Perspective: The tide has turned in the UK on gender-affirming treatment for children
Legal action over puberty blockers prescribed to minors will likely reverberate across the Atlantic
Over the past few weeks, an amazing turn of the tide has occurred in the United Kingdom, one which has profound ramifications for the United States. It involves The Tavistock Clinic in England, the hub of gender-affirming treatment under the country’s National Health Service.
The term “gender-affirming treatment” refers to the steps of treating gender dysphoria first with puberty blockers, then with cross-sex hormones and finally, for a sizable number of patients, with sex reassignment surgery.
“Affirming” means that any questioning of whether this stepladder of treatment is appropriate for a particular person expressing gender dysphoria was considered inappropriate, practically akin to “conversion therapy,” which has been outlawed in most Western countries.
The first clues that all was not going to end well for the Tavistock model were cases of Keira Bell and Sonia Appleby, both decided several months ago. In the Appleby case, Sonia Appleby was employed in the clinic as the “safeguarding lead” for gender dysphoric children being treated at Tavistock. She raised concerns that medics were not keeping careful records, not screening children for mental health comorbidities, and were being inconsistent in their treatment of children. She was then officially reprimanded — for trying to do her job. The court awarded her damages.
In the more famous Bell case, Keira Bell is the young woman treated at Tavistock who brought suit because she felt she was fast-tracked for gender affirmation treatment by the clinic, even though as a minor she had little understanding of the long-term consequences of what she was supposedly consenting to undergo. Now detransitioned, Bell accused Tavistock of shunting children along a treatment path to irreversible changes they could not possibly understand, such as sterility, bone loss, altered brain development and even inability to ever experience sexual climax.
From Bell’s standpoint, she and other children had been experimented upon in the most cruel fashion. The verdict was unanimously in her favor. The high court found much of the treatment is not based on solid evidence at all, and that children under 16 simply could not consent to a treatment with such major and irreversible consequences.
These two cases presaged the next development, which is known in the U.K. as the Cass Report. Dr. Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, was tasked by the Boris Johnson government with reviewing practices at Tavistock. Cass undertook a comprehensive literature review, a qualitative study of patients and clinicians at Tavistock, and a quantitative study of 9,000 patient outcomes. What she and her team found was disturbing. The evidence base for the treatment Tavistock was providing was found to be shaky and had already been repudiated by several other Western European countries, including Finland, Sweden and France.
Cass also found there was almost no follow-up of patients, and thus very little understanding of whether Tavistock’s treatment helped patients or not. In interviews, a number of patients and staff expressed concerns over the one-size-fits-all approach. Cass recommended, and the government agreed, that Tavistock be shuttered, that regional centers to treat gender dysphoria in a more whole-of-care fashion be established, and that a firm evidence base be established before puberty blockers, in particular, were used on children.
This week, the big news hit. A law firm in the U.K. is launching a class-action suit against Tavistock, and it anticipates that more than 1,000 clients will be joining the suit. The suit will accuse Tavistock of “multiple failures of duty of care” with regard to its pediatric patients suffering from gender dysphoria. The clinic will also be charged with having “recklessly prescribed puberty blockers with harmful side effects and (having) adopted an ‘unquestioning, affirmative approach’ to children identifying as transgender.”
The days of the “affirmation-only-no-debate” approach to pediatric gender dysphoric patients is over, at least in the U.K. This great turning of the tide in Britain has taken place in the space of approximately 11 months.
Will the same happen in the United States? I believe it will for pediatric cases. While most Americans take a live-and-let-live attitude toward adult transition, the increasing evidence that puberty blockers do not simply “press pause” on puberty and may have seriously damaging and irreversible effects on children who cannot meaningfully consent, is becoming too great to ignore. The American Association of Pediatrics is already embroiled in a civil war over the issue. In addition to states such as Florida and Texas pursuing investigations of clinicians and pharmaceutical companies, the law firm Girard Sharp appears poised to launch a similar class-action suit; the firm is soliciting reports of adverse effects of puberty blockers from the guardians and parents of children who have been treated with them.
What is currently termed “gender-affirming treatment” for pediatric patients is likely to one day be seen as one of the greatest medical scandals of the 21st century. The light that will be shone on the practice in U.S. courtrooms will see to that, as happened in the U.K.
Valerie M. Hudson is a university distinguished professor at The Bush School of Government and Public Service at Texas A&M University and a Deseret News contributor. Her views are her own.