00:14:14.400At the moment, I just don't think we have enough data to put any sense of scale on it.
00:14:18.400But 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.
00:14:36.400Hmm. And let's talk about the medical scandal.
00:14:39.400I feel bad because it feels like I've been grilling you about your own personal opinions.
00:14:43.400But the reason I've asked you about it is I think it kind of shows you how society is around this issue.
00:14:50.400And it's telling, I think. But anyway, let's not delve too far into that.
00:14:58.400I 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.
00:15:06.400And I think sometimes the language is really unfortunate and actually different people like different terms and what have you.
00:15:15.400But I just think it's important to have some compassion as well.
00:15:21.400But 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.
00:17:21.400And now we've got two thirds of the referrals, girls.
00:17:25.400But not just girls, but girls who actually, their gender distress only started in adolescence after the onset of puberty,
00:17:36.400which was completely different to the traditional presentation, if you like, which was sort of lifelong, since early childhood, gender incongruence.
00:17:48.400And lots of these girls, not all of them, but lots had really quite serious and distressing other difficulties that they were also contending with.
00:17:57.400So no one doubted that they were distressed about their gender.
00:18:00.400But loads of them had other associated difficulties as well, like anxiety, depression, perhaps they were self-harming, eating disorders.
00:18:09.400Maybe they had a traumatic childhood, all these things.
00:18:12.400In terms of how many were referred for puberty blockers, we don't know, because every time someone has asked,
00:18:21.400either the Tavistock and Portman or one of the two trusts that prescribed the puberty blockers,
00:18:28.400so either University College London Hospitals or Leeds Teaching Hospitals, they've not provided an answer.
00:18:35.400So best estimates from what is in the public domain, at least 1,500, I would say.
00:18:45.400I mean, a Freedom of Information request said that by 2017 there'd been over 1,200.
00:18:51.400So I don't think it's unreasonable to think we're in excess of 1,500, but the answer is we don't know.
00:18:56.400And I think that's one of the things that is so striking about this story is the lack of data
00:19:03.400and 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
00:19:14.400about the thousands of young people that they've seen.
00:40:38.400And so they took their concerns to David Bell and then it all came in the public.
00:40:44.400And that's when Marcus, you know, he resigned over the fact that he didn't feel that those concerns
00:40:51.400were being taken seriously enough by the trust and equally that Dr. Bell had been treated very poorly.
00:40:57.400But the clinicians themselves who were working at that point, I mean, they each had different moments,
00:41:08.400but there was several, it was really when the first bit of data came back from this study that had begun,
00:41:15.400which challenged all the assumptions they had about puberty blockers.
00:41:18.400Because what this showed was that of those who had become old enough by that point,
00:41:25.400every single one of them had gone from the puberty blocker to cross-sex hormones.
00:41:31.400But also that there'd been no psychological benefit to being on the puberty blocker.
00:41:37.400And so for Dr. Anna Hutchinson, she describes learning that as her holy fuck moment.
00:41:48.400Because it exploded everything that they were doing.
00:41:50.400She said, you know, what are the chances of being given time to think
00:41:54.400and all children and young people thinking the same way?
00:41:57.400She's like, that just doesn't happen. It doesn't happen in psychology.
00:42:00.400And 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.
00:42:12.400Because when you went on the blocker, you didn't have more talking, you had less.
00:42:17.400You got seen every three to six months.
00:42:20.400And so, and actually, these young people weren't feeling better.
00:42:26.400In some cases, both psychologically and physically, they were getting worse.
00:42:32.400And so at that point, quite a sizable number of clinicians just went, this isn't safe, what we're doing.
00:42:40.400And they became much more cautious, and they extended their assessments.
00:42:44.400And that's probably how we got to, you know, the 50, although very rare.
00:42:48.400But 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,
00:43:29.400Hannah, and I'm curious about what happened when, prior to that discovery, when people went and raised concerns and they were not taken seriously.
00:43:39.400Do we have a sense of why that happened?
00:43:41.400Because I think that's a question a lot of people would be asking.
00:43:43.400And 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.
00:44:34.400I 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.
00:44:51.400I 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.
00:45:01.400And 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.
00:45:15.400And yet these were people that we cared about. And, you know, you don't criticize your family.
00:45:19.400And then arguments would come back, well, we're doing it better than everybody else.
00:45:22.400Or, you know, the private sector would be worse.
00:45:25.400And they said, but that's not good enough.
00:45:28.400Like what we're doing is not good enough. We can't just say, well, other people would be worse.
00:45:35.400Some 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.
00:45:48.400So it went from an around 2015 being about 5% of income that came into the trust to about 13% at its peak.
00:45:57.400And when you combine that with the adult service, which the Tavistock took on 2017-18, it was a quarter of the entire income.
00:46:06.400And no one suggested that there was anything sort of really malicious about that.
00:46:10.400But 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.
00:46:27.400Dr. 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.
00:46:42.400It just required a complete overhaul, a radical rethink of exactly what they were doing.
00:46:49.400But hold on a second, Hannah. These are kids' lives that are being irreversibly damaged, their bodies.
00:46:57.400And I'm not saying obviously you, but they're putting the system ahead of that.
00:47:21.400So, 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?
00:47:40.400And Anna Hutchinson puts it, you know, why weren't the concerns taken seriously?
00:47:45.400Maybe, 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.
00:48:26.400The 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.
00:48:39.400I think the number or the stat that I keep remembering is 40% of these girls who were referred had autism.
00:48:46.400And they were dealing with mental health professionals.
00:48:50.400Why 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.
00:49:03.400So, I mean, their own research showed that I think it's 35% of boys and girls that were referred had autistic traits.
00:49:12.400So they spotted that, and it's what you do with it.
00:49:15.400And seemingly, it didn't change anything.
00:49:19.400And 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.
00:49:32.400Whether it's new knowledge on surgery, whether it's new knowledge on how the blocker might be working.
00:49:41.400Clinicians use this phrase, like, everything changed, but nothing changed.
00:49:51.400And 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.
00:50:01.400But they weren't collecting that data.
00:50:03.400And 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.
00:50:39.400I 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.
00:50:54.400And 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.
00:51:05.400And 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.
00:51:27.400I think this is the part of the story which people, particularly in, you know, liberal metropolitan cities, find the hardest to accept.
00:51:39.400And 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.
00:51:58.580And hearing that, I kind of, I thought we were done with that.
00:52:03.180I 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.
00:52:09.020And 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.
00:52:20.420And 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.
00:52:34.120And what they've turned around and said, look, they say, look at the data.
00:52:40.860Like, we don't have much of it, but what we do have absolutely bears that out.
00:52:44.560So 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.
00:53:25.620I 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.
00:53:33.040And I've never been attracted to a boy.
00:53:36.140So it's not – the data, the personal experiences, the experiences, the clinicians, it's there.
00:53:46.880And 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.
00:54:00.900It'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.
00:54:19.420I mean, and that has always been the case.
00:54:21.640So every study we have in this field is quite rubbish, but all of them highlighted that.
00:54:28.360And 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.
00:54:42.000The majority wouldn't, and the majority of them would be gay.
00:54:44.700And somehow this gets lost over the years, even though it was in the clinical presentations, and even though their own data showed them that.
00:55:00.460It wasn't – it was just not seen as a thing.
00:55:03.100Like, the gender identity was what mattered.
00:55:05.580So I described it as medical malpractice earlier, and I appreciate your commitment to impartiality, and it's very strong.
00:55:13.680But 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,
00:55:34.720were essentially treated for autism and homosexuality with puberty blockers, or in some way.
00:56:40.920And if we are, we're doing something quite dangerous.
00:56:47.260And it was that those fears couldn't be responded to adequately.
00:56:51.000And 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.
00:57:02.520There will always be a risk, because every single clinician I've spoken to said,
00:57:05.900you can never tell for sure who's going to benefit and who's not.
00:57:08.540But there are ways of minimising that, and there are ways of – and they felt that that isn't what was happening.
00:57:16.360But yes, I mean, if you go right back to where this started with a team in the Netherlands,
00:57:23.480they acknowledged right, right, right at the beginning that the risk of blocking puberty earlier, pre-16,
00:57:33.300was that you would get something which they referred to as, rather euphemistically, as false positives,
00:57:39.780i.e. in your attempts to help those who would grow up to be trans adults, you would probably –
00:57:45.500the risk was you would also include people who, had they not had their puberty blocked earlier,
00:57:51.920would not have transitioned and would have somehow come to either accept
00:57:57.220or their distress would have been relieved without physical interventions.
00:58:01.040And all the data suggests that those false positives are most likely gay, lesbian and bisexual people.
00:58:09.460Right. And Hannah, one thing I wanted to ask you as well is,
00:58:12.720given the rapid increase in the number of referrals over the years and the decades, as you described,
00:58:18.200where does that come from? Because gay people have always existed. Autistic people have always existed.
00:58:24.000How do we get from a handful to thousands?
00:58:31.080That's a $64 million question, isn't it? I think there are lots of –
00:58:35.800so there are clinicians who are much better at hypothesising about that than I am,
00:58:41.460so I'll just steal their ideas. But I think there are lots of reasons.
00:58:45.420And I was talking to someone recently who said, oh, it's either social contagion or it's greater social acceptance.
00:58:52.580I don't think that. I think it's both and. So I think for some people, and I've spoken to them,
00:59:00.300I think greater visibility of trans people and more social acceptance, I think that probably was the case for them.
00:59:05.500And I think there will be different things for different people.
00:59:07.700But I spoke to people in the book who are like, I always felt this way, but I didn't know what it was called.
00:59:12.640And it's not for me to question their story. I think for some people it's absolutely –
00:59:23.640whether we use the word contagion or not, but there's certainly influence of friends and peer groups.
00:59:30.680And even WPATH, the World Professional Association for Transgender Healthcare,
00:59:35.120acknowledges that in their most recent standards of care, that for some there will be that influence.
00:59:40.440Because why wouldn't there be? There is for everything. Like, we've all been teenagers.
00:59:45.300And again, I've spoken to people for whom that was definitely a factor,
00:59:48.340where all their group of friends were either trans or non-binary, and it was trendy and made them fit in.
00:59:53.560I think for the girls in particular, there are additional factors.
01:00:00.940I think right now it's really quite tough to be a teenage girl.
01:00:05.960We live in this quite hyper-sexualised world.
01:00:11.780Two JIDS clinicians, Anna Hutchinson and Melissa Midgine, call it the pornification,
01:01:57.100One 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.
01:02:39.460I mean, their own documents, their own information they've released under Freedom of Information shows that there was a time when they said,
01:02:46.660yes, 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.
01:02:57.400And for a couple of years, 2017, 18, they said, yep, we're doing that.
01:03:02.800And then they said, suddenly said, no, we're not going to do that.
01:03:10.000Only they will know why, because that seems quite important data to have.
01:03:14.480Because 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.
01:03:25.740So people have gone through a medical transition or surgical transition and then revert back to their natal sex.
01:03:30.540That doesn't undermine the experience of those for whom a medical transition might work.
01:03:40.720Actually, I've spoken to, you know, there's a trans researcher in Canada who's doing loads of research on detransition.
01:03:47.420And he says, we can make treatment better for everybody if we understand those for whom it doesn't work as well.
01:03:54.740That's equally important because everybody wants to prevent that happening.
01:04:00.540So, yeah, but we've had no follow-up of JIDS patients, so we don't know where they are.
01:04:13.800And it would be equally helpful to know, of those who never transitioned, what was it for them that worked or didn't work?
01:04:23.640I mean, these are all really important questions which we have no answers to.
01:04:26.300What 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.
01:04:38.460But how you ever get to reliable percentages, I just don't know.
01:04:42.000I 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.
01:05:03.520Now, that is quite, I mean, I watched Chernobyl the other day.
01:05:08.080You 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,
01:05:17.440you 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.
01:05:26.900But 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.
01:05:36.900That's sort of what it feels like here to me.
01:05:45.640I mean, I would, one of the people I spoke to before the book, Dr Juliette Singer, says she's a child and adolescent psychiatrist.
01:05:52.320She also happened to be a governor at the Tavistock.
01:05:56.360And she felt, she was constantly asking for data as soon as she arrived.
01:06:00.840And 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.
01:06:18.740But 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?
01:06:45.480Now, those are questions posed by people who work at the Trust.
01:06:54.020I 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.
01:07:00.880And just finishing off with these detransitioners, their bodies have been irreversibly changed.