes, you've been able to keep talking. You're talking to us here now on Woman's Hour. But what has that been like or felt like for you? Well, it means that my life for the last three years has had a shadow over it in terms of having to be constantly represented by lawyers but all that being said, it didn't stop me getting on with my job and I felt supported, often somewhat silently

and understandably silently, by many senior colleagues within the Trust who quietly told me how much they respected the position I was taking. And that was a great source of strength to me. Do you regret talking out? Not at all, no. I feel it has been quite a change in the last few years. That is, when I first got involved, there was nothing in the press about this.

Everyone was frightened to speak out was nothing in the press about this. Everyone was frightened to speak out at all in the trust. Everyone was frightened of being called transphobic rather than being seen as wanting to engage with their concerns about this service. I think it's becoming more and more possible for people to speak out. And of course, the findings of the judicial review and now the Care Quality Commission have quite a quantum effect in signaling to people that these people have been raising concerns, that the concerns are real. We asked the Tavistock and Portland NHS Foundation Trust to come on to the programme to respond to the points made by Dr David Bell, they declined our invitation but gave us this statement. We are disappointed to hear these allegations. The Gender Identity Development Service

was not set up as a conduit to puberty blockers. This is an inaccurate and frankly insulting representation of the service which was set up over 30 years ago when puberty blockers were not on the table. The service exists to help children and young people who experience distress around the development of their gender identity to explore their feelings and choose the path that best suits their needs and wishes for the future.

The service accepts and respects young people's perception of their gender which may remain stable over time or change and may or may not lead them to wish to pursue a physical transition. The service does not presume any particular outcome and indeed young people follow a range of pathways. Most often this does not include access to physical treatment in the service. The minority of our patients who are referred for puberty blockers prescribed by other NHS trusts have undergone a thorough assessment. Additionally, the Care Quality Commission's view is that referrals of young people for medical treatment

are consistent with good practice. It is wrong to suggest that there is any rush to physical treatment. The average of starting puberty blockers at the Gender Identity Development Service is over 15 years old. Gender Identity Development Service is actively contributing to the small but growing evidence base for this intervention. Our practice will always be guided by the evidence. They go on to say that they have always been confident that fewer than half of children they see go on to have physical treatment. For the recent judicial review, they conducted a review of patients discharged in the year 2019 to 2020, i.e. those who completed their journey with the

Gender Identity Development Service in that year. Quote, it showed that 16% of that cohort referred to us had accessed endocrinology, puberty blockers, while with us. The Care Quality Commission found in its recent report that 28% of patients assessed by us were referred to the endocrine clinics for medical treatment. On Dr Bell's argument that the Gender Identity Development Service has elided gender dysphoria with being transgender, the Trust say this, quote, gender dysphoria and being transgender are quite clearly different things. We have often said that gender dysphoria is in fact a poor predictor for who goes on to transition. Gender dysphoria may resolve in a number of ways.

This is what the exploration that the service does with young people is concerned with. Respecting young people's dysphoric feelings or self-identification does not mean that assumptions are made about how this may evolve over time or what support or treatment may be appropriate. The Trust goes on to say the Gender Identity Development Service works as a multidisciplinary team in which there are inevitably a range of views. All members of the team have a responsibility to be respectful and promote considerate discussion of these in the best interest of the young people and their families who attend the service. We have never heard anyone refer to team members as angry gay people.

Quote, no clinician would be removed from a case without discussion and agreement. We will be following here on the programme the appeal of the judicial review as it unfolds and hope to hear from other interested parties in that process. And if you didn't hear the interviews we broadcast in December with two mothers of children experiencing gender dysphoria reacting to the High Court judgment, you can find them on BBC Sounds under Woman's Hour. Now, the Vendee Globe's solo round-the-world sailing race

is considered to be one of the toughest sporting competitions. 24,000 miles as the crow flies no help no stops no turning back the three-month solo non-stop round the world race is also known as the everest of the seas one woman pip hair has been competing in the grueling race since the 8th of november and is now on the home straight currently at 20th place in the race pip joins us now from the atlantic ocean pip hello where are you exactly or what can you see what can you tell us hello um i am just off finnish air um just to the north of finnish air um and i can't see a lot

other than ocean um i've had a pretty rough night. One of my sails fell over the side during the night because the halyard lock failed on the mast. So I was up all night kind of resting sails back on board and today I'm just fixing the damage. But it's 344 miles to go to the finish. Wow, okay. And I mean, sorry for your tough night. You've probably had quite a few of those.

How do you cope? It's really interesting. I mean, I think you cope because you have to. And that's one of the reasons that I love this sport so much because it really, it forces me to solve all these problems head on. And, you know, the boat's huge. It's 60 foot long and it has 600 square metres of sail when everything's up. And just one person trying to manage all that on their own,

you really have to be strategic and think about things. But the fact is that no one else is going to help you there is no one to help you so you just have to roll your sleeves up and get on with it i love what you said about women and men in terms of competing in this uh when a woman we should say compete in this competition on equal terms but of that you've been reported to say more men have walked on the moon than women have completed this race the vende global which is all the inspiration i need to succeed yeah it's true so so providing i get to the finish line and nothing's ever a given in sailing but um providing i get to the finish line i will be the eighth woman ever in history

to finish this race and 12 men have walked on the moon and I think it's great, I love the fact that we are competing on equal terms with the men and the fact that this is the toughest sailing race on the globe and men and women can compete on equal terms

because I think when things become this tough when it's sheer endurance then it does become more about your strategic brains than your physical ability and after three months at sea we're all depleted of muscle mass and so you know I love the fact that in a sport this tough it's a level playing field still. But what I love is that you've had to turn, or not have to, but you have been very buoyed by a man sending you birthday wishes

for your 47th birthday last Sunday, the gladiator, no less, the actor Russell Crowe. Yes, that was one of the more surreal moments of the race. Basically, a local radio DJ from Dorset went out and asked a whole heap of people to record me birthday messages. And I got one from Ellen MacArthur and one from Jasmine Harris, the ultra distance runner, and from Russell Crowe, which was just so left field. I'm still a little bit stunned about it. What was your reaction?

Just speechless. I mean, absolutely speechless. I mean, not in my wildest dreams would I have imagined that was going to happen. And I mean, overall, I'm just really, really touched by the fact that, A, Steve Harris, the DJ, went out and got all these messages for me. And then all these other people, and Russell Crowe was not the only one, but all these other people who have never met me and have no reason at all to give me birthday wishes, they all recorded messages for me. And I've been on my own for 88 days at that stage. And it's a really lovely feeling to know you have that sort of support. It must be.

We're wishing you all the best to get to that finishing line. We're rooting for you here on Woman's Hour and all of our listeners too, if I'm able to say that on behalf of them, because of course you are so close now. What is the one thing you've been dreaming of, apart from those famous people who've sent you messages, of course,

when you're back on land? What are you visualising as something you just really want or need? So it's all, unsurprisingly, food and drink plays a huge part in it because i've been living on freeze-dried food and desalinated water for three months so fresh vegetables fresh food fruit a really nice glass of wine and then face-to-face conversation would be amazing well i'm hoping for you good luck for the last bit for the final push got a message here from hannah who says uh you are sounding great pip though a sail over the side sounds pretty scary so all the best pip good luck with

those repair jobs and thank you for talking to us today as you on the home straight there that's all for today's Woman's Hour thank you so much for your time join us again for the next one hi I'm Zand Van Tulleken and I'm Kimberley Wilson and just before you go we wanted to quickly tell you about our podcast made of stronger stuff from BBC Radio 4 I'm a psychologist and Zand is a medical doctor and we're bringing together our specialties to take a tour of the human body. Each week we hone in on a specific body part from the eyes and lungs to the appendix or the vagus nerve and we ask how we can understand it better, ourselves more and combine the body and mind to produce positive change. So subscribe to Made of Stronger Stuff on BBC Sounds. I started like warning everybody. Every doula that I know. It was fake. No pregnancy.

And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.