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

00:00:00.720 Mental health professionals who worked at the Tavistock, who undertook these assessments,

00:00:07.000 who referred some of those young people, that they themselves fear that they've been part

00:00:11.320 of a major medical scandal.

00:00:14.560 Some people say there was pressure to refer quickly because it freed up their time as

00:00:18.240 clinicians because the waiting list was growing and once you referred a young person to endocrinology

00:00:23.600 you saw them less frequently so it freed up some clinical time.

00:00:27.800 Were you into, I mean...

00:00:30.120 That's horrifying.

00:00:31.120 Yeah.

00:00:32.120 Perhaps you get to the point that you can't, you can't change direction because what does

00:00:35.800 that mean?

00:00:36.800 What does that mean for you as a human being to go, oh my God, I might have got this wrong

00:00:42.800 and I might have got it wrong for some of the most vulnerable young people there are.

00:00:47.440 How do we get from a handful to thousands?

00:00:53.280 That's a $64 million question, isn't it?

00:00:55.360 If I'm an ordinary person watching this, based on every time we've gone down one of these

00:00:59.800 cul-de-sacs, we always end up with, there was not enough data, they stopped collecting it.

00:01:05.360 I'm thinking cover-up.

00:01:06.680 Hello and welcome to Trigonometry.

00:01:18.680 I'm Francis Foster.

00:01:20.000 I'm Constantine Kissin.

00:01:21.120 And this is a show for you if you want honest conversations with fascinating people.

00:01:26.120 Our terrific guest today is an author and journalist whose latest book called Time to Think is about

00:01:31.320 the demise of the Tavistock Gender Clinic here in the UK. Hannah Barnes, welcome to Trigonometry. 0.79

00:01:35.400 Trigonometry.

00:01:37.400 Thanks for having me.

00:01:38.400 It's a pleasure.

00:01:39.400 We've been trying to make this happen for a while.

00:01:40.400 We had COVID.

00:01:41.400 You had COVID.

00:01:42.400 It didn't happen.

00:01:43.400 Here you are finally.

00:01:44.400 Before we get into your book, and it's a very important book.

00:01:45.400 Who are you?

00:01:46.400 How are you where you are?

00:01:47.400 What has been the journey through life that leads you to be here sitting and talking to

00:01:50.400 us?

00:01:51.400 Journey through life?

00:01:52.400 Well, I've been a journalist at the BBC for 15 years.

00:01:55.400 Before that, I worked in commercial radio as a newsreader and reporter.

00:02:00.400 I'm a mum of two kids, young kids.

00:02:04.400 I grew up in the suburbs of London, had a pretty normal childhood.

00:02:10.400 I went to Oxford and did the degree of politicians, PPE, and obviously by most people's standards,

00:02:17.400 I'm a massive failure because I'm not prime minister.

00:02:20.400 And then went into journalism from there.

00:02:23.400 And you mentioned you're a BBC journalist.

00:02:26.400 I saw you a couple of days ago at Newsnight, actually.

00:02:29.400 You did.

00:02:30.400 But if I may say so, I hope it's not an unfair representation, but I feel like the issue of

00:02:35.400 transgenderism and some of the issues to do with trans ideology and so on, sort of was

00:02:41.400 the coverage of that was led from the new media and older media took some time to get

00:02:47.400 there.

00:02:48.400 I don't know if that's a fair characterization.

00:02:49.400 Do you...

00:02:50.400 You don't agree?

00:02:51.400 I would agree and disagree.

00:02:53.400 So I think at Newsnight, we were really ahead of the curve.

00:02:59.400 And actually, much of the stuff that we know is because of the reporting that I did with

00:03:03.400 my former colleague, Deb Cohen.

00:03:06.400 So, you know, we started doing that in 2019.

00:03:08.400 At that point, there really wasn't much around.

00:03:10.400 There was...

00:03:11.400 We were doing it in 2018, but you're fine.

00:03:12.400 No, sure.

00:03:13.400 No, sure.

00:03:14.400 But, you know, Janice Turner was writing in the Times and there was some stuff in print

00:03:18.400 media, but I think it wasn't really till, you know, I think our reporting directly led

00:03:25.400 the CQC to inspect the Gender Identity Development Service at the Tavistock.

00:03:33.400 I think we did have a big impact.

00:03:35.400 Oh, sorry.

00:03:36.400 I feel like I've opened the interview by what appears as me having a massive go at you,

00:03:41.400 even though you're one of the people that's done well.

00:03:43.400 Where I was trying to get to is, why do you think, unlike you, that's maybe the way I

00:03:49.400 should have phrased it, many people took a long time to get to this point where this

00:03:53.400 conversation was even being had?

00:03:55.400 Because I think the media just reflects all these other organizations that have taken

00:03:59.400 a huge amount of time to get to the point that we're at today.

00:04:02.400 So, you know, you could you could lump politicians in with that, the regulators, the NHS, the

00:04:10.400 central NHS.

00:04:11.400 I mean, the way that several clinicians at the Tavistock put it to me was that this word

00:04:17.400 gender in some way muddied the waters and sort of the usual checks and balances, if you 0.99

00:04:22.400 like, that you'd expect in medicine and particularly when you're caring for children and young people

00:04:27.400 just weren't there.

00:04:28.400 People were frightened that in some way asking the same questions or raising the same concerns

00:04:34.400 that you would in any other part of caring for young people.

00:04:38.400 When you did that in this space, there was a fear of being branded transphobic, whereas

00:04:43.400 actually all they were saying was, we're not sure this is safe.

00:04:46.400 And, you know, another said, everybody assumed that we knew what we were doing, that we were

00:04:51.400 the specialists and somehow it must be really complicated.

00:04:55.400 And there was this cloak of mystery.

00:04:57.400 So that's the only explanation that I think potentially explains why so many people looked

00:05:03.400 away for so long.

00:05:04.400 And as Hilary Cass has said, this hasn't been subject to the normal oversight you'd expect, especially

00:05:11.400 when we're talking about children and drugs that are being used off label, about which we don't

00:05:17.400 know the long term impact.

00:05:18.400 And before we get into the book, the question that I already asked you is, what motivated

00:05:23.400 you to write this book?

00:05:24.400 What motivated you to go into the eye of the storm?

00:05:30.400 And it is a storm and it is possibly the most toxic issue of our time.

00:05:35.400 Well, I got to the point that we'd done sort of four films at Newsnight.

00:05:39.400 We also did a radio documentary.

00:05:42.400 But always with journalism, there's so much more that you know that you can never put

00:05:50.400 on screen.

00:05:51.400 I mean, not at all that we were blocked in any way.

00:05:53.400 We were enormously supported by Newsnight.

00:05:56.400 But I knew so much more.

00:05:59.400 And, you know, I've lost sleep over it.

00:06:03.400 And I was really worried by some of the stuff I heard.

00:06:06.400 And I just thought, this is a story that has to be told, because unless this is in the

00:06:13.400 public domain, we can't have an adult, calm, evidence based discussion about how best to

00:06:21.400 care for this group of often very vulnerable children and young people.

00:06:24.400 I didn't think it was my job to provide answers.

00:06:27.400 I don't think that I'm not a campaigning journalist.

00:06:30.400 I felt there needed to be a lasting record of what has happened, because I think it's

00:06:35.400 undeniable things have gone wrong.

00:06:38.400 Some things have gone well as well.

00:06:42.400 And some clinicians, not all, wanted their story told.

00:06:48.400 And this conversation had to come out of the gender clinics and into wider society, because 0.93

00:06:54.400 the welfare of children really is kind of everyone's business.

00:06:58.400 I agree with you.

00:06:59.400 And what were the things that you lost sleep over, Hannah?

00:07:04.400 Well, that potentially very vulnerable children might have been harmed.

00:07:13.400 And, you know, documents from the clinic, transcripts of interviews that JID's clinicians gave to the

00:07:21.400 medical director in, well, across 2018, they were deeply upsetting.

00:07:29.400 And those clinicians talked about the young people they were seeing, not all of them, but

00:07:34.400 some being some of the most vulnerable children they've ever seen, and being in really quite

00:07:38.400 a terrible state.

00:07:39.400 And in some cases, and again, not very many, but in some cases they were referred for quite

00:07:45.400 a major physical intervention after an hour or two, or even three or four, which was allowed.

00:07:51.400 But the levels of trauma that some of those children had suffered prior to that, that didn't seem

00:08:00.400 to be being explored, it's upsetting, you know.

00:08:03.400 And I became a mum in 2016, and it just changes your outlook, I suppose.

00:08:08.400 Of course it does.

00:08:09.400 I mean, when you say major interventions, because there's going to be people who are listening

00:08:14.400 to this who won't know what that means, and you were talking about major trauma.

00:08:18.400 So let's explore a little bit what those terms mean.

00:08:21.400 What does it mean, major trauma, and what do major interventions mean?

00:08:24.400 So trauma, so some of these young people had suffered physical or sexual abuse.

00:08:35.400 Some had lost a parent very young, through bereavement or, you know, had suffered family

00:08:42.400 breakdown, a small but sizable proportion were living in care, which sort of implies that

00:08:51.400 there's been the difficult circumstances leading up to that.

00:08:54.400 Some were living in quite a risky way in terms of their sexual behaviour.

00:09:00.400 Those are all traumatic.

00:09:02.400 Some had parents that were abusing alcohol or drugs, or who had mental breakdown,

00:09:07.400 and that's not those parents' fault, but that's quite traumatic for a child to grow up

00:09:11.400 in that living environment as well.

00:09:13.400 So all those kinds of things that were put together in a broad umbrella under trauma,

00:09:20.400 in terms of major interventions, I mean, people will dispute this, but I'm talking about

00:09:28.400 the first intervention and sort of the primary one that JIDS would refer to,

00:09:33.400 well, would refer young people for is, colloquially, puberty blockers.

00:09:39.400 And it would seem, from the very poor but in limited data that we have,

00:09:45.400 that once on puberty blockers, the vast, vast majority of those young people would then

00:09:50.400 go on to hormones, so either synthetic testosterone or oestrogen, depending on your sex.

00:09:57.400 And, you know, with those came lots of physical potential risks, particularly if you block puberty early

00:10:09.400 and you go straight on to hormones, you will be sterile, for example.

00:10:17.400 Not so much if you go on later, then there's chances to preserve fertility, but, you know, all sorts of things.

00:10:23.400 And to even those who are very happy as trans adults, and for them it was the right and only path,

00:10:34.400 they will tell you that it's not always easy living as a trans man or woman.

00:10:38.400 You have to take medication for the rest of your life.

00:10:41.400 If you medically transition, you may have several intrusive surgeries.

00:10:47.400 So to go through that and it not be the right path is awful.

00:10:53.400 And, Hannah, I want to go back to the core of this issue with the Tavistock

00:10:59.400 and for you to explain a little bit more at a more basic level for people who,

00:11:02.400 we've got a big audience around the world.

00:11:04.400 But before we do, there is a, and forgive me for asking this question,

00:11:09.400 but I actually do think it's important.

00:11:11.400 The way you talk about it, I feel like there's a tension within you

00:11:16.400 because on the one hand, I think you want to communicate about these issues

00:11:19.400 that you truly care about.

00:11:20.400 On the other hand, I think you feel like you have to be very careful as well.

00:11:25.400 Or maybe I'm imposing that on you, I don't know.

00:11:27.400 The reason I'm asking this is that it feels to me like if 20 years ago

00:11:32.400 a story had come out about some children being harmed by medical malpractice.

00:11:38.400 A journalist at BBC Newsnight would be like,

00:11:41.400 this is the biggest story, I'm going to get the scoop,

00:11:43.400 I'm going to go out and cover this, which you've done.

00:11:46.400 I don't know that they would have had the same sort of feeling

00:11:50.400 that this is a landmine issue.

00:11:52.400 Why is that?

00:11:54.400 Why is a medical malpractice on children an issue about which you have to be so careful?

00:12:00.400 I think there's lots of different aspects to what you've said there.

00:12:08.400 So I think, well, generally, when you're talking about medical malpractice,

00:12:16.400 as you put it, it's a question of, you know, a botched medical procedure, isn't it?

00:12:21.400 But what's happening here is it's so intertwined with someone's sense of themselves and identity.

00:12:28.400 And I don't think you have that in other stories.

00:12:33.400 Now, I am cautious because I think, you know, there are lots of people out there commenting on this.

00:12:42.400 So, and do so probably in much stronger terms than I do.

00:12:47.400 But what I've done, and why I think the book has been received so well,

00:12:51.400 is I'm not telling people what to think.

00:12:54.400 I've laid out the evidence and everything.

00:12:57.400 You know, I think there's 70 pages of references in the best way that I can,

00:13:01.400 in the fairest way I can, and for people then to make up their own minds.

00:13:04.400 Because, partly because I work for the BBC, and we're absolutely committed to impartiality.

00:13:09.400 But I just think there are lots of people out there who will express their opinions.

00:13:15.400 And I think actually what so many people have said to me from reading the book is,

00:13:21.400 I just never knew any of this.

00:13:23.400 And it's trying to be calm.

00:13:25.400 And I think I don't talk about it in the same way I would, as you say, you know, another medical scandal.

00:13:33.400 Because I actually think the only honest thing to say is that we don't really know the scale at the moment.

00:13:38.400 So, I would say, what do we know?

00:13:42.400 We know that some young people have been harmed.

00:13:45.400 And I've spoken to them and their stories are in the book.

00:13:48.400 And we know that other young people appear to have been helped.

00:13:53.400 They say they've been helped and they're happy.

00:13:56.400 We don't know what the numbers are either way.

00:13:58.400 And those will undoubtedly change over time.

00:14:01.400 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.

00:14:13.400 It may well be.

00:14:14.400 At the moment, I just don't think we have enough data to put any sense of scale on it.

00:14:18.400 But what I think and what I felt was so striking is that mental health professionals who worked at the Tavistock, 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.

00:14:36.400 Hmm. And let's talk about the medical scandal.

00:14:39.400 I feel bad because it feels like I've been grilling you about your own personal opinions.

00:14:43.400 But the reason I've asked you about it is I think it kind of shows you how society is around this issue.

00:14:50.400 And it's telling, I think. But anyway, let's not delve too far into that.

00:14:55.400 So, I mean, you're right.

00:14:58.400 I think I think 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.

00:15:06.400 And I think sometimes the language is really unfortunate and actually different people like different terms and what have you.

00:15:15.400 But I just think it's important to have some compassion as well.

00:15:19.400 Oh, 100 percent.

00:15:20.400 100 percent.

00:15:21.400 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.

00:15:29.400 Some people would argue, too.

00:15:30.400 And that's the debate, I think.

00:15:32.400 I think you've done a great job of actually laying out the facts.

00:15:35.400 So let's talk about the facts.

00:15:37.400 The Tavistock was shut was a clinic here in the UK.

00:15:42.400 And give us some of the numbers.

00:15:44.400 What sort of numbers are we talking about?

00:15:46.400 How many people were coming through?

00:15:47.400 How many people would have been referred for puberty blockers?

00:15:50.400 What other things did you find that sort of people should know about?

00:15:55.400 Well, in the early days, so that the the the unit, the gender identity development unit as it originally was,

00:16:01.400 started off at another London hospital in South London, St. George's.

00:16:05.400 And I think the first year, two children were referred.

00:16:08.400 It moves to the Tavistock and Portman NHS Foundation Trust in the mid 90s.

00:16:13.400 And it still was about a dozen a year.

00:16:17.400 It grows.

00:16:18.400 You know, it ticks up.

00:16:21.400 And then fast forward to 2009.

00:16:23.400 We've got 97 referrals.

00:16:25.400 2019, another decade.

00:16:28.400 And we've got two and a half thousand.

00:16:30.400 And the last year we have numbers force, which is 21, 22, more than 5,000.

00:16:37.400 So we've had quite a big increase.

00:16:42.400 Yeah, I'd say so.

00:16:43.400 You know, you look at it, it's that classic hockey stick graph.

00:16:48.400 And from 2009 to 15, the referrals go up at 50 percent per annum.

00:16:54.400 And then in 2015, 16, they double.

00:16:57.400 And at the same time, you have this really quite radical shift in the demographics of the young people being referred.

00:17:03.400 So initially, the majority of those referred were boys, birth registered males, assigned males, whatever language we want to use.

00:17:14.400 From 2011, there's parity, equal number of boys and girls referred.

00:17:19.400 And then by 2015, total reversal.

00:17:21.400 And now we've got two thirds of the referrals, girls. 0.99

00:17:25.400 But not just girls, but girls who actually, their gender distress only started in adolescence after the onset of puberty,

00:17:36.400 which was completely different to the traditional presentation, if you like, which was sort of lifelong, since early childhood, gender incongruence.

00:17:48.400 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.

00:17:57.400 So no one doubted that they were distressed about their gender. 0.99

00:18:00.400 But loads of them had other associated difficulties as well, like anxiety, depression, perhaps they were self-harming, eating disorders.

00:18:09.400 Maybe they had a traumatic childhood, all these things.

00:18:12.400 In terms of how many were referred for puberty blockers, we don't know, because every time someone has asked,

00:18:21.400 either the Tavistock and Portman or one of the two trusts that prescribed the puberty blockers,

00:18:28.400 so either University College London Hospitals or Leeds Teaching Hospitals, they've not provided an answer.

00:18:35.400 So best estimates from what is in the public domain, at least 1,500, I would say.

00:18:45.400 I mean, a Freedom of Information request said that by 2017 there'd been over 1,200.

00:18:51.400 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.

00:18:56.400 And I think that's one of the things that is so striking about this story is the lack of data

00:19:03.400 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

00:19:14.400 about the thousands of young people that they've seen.

00:19:18.400 That's shocking.

00:19:20.400 The fact that they didn't even keep records.

00:19:23.400 Well, it's either one or two things.

00:19:24.400 They either didn't keep the records or they're refusing to disclose them.

00:19:27.400 I don't know which is worse.

00:19:28.400 Yeah.

00:19:29.400 Either of those two options are, I mean, that's horrific.

00:19:34.400 Well, this is the thing that has really sort of shocked clinicians as well who work there

00:19:39.400 because they say, well, look, we had a research team.

00:19:41.400 We collected loads and loads of data.

00:19:43.400 So where is it?

00:19:44.400 Now, as you say, it's either there but not somehow collatable in a meaningful way

00:19:52.400 or they collected the wrong data, you know, stuff that doesn't matter.

00:19:58.400 I don't know.

00:19:59.400 But we don't know it.

00:20:01.400 And, for example, one example of this is that for years they said 40% of young people

00:20:09.400 referred to us are then referred for puberty blockers.

00:20:13.400 Subsequently, that's come down.

00:20:14.400 But they were consistent about that for many, many years in the press and everything like that.

00:20:18.400 They put this figure in an academic paper and then they explained where it had come from.

00:20:25.400 And the Tavistock were asked, well, through freedom of information,

00:20:33.400 could they give the actual numbers behind this graph which put age of referral

00:20:40.400 and the proportion of which had gone on to endocrinology?

00:20:44.400 And they said, no, we don't have it.

00:20:47.400 The lead author is a professional at UCLH.

00:20:51.400 Ask them.

00:20:52.400 And the person that did the number crunching, if you like, doesn't work here.

00:20:56.400 They were a research doctoral assistant.

00:21:00.400 So UCLH were asked that same question.

00:21:03.400 You've got this graph.

00:21:05.400 Can we just have the data behind it?

00:21:07.400 We don't have it.

00:21:08.400 Please go back to the Tavistock.

00:21:10.400 Now, the Tavistock then said, we've done a search and we don't have it.

00:21:16.400 Now, one of several things is true then.

00:21:19.400 Either they do have those numbers but don't want to release them for whatever reason,

00:21:27.400 or they don't have them.

00:21:28.400 And it's like, well, what does that tell you?

00:21:31.400 So this is their core treatment pathway, referral of young people for puberty blockers.

00:21:39.400 They have this really quite important data, their data, but they've not kept it.

00:21:47.400 And they've not continued that either.

00:21:49.400 I mean, it's baffling.

00:21:52.400 I don't know which of those is true.

00:21:54.400 But either way, it would be helpful to know.

00:21:59.400 That's such a British way of putting it.

00:22:01.400 That is the most BBC way of putting it.

00:22:04.400 Hannah, so thousands of young people are referred to this clinic.

00:22:10.400 Can you describe to us as a kind of, as a customer of this thing,

00:22:14.400 or whatever the right term is, as a patient, whatever it is,

00:22:17.400 what is your experience like?

00:22:18.400 So you're a child.

00:22:19.400 Let's say you're, I don't know, what would be a sort of median age?

00:22:23.400 11, 12, 13.

00:22:25.400 So you're 11, 12.

00:22:26.400 You may be coming from care.

00:22:28.400 You may be coming from a dysfunctional family.

00:22:30.400 You may have been abused.

00:22:31.400 You get there.

00:22:33.400 What happens to you?

00:22:35.400 I'll answer that.

00:22:36.400 I just wanted to stress, not all kids were like that.

00:22:40.400 Yeah.

00:22:41.400 And I just want to say, like, so many of these young people,

00:22:44.400 actually, you know, they had loving families

00:22:46.400 and they just didn't know what to do.

00:22:48.400 There's nothing worse is there than seeing your children in pain.

00:22:50.400 So I just want to put that...

00:22:52.400 You're absolutely right.

00:22:53.400 And look, as a parent...

00:22:54.400 And they were going to the professionals to ask for help.

00:22:56.400 Well, quite.

00:22:57.400 And as a parent, I think actually, you know,

00:22:58.400 this is sometimes where people go,

00:22:59.400 well, why do people care so much about this issue?

00:23:01.400 It's not that many people and whatever.

00:23:03.400 But you mentioned yourself becoming a mother,

00:23:05.400 and as a parent now myself, I think for a lot of parents,

00:23:08.400 their big fear is that, A, and we'll get onto this,

00:23:12.400 where do young people, particularly young girls,

00:23:14.400 get the idea that this is the right thing for them, number one?

00:23:17.400 Let's say your child has that,

00:23:19.400 and then you go to the professionals and you're like,

00:23:22.400 look, I'm just a parent.

00:23:23.400 I don't know what's going on.

00:23:24.400 Can you please help me?

00:23:25.400 And then after a couple of hours,

00:23:27.400 they're on the pathway to help, right?

00:23:29.400 That's, I think, where parents' concerns are.

00:23:31.400 So, but tell me more.

00:23:33.400 So, let's...

00:23:34.400 So, any given young person's experience, to be frank,

00:23:39.400 will be completely different depending on who you and your family

00:23:43.400 happen to be assigned to, like which pair of clinicians you see.

00:23:48.400 That's reassuring, isn't it?

00:23:49.400 And this is part of the difficulty

00:23:52.400 and something that was absolutely highlighted by Hilary Cass

00:23:55.400 and by the CQC when they inspected JIDS.

00:23:58.400 So, on the one hand, you had assessments that could be,

00:24:02.400 and the CQC found this, let's say, two appointments.

00:24:05.400 So, it's two hours.

00:24:07.400 On another hand, at the absolute extreme,

00:24:10.400 there could be 50 sessions.

00:24:12.400 So, that's...

00:24:13.400 Therefore, you're talking years in the latter,

00:24:16.400 a couple of hours in the former.

00:24:18.400 Now, the experience that that young person and their family have

00:24:21.400 is so worlds apart in those two things.

00:24:24.400 Now, it could have been in the 50 session assessment,

00:24:26.400 which is rare, was rare.

00:24:30.400 It could be that that person was then referred for puberty blockers.

00:24:34.400 But having gone through years of talking therapy

00:24:37.400 and everybody being as sure as they could be,

00:24:41.400 because there's never certainty,

00:24:42.400 but as sure as they could be and fully informed

00:24:44.400 and making that decision along with their professionals.

00:24:49.400 That is a very different kind of relationship

00:24:54.400 and, you know, care offering

00:25:01.400 than the young person who's seen two, three, four times.

00:25:04.400 And so, this was part of the difficulty

00:25:07.400 and there was no agreement amongst the staff group

00:25:12.400 about how best to care for these young people.

00:25:14.400 And I think this is really important to stress

00:25:16.400 that actually, globally, there is not clinical agreement

00:25:19.400 on how to best care for this group of young people.

00:25:23.400 And that might mean, and it probably does mean,

00:25:26.400 there won't be one way either.

00:25:29.400 It might well be that what works for some

00:25:31.400 just won't work for others because kids are different.

00:25:35.400 And just as there are different ways that someone might get

00:25:38.400 to their gender dysphoria or gender incongruence,

00:25:41.400 there's probably going to be different ways out of it as well.

00:25:44.400 So, there is disagreement amongst people

00:25:46.400 even that working in gender clinics today

00:25:48.400 about how we best do this.

00:25:50.400 But, fundamentally, that makes the service really difficult

00:25:56.400 because, you know, there was no agreement

00:26:01.400 on what it was that they were treating

00:26:04.400 in the loosest possible sense, you know,

00:26:06.400 not to pathologise these young people,

00:26:08.400 but if you can't agree on what it is you're treating

00:26:13.400 and how best to treat it,

00:26:14.400 how can there ever be a sort of consistent assessment

00:26:18.400 and consistent care?

00:26:20.400 And there wasn't.

00:26:21.400 If you believe that gender dysphoria equals being trans 0.94

00:26:27.400 and, therefore, that is a stable, lifelong identity,

00:26:31.400 then, of course, you would refer for physical interventions.

00:26:35.400 If you believe that, actually, gender dysphoria

00:26:37.400 might lead to a trans outcome,

00:26:39.400 but, equally, it might be related to something else

00:26:45.400 that's causing you distress in your life, then you might not

00:26:48.400 or you'd be far more cautious about doing that.

00:26:51.400 And that was the difficulty.

00:26:53.400 I mean, I was really struck by...

00:26:56.400 There was a clinician who's in the book, Dr Kirsty Entwistle,

00:27:00.400 who worked up in the Leeds site for JIDS,

00:27:03.400 which doesn't really get a huge amount of attention.

00:27:05.400 And she's very worried pretty much as soon as she joins.

00:27:10.400 And she has a massive difference of opinion 1.00

00:27:13.400 with the clinician that she's working with

00:27:15.400 about a couple of cases.

00:27:17.400 Now, the solution of the managers of the Leeds JIDS site

00:27:21.400 is that Kirsty Entwistle and this other clinician

00:27:25.400 just won't ever work together again.

00:27:31.400 And one of their colleagues told me,

00:27:36.400 well, that was the only sensible solution

00:27:38.400 because they were so poles apart

00:27:39.400 that they couldn't work with families.

00:27:41.400 Now, what are the implications of that?

00:27:43.400 That you have two people working in the same NHS service

00:27:47.400 whose views are so opposed

00:27:51.400 and their opinions on how to care for the patients

00:27:57.400 that they can't work together.

00:27:59.400 It's quite extraordinary.

00:28:03.400 So, it's a very long-winded answer.

00:28:05.400 So, it depends who you saw.

00:28:07.400 It depends who you saw.

00:28:09.400 However, I take it from what you're saying is

00:28:11.400 there was variation in how different patients were treated

00:28:15.400 and some would have had a long time to think about

00:28:17.400 and go through the process.

00:28:19.400 But I also take it that there were some people

00:28:22.400 who would have turned up, had a couple of sessions

00:28:25.400 and onto the puberty block as they went.

00:28:28.400 Is that accurate?

00:28:29.400 Yes. Yeah.

00:28:31.400 And how did that happen exactly?

00:28:34.400 Why was that allowed?

00:28:37.400 Well, I think in the earlier years.

00:28:44.400 So, puberty blockers became available

00:28:49.400 as sort of standardised practice

00:28:52.400 at these younger ages from 2014

00:28:55.400 after they'd...

00:28:56.400 Well, they hadn't really completed,

00:28:57.400 but after an initial attempt at a study.

00:29:01.400 And at that stage, 2014-15,

00:29:07.400 although some of the clinicians didn't understand

00:29:11.400 perhaps why you might refer,

00:29:14.400 even after six sessions,

00:29:15.400 which was kind of the assessment model,

00:29:17.400 they didn't...

00:29:19.400 They weren't overly concerned

00:29:21.400 because in their eyes at that time,

00:29:23.400 what they were constantly being told

00:29:25.400 and there was nothing to suggest to the contrary,

00:29:27.400 was that what the puberty blockers did

00:29:29.400 was they provided time to think

00:29:32.400 and there were no long-term effects

00:29:36.400 and they were completely reversible.

00:29:38.400 And actually, what so many of those young people needed

00:29:42.400 was time to think.

00:29:43.400 They were very, very distressed.

00:29:44.400 And the rationale of the blocker makes perfect sense,

00:29:47.400 that you're just...

00:29:49.400 You've got this mismatch between your biological sex

00:29:52.400 and the gender identity that you, you know,

00:29:56.400 that you perceive.

00:29:58.400 You stop your body going through the puberty 0.79

00:30:01.400 of your biological sex

00:30:02.400 and then you can hopefully take away some of that distress

00:30:04.400 and then think about things.

00:30:07.400 Now, it was only really when...

00:30:11.400 So, in those years, 2015-ish,

00:30:15.400 lots of clinicians told me that

00:30:18.400 pretty much any young person that wanted the blocker

00:30:22.400 could have it during quite a quick assessment.

00:30:25.400 And actually, as long as they met the criteria for gender dysphoria, 0.99

00:30:29.400 which pretty much all of them did because they're silly 0.97

00:30:32.400 and most teenagers would meet them, 0.99

00:30:36.400 they would be referred for puberty blockers. 0.88

00:30:38.400 What were the criteria for gender dysphoria that you say were silly? 0.56

00:30:42.400 Well, they're things... 0.79

00:30:45.400 I mean, one area...

00:30:47.400 This is a rare moment of agreement from both those

00:30:51.400 who are very pro-medical intervention and those who are very against

00:30:54.400 is that, you know, they're steeped in gender stereotypes. 0.96

00:30:57.400 So, it would be things like playing with toys

00:31:01.400 that are typically associated with the opposite sex,

00:31:04.400 having friends that are mostly of the opposite sex,

00:31:08.400 wanting to be the opposite...

00:31:12.400 You know, they're just...

00:31:14.400 So, if I were a girl who was a bit of a tomboy, quote-unquote,

00:31:17.400 and I felt some sort of distress, puberty blockers, off you go.

00:31:21.400 Well, yeah, you have to have the distress,

00:31:23.400 and it has to be for more than six months.

00:31:24.400 But six months is not a huge amount of time.

00:31:26.400 No.

00:31:27.400 It's not a huge amount of time.

00:31:29.400 And actually, the small amount of data that we do have

00:31:36.400 kind of bears out that in those years of 2014, 15, 16,

00:31:42.400 lots of people...

00:31:44.400 Well, proportionally, lots of people were referred.

00:31:46.400 Like, this data that I mentioned before that they didn't release

00:31:51.400 because apparently no one has it.

00:31:52.400 But there's a graph.

00:31:53.400 It's the only graph in the book.

00:31:54.400 And it actually shows that, you know,

00:31:56.400 of those who were referred in adolescence,

00:31:58.400 the majority went on to be referred for puberty blockers.

00:32:02.400 And the peak is at about 14.

00:32:04.400 And I turned into an absolute uber-geek,

00:32:07.400 and I actually blew this thing up, and I'm measuring it,

00:32:11.400 and I'm like, oh, one millimetre is this.

00:32:13.400 And so I do actually get their numbers,

00:32:15.400 and it's about 70% of 14-year-olds

00:32:18.400 during this particular time period.

00:32:20.400 And now you get an average of a minority, 40%,

00:32:25.400 because the really young ones obviously aren't eligible to be referred.

00:32:30.400 And so it's the classic, the average, the mean.

00:32:34.400 The mean is meaningless because it hides what's going on in the middle.

00:32:38.400 So there was that, that they didn't think it made sense.

00:32:42.400 There was also the fact that some people say there was pressure

00:32:46.400 to refer quickly because it freed up their time as clinicians,

00:32:49.400 because the waiting list was growing.

00:32:51.400 As we've already mentioned, the referrals were going through the roof.

00:32:54.400 They breached their 18-week waiting target for the first time

00:32:59.400 in sort of autumn 2015, and they never met it again.

00:33:02.400 And once you referred a young person to endocrinology,

00:33:05.400 you saw them less frequently.

00:33:07.400 So it freed up some clinical time.

00:33:10.400 Hannah, we interviewed, I mean...

00:33:13.400 That's horrifying.

00:33:15.400 Yeah.

00:33:16.400 Anyway.

00:33:17.400 Hannah, we interviewed Marcus Evans,

00:33:20.400 who was one of the whistleblowers on this show two years ago.

00:33:24.400 And he said something on that interview, which has always stuck with me,

00:33:28.400 which he said that some of the people who were working at the Tavistock

00:33:33.400 were motivated more by ideology than patient care.

00:33:38.400 Was that your experience when you were doing your studies

00:33:42.400 and you were actually looking into this case, or did you find something else?

00:33:47.400 I think it's a bit more complicated than putting it that way, in my view.

00:33:57.400 I don't think that the majority of people that worked at JIDS were ideologues.

00:34:03.400 They were just hardworking, caring professionals who wanted to help kids,

00:34:08.400 like the vast majority.

00:34:10.400 And that's why...

00:34:12.400 And they became concerned when the reality doesn't really match the theory, if you like.

00:34:19.400 Where I think ideology really impacted on JIDS is that there seemed to be this inability

00:34:25.400 to stand up to some of the trans charities and groups.

00:34:32.400 And, you know, it was lobbying in part, not totally, absolutely not,

00:34:39.400 but pressure from those groups that helped lower the age at which puberty blockers

00:34:46.400 could be available in the first place.

00:34:47.400 There was a real big push for that.

00:34:48.400 But there was pressure from elsewhere too, and in the medical community.

00:34:53.400 But I think there was this almost...

00:34:56.400 Clinicians have described to me there was this fear of sort of upsetting those groups.

00:35:02.400 Groups like mermaids, which people have probably heard of, and gyrus.

00:35:07.400 And that when data became available that challenged what they thought they knew

00:35:14.400 and that perhaps showed that actually puberty blockers weren't working in the way they thought

00:35:19.400 and had been telling families, they didn't change direction.

00:35:24.400 And some people told me, some clinicians told me that they felt that that was because

00:35:30.400 there was a fear of how some of the groups might respond.

00:35:33.400 And similarly, you know, as more information came out, nothing was codified.

00:35:39.400 Nothing was written down.

00:35:40.400 So in all fairness to some of these clinicians who didn't pass on information,

00:35:44.400 you could only pass on something that you know.

00:35:47.400 You can't pass on what you don't know.

00:35:50.400 And, you know, there's a meeting in the book, and it was an absolute turning point for lots of people,

00:35:56.400 but they have a visit.

00:35:58.400 The GID staff have a visit from a surgeon who performs vaginoplasties on trans women. 1.00

00:36:05.400 So taking a penis and surgically constructing a vagina. 1.00

00:36:11.400 And he tells the GID staff, he said, look, there's a problem. 0.99

00:36:14.400 If you block puberty too early in males, there isn't enough penile tissue to do that surgery in the safest and most effective way.

00:36:26.400 You can still do it, but it's riskier and, you know, you might have to have subsequent surgery.

00:36:33.400 To everybody listening to that, that I spoke to, they, from that moment on, pass that on to all of the relevant families.

00:36:40.400 So no one questions that, but it was never written down despite the efforts of one clinician who wrote a leaflet,

00:36:46.400 had it approved by that surgeon and one of the members of the leadership, but it was never signed off.

00:36:52.400 So I spoke to clinicians who joined the service subsequent to that, so that was in 2016, who never knew that.

00:37:00.400 So they couldn't pass it on.

00:37:02.400 And I'm told by people who work in adult services that you can see that in some notes,

00:37:06.400 that some trans women who, you know, when they were boys and looking to transition,

00:37:13.400 were not told that when they started the blocker, and some were.

00:37:16.400 But again, it's this lottery.

00:37:18.400 So to go back to your question, I don't think most of the people working there were ideologues.

00:37:25.400 I think there was a, but I think the service became, if not captured, then frightened to stand up to ideology

00:37:34.400 when evidence became available that showed actually this intervention was not working for some people.

00:37:40.400 So effectively, these charities, and push back if you think my language is too inflammatory,

00:37:45.400 but I'm trying to be as accurate as I possibly can be.

00:37:48.400 These clinics were essentially bullied by these charities because they were intimidated by what could happen

00:37:57.400 or how essentially if they didn't adhere to what these charities felt was best.

00:38:04.400 And as a result of that, patient care was compromised.

00:38:08.400 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?

00:38:15.400 They're there to put forward their view of what they feel is the best treatment for the people they represent.

00:38:23.400 So you can't blame them.

00:38:26.400 Why they didn't stand up to them, I don't know.

00:38:28.400 What's the worst that could have happened?

00:38:29.400 These are all hypothetical questions.

00:38:31.400 I mean, it's, but it's striking.

00:38:34.400 I think it's very easy to understand why the medical pathway was introduced

00:38:42.400 and why the age was lowered originally and why they wanted to do more research.

00:38:49.400 I think it's much harder to understand why there was no change in direction or at least pausing to reflect

00:38:57.400 when data came back which suggested their original assumptions were not the case.

00:39:02.400 So, that being the case, we have this situation which is awful, absolutely awful.

00:39:09.400 When was the moment that the medical community and people like Marcus Evans started to go,

00:39:16.400 there's something very wrong going on here?

00:39:21.400 I think it happened for different people at different times.

00:39:23.400 So, Marcus is married to Sue Evans, who was the first whistleblower, if you like.

00:39:30.400 And she had concerns as far back as 2005 that some young people were being referred to quickly.

00:39:37.400 And bearing in mind, you had to be 16 at that point.

00:39:40.400 But she, you know, she saw some colleagues refer young people after four appointments

00:39:48.400 and she felt that was too quick in all cases.

00:39:52.400 So, Marcus Evans had lived through that experience, if you like.

00:39:56.400 And then there was a sort of a quite a big gap between Sue leaving in around 2007.

00:40:02.400 And then lots of people taking their concerns to Dr. David Bell,

00:40:11.400 who was a very senior psychiatrist in the adult service of the Tavistock,

00:40:15.400 but also at that time, the staff governor.

00:40:18.400 So he was the representative on the board of governors who kind of spoke for staff across the trust.

00:40:22.400 And essentially 10 members of JIDS staff who had tried repeatedly,

00:40:28.400 and there's a paper trail that shows this to raise their concerns within JIDS

00:40:32.400 and within the trust to very, very senior board members.

00:40:37.400 Nothing changed.

00:40:38.400 And so they took their concerns to David Bell and then it all came in the public.

00:40:44.400 And that's when Marcus, you know, he resigned over the fact that he didn't feel that those concerns

00:40:51.400 were being taken seriously enough by the trust and equally that Dr. Bell had been treated very poorly.

00:40:57.400 But the clinicians themselves who were working at that point, I mean, they each had different moments,

00:41:08.400 but there was several, it was really when the first bit of data came back from this study that had begun,

00:41:15.400 which challenged all the assumptions they had about puberty blockers.

00:41:18.400 Because what this showed was that of those who had become old enough by that point,

00:41:25.400 every single one of them had gone from the puberty blocker to cross-sex hormones.

00:41:31.400 But also that there'd been no psychological benefit to being on the puberty blocker. 0.99

00:41:37.400 And so for Dr. Anna Hutchinson, she describes learning that as her holy fuck moment. 0.98

00:41:48.400 Because it exploded everything that they were doing. 0.98

00:41:50.400 She said, you know, what are the chances of being given time to think

00:41:54.400 and all children and young people thinking the same way?

00:41:57.400 She's like, that just doesn't happen. It doesn't happen in psychology.

00:42:00.400 And also, even if we gave them time that this is what they did do, there was no space to think in the Tavistock model anyway, in the JIDS model.

00:42:12.400 Because when you went on the blocker, you didn't have more talking, you had less.

00:42:17.400 You got seen every three to six months.

00:42:20.400 And so, and actually, these young people weren't feeling better.

00:42:26.400 In some cases, both psychologically and physically, they were getting worse.

00:42:32.400 And so at that point, quite a sizable number of clinicians just went, this isn't safe, what we're doing.

00:42:40.400 And they became much more cautious, and they extended their assessments.

00:42:44.400 And that's probably how we got to, you know, the 50, although very rare.

00:42:48.400 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 on to cross-sex hormones,

00:43:02.400 totally changed the way I practiced.

00:43:04.400 Because if I didn't think that a young person should go on hormones, I wasn't going to put them on the blocker.

00:43:10.400 Because you had to do the work then.

00:43:13.400 It was far too late once they were on the blocker.

00:43:15.400 Because the other thing that they noticed was that actually a young person tended to shut down once they got on the medication.

00:43:23.400 They got what they wanted.

00:43:25.400 They weren't at all open to talking.

00:43:29.400 Hannah, and I'm curious about what happened when, prior to that discovery, when people went and raised concerns and they were not taken seriously.

00:43:39.400 Do we have a sense of why that happened?

00:43:41.400 Because I think that's a question a lot of people would be asking.

00:43:43.400 And I think you've got a very measured take on all of this in 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.

00:43:55.400 Is that what happened?

00:43:57.400 Was there people at the board level who felt that this is the path that they must proceed down?

00:44:03.400 Why did those concerns not get taken seriously prior to this discovery?

00:44:07.400 I think there are different reasons why these concerns weren't acted on.

00:44:12.400 One appears to be that certain people in the trust just believed that this was the right thing to do.

00:44:22.400 Like this is a vulnerable group of young people.

00:44:25.400 Trans people are marginalized and stigmatized and we're helping them.

00:44:31.400 And any concern is transphobic.

00:44:34.400 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.

00:44:51.400 I mean, I like my colleagues, but people at JIDS describe it as a family and they were encouraged to think that way, at least for a time before it became absolutely enormous.

00:45:01.400 And when concerns were raised about clinical practice, it was made to appear to the rest of the team that you were criticizing the leadership or you were criticizing a person.

00:45:15.400 And yet these were people that we cared about. And, you know, you don't criticize your family.

00:45:19.400 And then arguments would come back, well, we're doing it better than everybody else.

00:45:22.400 Or, you know, the private sector would be worse.

00:45:25.400 And they said, but that's not good enough.

00:45:28.400 Like what we're doing is not good enough. We can't just say, well, other people would be worse.

00:45:35.400 Some people have suggested that the concerns weren't taken seriously enough because over time, the contribution that JIDS made to the overall income of the trust was quite significant.

00:45:48.400 So it went from an around 2015 being about 5% of income that came into the trust to about 13% at its peak.

00:45:57.400 And when you combine that with the adult service, which the Tavistock took on 2017-18, it was a quarter of the entire income.

00:46:06.400 And no one suggested that there was anything sort of really malicious about that.

00:46:10.400 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.

00:46:27.400 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.

00:46:42.400 It just required a complete overhaul, a radical rethink of exactly what they were doing.

00:46:49.400 But hold on a second, Hannah. These are kids' lives that are being irreversibly damaged, their bodies.

00:46:57.400 And I'm not saying obviously you, but they're putting the system ahead of that.

00:47:01.400 That to me is, it's abhorrent.

00:47:05.400 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.

00:47:16.400 Agreed.

00:47:17.400 We don't think there's any evidence for that.

00:47:19.400 Have children been harmed?

00:47:20.400 Yes, they have.

00:47:21.400 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?

00:47:34.400 I've done something really wrong.

00:47:35.400 Yeah, that's true.

00:47:36.400 And, and they did do that.

00:47:40.400 And Anna Hutchinson puts it, you know, why weren't the concerns taken seriously?

00:47:45.400 Maybe, she says, it might be that those people at the top of the service who have been there for years, well over a decade, referring young people for puberty blockers, perhaps you get to the point that you can't.

00:48:00.400 You can't change direction.

00:48:02.400 Because what does that mean?

00:48:03.400 What does that mean for you as a human being to go, oh my God, I might have got this wrong.

00:48:09.400 And I might have got it wrong for some of the most vulnerable young people there are.

00:48:15.400 And perhaps that's intolerable.

00:48:17.400 And perhaps that explains in part why they didn't change direction.

00:48:20.400 I don't like.

00:48:21.400 Yeah, absolutely.

00:48:22.400 Yeah.

00:48:23.400 Look, it's a very, very good point.

00:48:26.400 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.

00:48:39.400 I think the number or the stat that I keep remembering is 40% of these girls who were referred had autism.

00:48:46.400 And they were dealing with mental health professionals.

00:48:50.400 Why did someone not jump on this sooner and go, hang on, there's a very real link here between autism, gender dysphoria, then something else is happening here.

00:49:00.400 Do you see what I mean?

00:49:01.400 Well, I think they did spot that.

00:49:03.400 So, I mean, their own research showed that I think it's 35% of boys and girls that were referred had autistic traits.

00:49:12.400 So they spotted that, and it's what you do with it.

00:49:15.400 And seemingly, it didn't change anything.

00:49:19.400 And this is another theme, if you like, that whether it's that, that you realise that over a third of your referrals are autistic compared to 1%, 2% nationally.

00:49:32.400 Whether it's new knowledge on surgery, whether it's new knowledge on how the blocker might be working.

00:49:41.400 Clinicians use this phrase, like, everything changed, but nothing changed.

00:49:47.400 So practice just never changed.

00:49:49.400 So they knew that.

00:49:50.400 They knew.

00:49:51.400 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.

00:50:01.400 But they weren't collecting that data.

00:50:03.400 And when Keira Bell, who was seen at JIDS 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.

00:50:21.400 That JIDS didn't have that data.

00:50:24.400 How many of the people you refer are autistic?

00:50:26.400 They didn't know. 0.86

00:50:27.400 And it's also the element of how many of these kids who are going through this process, they're just gay. 0.97

00:50:38.400 They're just gay kids. 0.99

00:50:39.400 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.

00:50:54.400 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 and she approached me and we were having a nice conversation.

00:51:05.400 And she just looked at me and she went, thank God that I'm in my late twenties, 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 I was at the fact that I was gay or I am gay.

00:51:27.400 I think this is the part of the story which people, particularly in, you know, liberal metropolitan cities, find the hardest to accept.

00:51:39.400 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.

00:51:58.580 And hearing that, I kind of, I thought we were done with that.

00:52:03.180 I thought it just wasn't a thing anymore to, for people to think it's not okay to be gay, but it, but it is.

00:52:09.020 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.

00:52:20.420 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.

00:52:34.120 And what they've turned around and said, look, they say, look at the data. 0.99

00:52:38.320 Like, it's really rubbish.

00:52:40.860 Like, we don't have much of it, but what we do have absolutely bears that out.

00:52:44.560 So JIDS's data from every single young person that was referred to them in 2012, of the ones they have data for, which is the sort of the older ones, they didn't ask the very young kids.

00:52:57.800 What is it?

00:52:58.800 I think 90% of the girls identified as either same-sex attracted or bisexual, and 80% of the boys.

00:53:07.500 And then in slightly more recent stats, those come down to about 70% and 60% respectively.

00:53:13.540 But they're still incredibly high.

00:53:16.220 So they're saying, we weren't seeing something that wasn't there.

00:53:18.680 And I've spoken to young people themselves.

00:53:20.640 There's a case in the book, Harriet, who said, I was a lesbian.

00:53:24.440 And it was so obvious.

00:53:25.620 I went into my JIDS assessment, and they 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.

00:53:33.040 And I've never been attracted to a boy.

00:53:35.080 And all that was ignored.

00:53:36.140 So it's not – the data, the personal experiences, the experiences, the clinicians, it's there.

00:53:46.880 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.

00:54:00.900 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.

00:54:19.420 I mean, and that has always been the case.

00:54:21.640 So every study we have in this field is quite rubbish, but all of them highlighted that.

00:54:28.360 And when Domenico Dicelli opened JIDS back in 89, he always made that point that of this – of any group of kids, some would grow up to be trans, but there would be the minority. 0.96

00:54:42.000 The majority wouldn't, and the majority of them would be gay. 1.00

00:54:44.700 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.

00:54:55.400 And it wasn't – I don't know.

00:55:00.460 It wasn't – it was just not seen as a thing.

00:55:03.100 Like, the gender identity was what mattered. 0.81

00:55:05.580 So I described it as medical malpractice earlier, and I appreciate your commitment to impartiality, and it's very strong.

00:55:13.680 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 in 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,

00:55:34.720 were essentially treated for autism and homosexuality with puberty blockers, or in some way.

00:55:45.620 Is that overstating it?

00:55:48.200 Well, I mean, I'm not sure you need to treat homosexuality. 0.95

00:55:53.380 But that's what – well, I don't – well, I wasn't there doing it.

00:55:56.140 No, no, no, no.

00:55:56.800 I mean –

00:55:57.700 But that's what I'm saying.

00:55:58.920 Yeah, I mean, that was certainly the fear.

00:55:59.740 People presenting with mental health issues, autism and homosexuality, were treated as if they need this medical intervention.

00:56:07.760 Yeah, I mean, several things.

00:56:08.740 One is, like, you know, not everybody was referred for puberty blockers, which I think we've clearly established.

00:56:15.280 But, yeah, that was – and that was disgust.

00:56:18.320 I mean, you know, and the medical director, various people were told this.

00:56:22.480 You know, they would have discussions.

00:56:23.540 I mean, it wasn't that discussion was shut down and that they talked all the time.

00:56:26.760 The fact is that they just talked, but nothing changed.

00:56:29.120 So that was the problem.

00:56:30.200 But they would have staff meetings and, you know, really worried clinicians would say, 0.94

00:56:35.440 maybe we're medicating gay kids. 0.92

00:56:38.000 Maybe we're medicating autistic kids. 1.00

00:56:40.920 And if we are, we're doing something quite dangerous.

00:56:47.260 And it was that those fears couldn't be responded to adequately.

00:56:51.000 And that's why ultimately people left, because they felt that the risks weren't – the risks in the work weren't being adequately acknowledged or minimised even.

00:57:02.520 There will always be a risk, because every single clinician I've spoken to said,

00:57:05.900 you can never tell for sure who's going to benefit and who's not.

00:57:08.540 But there are ways of minimising that, and there are ways of – and they felt that that isn't what was happening.

00:57:16.360 But yes, I mean, if you go right back to where this started with a team in the Netherlands,

00:57:23.480 they acknowledged right, right, right at the beginning that the risk of blocking puberty earlier, pre-16,

00:57:33.300 was that you would get something which they referred to as, rather euphemistically, as false positives,

00:57:39.780 i.e. in your attempts to help those who would grow up to be trans adults, you would probably –

00:57:45.500 the risk was you would also include people who, had they not had their puberty blocked earlier,

00:57:51.920 would not have transitioned and would have somehow come to either accept

00:57:57.220 or their distress would have been relieved without physical interventions.

00:58:01.040 And all the data suggests that those false positives are most likely gay, lesbian and bisexual people.

00:58:09.460 Right. And Hannah, one thing I wanted to ask you as well is,

00:58:12.720 given the rapid increase in the number of referrals over the years and the decades, as you described,

00:58:18.200 where does that come from? Because gay people have always existed. Autistic people have always existed. 0.98

00:58:24.000 How do we get from a handful to thousands?

00:58:31.080 That's a $64 million question, isn't it? I think there are lots of –

00:58:35.800 so there are clinicians who are much better at hypothesising about that than I am,

00:58:41.460 so I'll just steal their ideas. But I think there are lots of reasons.

00:58:45.420 And I was talking to someone recently who said, oh, it's either social contagion or it's greater social acceptance.

00:58:52.580 I don't think that. I think it's both and. So I think for some people, and I've spoken to them,

00:59:00.300 I think greater visibility of trans people and more social acceptance, I think that probably was the case for them.

00:59:05.500 And I think there will be different things for different people.

00:59:07.700 But I spoke to people in the book who are like, I always felt this way, but I didn't know what it was called.

00:59:12.640 And it's not for me to question their story. I think for some people it's absolutely –

00:59:23.640 whether we use the word contagion or not, but there's certainly influence of friends and peer groups.

00:59:30.680 And even WPATH, the World Professional Association for Transgender Healthcare,

00:59:35.120 acknowledges that in their most recent standards of care, that for some there will be that influence.

00:59:40.440 Because why wouldn't there be? There is for everything. Like, we've all been teenagers.

00:59:45.300 And again, I've spoken to people for whom that was definitely a factor,

00:59:48.340 where all their group of friends were either trans or non-binary, and it was trendy and made them fit in.

00:59:53.560 I think for the girls in particular, there are additional factors.

01:00:00.940 I think right now it's really quite tough to be a teenage girl.

01:00:05.960 We live in this quite hyper-sexualised world.

01:00:11.780 Two JIDS clinicians, Anna Hutchinson and Melissa Midgine, call it the pornification, 0.99

01:00:16.020 you know, this – and pinkification. 0.97

01:00:19.200 And I think if – I think for some young women, if they don't feel that they are –

01:00:28.020 or present in a way that is seen as typically uber-feminine, whatever that means, it's nonsense,

01:00:34.540 then you can look for another way that explains why you feel that you don't fit in.

01:00:41.100 And I think for some people, even for those for whom transition hasn't worked,

01:00:46.960 most of them will say that it did for a time.

01:00:50.260 And initially, in the early stages, they felt great.

01:00:55.380 Because it was like, oh, this explains why I've been unhappy.

01:01:01.240 Not everybody.

01:01:01.720 But if you inject me with testosterone, I'll probably feel great for a while as well.

01:01:04.860 Well, it's a natural antidepressant.

01:01:06.380 That's what I mean.

01:01:07.000 Right.

01:01:07.200 So when you inject people with drugs, they often feel great.

01:01:11.040 This is not necessarily evidence of that being the right thing to do.

01:01:14.040 And as we've discussed, like internalised homophobia will explain it for other people.

01:01:17.460 So I think there are all kinds of reasons.

01:01:19.540 Can you put some percentages on those things for us?

01:01:22.700 Because – well, the difficulty is that I agree with you that there's a complex range of explanations.

01:01:29.180 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.

01:01:34.880 I'm just trying to get to the truth here – that can be a way to conceal the reality of what's happening.

01:01:41.860 Do you see what I'm saying?

01:01:42.680 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.

01:01:50.100 Yeah, but I'll put it back to you.

01:01:51.040 Like, how could we possibly come up with the percentages?

01:01:53.220 I mean, what would that look like?

01:01:54.240 How would we arrive at that data?

01:01:55.740 I think it's hard to say.

01:01:57.100 One of the things I think we ought to look at 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.

01:02:09.980 Yep.

01:02:10.380 And then you kind of break it down from there.

01:02:12.320 At the very least, we probably would want to know how many people receive treatment that they shouldn't have received.

01:02:17.940 This seems to me quite a priority here.

01:02:20.100 Yeah, that would be good to know, wouldn't it?

01:02:21.460 I would think so.

01:02:22.360 But we don't know.

01:02:23.620 And why not?

01:02:24.060 Well, I think there are several reasons we don't know.

01:02:27.260 So one is, if we keep it focused on JIDS, I think they haven't wanted to find out.

01:02:38.480 They haven't found out.

01:02:39.460 I mean, their own documents, their own information they've released under Freedom of Information shows that there was a time when they said,

01:02:46.660 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.

01:02:57.400 And for a couple of years, 2017, 18, they said, yep, we're doing that.

01:03:02.800 And then they said, suddenly said, no, we're not going to do that.

01:03:05.700 It's really time consuming.

01:03:07.080 So they never collected that data.

01:03:10.000 Only they will know why, because that seems quite important data to have.

01:03:14.480 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.

01:03:25.740 So people have gone through a medical transition or surgical transition and then revert back to their natal sex.

01:03:30.540 That doesn't undermine the experience of those for whom a medical transition might work.

01:03:40.720 Actually, I've spoken to, you know, there's a trans researcher in Canada who's doing loads of research on detransition.

01:03:47.420 And he says, we can make treatment better for everybody if we understand those for whom it doesn't work as well.

01:03:54.740 That's equally important because everybody wants to prevent that happening.

01:04:00.540 So, yeah, but we've had no follow-up of JIDS patients, so we don't know where they are.

01:04:07.280 We don't know who's happy, who's unhappy, who's medically transitioned, who hasn't.

01:04:13.800 And it would be equally helpful to know, of those who never transitioned, what was it for them that worked or didn't work?

01:04:23.640 I mean, these are all really important questions which we have no answers to.

01:04:26.300 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.

01:04:38.460 But how you ever get to reliable percentages, I just don't know.

01:04:42.000 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.

01:05:00.020 I'm thinking cover-up.

01:05:01.100 That's what I'm hearing.

01:05:03.520 Now, that is quite, I mean, I watched Chernobyl the other day.

01:05:08.080 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,

01:05:17.440 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.

01:05:26.900 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 didn't look into it, they didn't want to know this.

01:05:36.900 That's sort of what it feels like here to me.

01:05:39.180 It may be.

01:05:44.120 I don't know.

01:05:45.640 I mean, I would, one of the people I spoke to before the book, Dr Juliette Singer, says she's a child and adolescent psychiatrist.

01:05:52.320 She also happened to be a governor at the Tavistock.

01:05:56.360 And she felt, she was constantly asking for data as soon as she arrived.

01:06:00.840 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.

01:06:15.740 And that might be the case.

01:06:17.260 Only they will know for sure.

01:06:18.740 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, you know, 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?

01:06:44.440 Because what are you experts in?

01:06:45.480 Now, those are questions posed by people who work at the Trust.

01:06:54.020 I don't, you know, it won't surprise me 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.

01:07:00.880 And just finishing off with these detransitioners, their bodies have been irreversibly changed. 1.00

01:07:11.240 What are they experiencing?

01:07:12.380 In what physical state are they left in now as a result of these puberty blockers, the surgeries, the hormones?

01:07:21.360 Do we know?

01:07:24.940 I think different people are in different situations.

01:07:27.940 So, a young, I mean, your body from puberty blockers, that's not, you're not going to be permanently altered.

01:07:37.920 But what I would say is that I'm still in touch with them.

01:07:41.220 A young, still identifies as trans, a young trans man, he's 20 now.

01:07:44.600 So, he was on blockers for four years, between the ages of 12 and 16.

01:07:49.600 And he's chosen not to take testosterone, but still identifies as male.

01:07:54.920 Now, he broke four bones while on the blocker.

01:08:00.140 And the talk that it's physically completely reversible, well, do we know that?

01:08:06.720 Because so few people come off the blocker that we don't really know.

01:08:11.120 And when he came off the blocker, no one from either UCLH or the Tavistock ever followed up on him.

01:08:17.960 So, he came off at 16.

01:08:19.300 It wasn't until 18, two years later, that he got his periods.

01:08:22.160 And even now, another two years later, they're not regular.

01:08:27.560 He feels left behind, I suppose, cognitively and emotionally from his peers.

01:08:33.440 Is that to do with the blocker?

01:08:35.440 Well, we don't know.

01:08:36.560 There are no studies, there's no follow-up, so we don't know.

01:08:40.800 In terms of detransitioners, I think people handle it in different ways.

01:08:49.000 I mean, Harriet, who I spoke to for the book, when I caught up with her again recently after it was published,

01:08:55.360 she's actually doing really well, which is great.

01:08:57.820 And she's much happier.

01:09:01.080 You know, she lives with her voice being a lot lower and obviously sounding masculine, 1.00

01:09:07.120 and she's had a double mastectomy. 1.00

01:09:09.340 But I think there are also, I think talk of detransition actually masks lots of things as well.

01:09:16.220 Because there are, what does it mean?

01:09:20.080 Like, there are people who have fully surgically transitioned,

01:09:23.860 who have had what people in the trans community would call, you know,

01:09:26.960 both top surgery and bottom surgery.

01:09:28.620 They've fully surgically transitioned.

01:09:30.940 Now, and some, and I can't put any numbers on it,

01:09:36.540 some are really unhappy, like desperately unhappy.

01:09:39.540 And given the chance again, they would not have done this.

01:09:42.940 Can they detransition?

01:09:43.860 Absolutely not.

01:09:45.600 Because what would that look like?

01:09:49.460 Your, the body has been totally changed by hormones.

01:09:54.140 If you've had a hysterectomy and you're female, you're going to have to, you know, 1.00

01:09:58.240 you're going to have to take some kind of hormone all the time. 1.00

01:10:01.680 And if you've fully surgically transitioned, it doesn't matter how you feel in and of yourself.

01:10:07.340 Society will never perceive you as your birth sex again.

01:10:10.840 And that's just a, that's just a sad reality.

01:10:14.340 So in a way, detransition, it's all a bit more complicated, isn't it?

01:10:21.620 How do you measure it?

01:10:23.880 Absolutely.

01:10:24.500 Hannah, we could talk for hours more and we will on our locals with questions from our supporters.

01:10:28.840 But for now, I'll just remind everybody the book is time to think.

01:10:31.740 Thank you for writing it.

01:10:32.960 Before we head on over to locals, two things.

01:10:35.780 We'll ask you our last question.

01:10:36.760 The other thing I should say as well is, I know that this is not an easy issue to cover.

01:10:43.660 Mainstream news, non-mainstream news, whatever.

01:10:45.740 So well done for writing this.

01:10:47.420 Thank you.

01:10:47.980 I know, and I can, you know, as I have alluded to repeatedly,

01:10:51.720 I can see it's not an easy thing to have done necessarily, but it is an important one.

01:10:55.480 So time to think.

01:10:56.480 I hope everybody reads it.

01:10:57.400 But what's the one thing we're not talking about as a society that we should be?

01:11:05.300 The standard of maternity care.

01:11:08.280 Tell us more.

01:11:12.480 I think.

01:11:17.660 You've gone BBC mode again.

01:11:19.120 No, I haven't.

01:11:19.700 I'm actually, I'm actually thinking.

01:11:21.220 I think when you have one of the most developed nations in the world and, you know,

01:11:29.260 close to 40% of maternity trusts are inadequate or requiring improvement,

01:11:35.020 I don't think that's a good place to be for women and their partners and their children. 1.00

01:11:43.120 Agreed.

01:11:44.240 Head on over to locals where we continue the conversation.

01:11:46.420 What would you say to people who may be watching from other countries about, you know,

01:11:55.700 how these things ought to be looked at or handled?

01:11:58.240 What is the right approach?

01:11:59.300 What is the right approach?

TRIGGERnometry - August 20, 2023

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

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