Huw Evans Picture Agency 10 Sun Online journalist Hannah Ferrett sat down with Helen to discuss why she believes transgender care for kids needs an overhaul in the UK
“I’m not an advocate of giving sex change hormones to 12-year-olds. I think 14, 15, 16 is a much better age.
“There have been 14 and 15-year-olds that I’ve given [hormones to] – a handful.”
Helen qualified as a doctor in 1992, teaching herself about transgender health after moving to Wales in 2006 to work as a GP and realising there was no service in the country.
That meant her patients would have to travel to London, so she started a website offering help.
She’s treated 500 adults and 50 youngsters, the vast majority of whom received hormone blockers.
She wants kids who are querying their gender to have easier access to these.
Rather than being given testosterone or oestrogen to begin the transition, blockers are three-monthly injections which act as a puberty "pause button" so bodily changes are put on hold. Stop them and puberty starts again, so Helen’s argument is that they give a child who is questioning their gender some breathing space.
“Puberty is excruciating for children when it’s completely the wrong puberty,” she argues. “It’s just crucifying."
“If you ask a transgender adult, ‘When would you like to have started treatment?’ they will all say at the beginning of puberty.
“That buys you time. You don’t have to rush in and swap hormones or do surgery or anything like that."
‘The distress is heartbreaking to see’ – Jo’s story Katy*, mum to Jo*, nine, said:
“My child has identified as being a different gender from the age of one-and-a-half, two.
“He was born female, but always wanted to stand up for a wee.
“Putting girls clothes on would cause so much distress when he was two-and-a-half we let him pick. It was Star Wars T-shirts, boys’ clothes.
“Jo wanted all of his hair cut off, which I found very difficult and I put off for as long as I possibly could. Then when he was two-and-a-half we did it and the smile, the beam of just absolute happiness, was just wonderful.
“When you look at all the school photos it always looks like Jo was a little boy.
“They learnt about puberty last year and we went into crisis point on that very day.
“I reached out to some professionals for some advice and was pretty much in a state of distress myself because Jo was in such anxiety he was at risk of self-harm.
“I found Helen and my plan was to go to her for the first blockers injection, as a harm reduction more than anything.
“Puberty is evidently on its way, physical changes have started to occur which is causing untold stress.
“It’s heart-breaking to see the distress of that little person who has to have a bath in shorts because he can’t bear to see something’s not there.
“When I found out that Helen was no longer able to help us my life fell apart in 24 hours.
“I just rang America and said, ‘Please help me, because I can’t bury my child and that’s what will happen if someone doesn’t help me.’”
“If Jo was to come home from school and say, ‘Do you know what mum I think I’ve made a complete mistake and I’d like to forget all of that and just be a girl,’ I would probably feel relief. Nobody wants this for their kids.”
It’s something Kate* and her child Jo* are going through every day. Jo was born female but identifies as male. He’s nine and on the cusp of puberty, something which terrifies him.
Jo has been petrified that his body will begin to develop since learning about male and female puberty last year. He was being treated by Helen before she was suspended, and his family are now taking him to America, where kids can get blockers easier, for the injections.
Despite needing to borrow thousands for the trip – which will cost £5,000 this time, and they’ll need to go every three months – Jo’s parents see it as their only option.
“We went into crisis point on the very day they learnt about puberty,” Kate recalled.
“It was, ‘This can’t happen to me mummy, I can’t have boobies.’ The distress was so significant, it shocked me to my core.
“Jo’s self-harm had got to a situation where my husband and I had to intervene to make sure he was safe.
“You [can’t understand until you’ve] had to pull your child out of the bath with a razor blade.
“He can’t cope with the thought of having to go through puberty in the wrong gender. It’s just gut-wrenchingly, sickeningly barbaric.
How gender dysphoria is treated Gender dysphoria treatment aims to help people with the condition live in their preferred gender identity. Children and young people will be referred to a Gender Identity Clinic, where they’ll receive a combination of family therapy, individual counselling and group work. If a child still has gender dysphoria at puberty, they may be prescribed hormone blockers which stop the naturally-occurring hormones in the body – testosterone for boys, oestrogen for girls. Teenagers of 17 or over will be transferred to adult services, where they will continue to have counselling. This is when they may be prescribed cross-change hormones to start the process of changing their body into their preferred gender. They can be taken indefinitely. Other treatment, like hair removal, speech therapy and eventually surgery may also take place.
“Jo hates the term transgender because he doesn’t see himself as transgender, he’s a boy. So what harm is it to give him a blocker now rather than see him go through puberty in the wrong gender? Why try and fix something once it’s broken?”
The Gender Identity Development Service (GIDS) at the Tavistock Centre in London works with children who are questioning their gender and does not advocate giving sex-change hormones to under 16s.
“The effects of cross sex hormones are not fully reversible,” Dr. Polly Carmichael, Director and Consultant Clinical Psychologist of GIDS, explained.
Born in the wrong body – Lewis’ story Libby, from Southampton, loved football, golf and ice-hockey as a child, and would pull out the pink ribbons her mum Jan put in her hair. At 12 she wanted her hair cut, and as puberty hit she asked for a binder to flatten her chest. Eventually Libby told her sister Tara she felt like she was a boy and wanted to be called Lewis. Her family backed her decision fully, with Jan adamant Lewis was born in the wrong body. Lewis has been receiving help at a gender clinic since November 2016, but it’s been a tough road. He has an appointment to start blockers in December. Tara, 29, Lewis’ sister said:
“Having to wait for blockers, while he has counselling, has been stressful.
“They have to go down the line that he’s not going to change back to a girl.
“Should kids get testosterone or hormones? I don’t know. Personally, with the stress we’ve had, I would just say give it to them. But deep down, I think because their bodies are still growing, it’s hard.
“I wish they started hormone blockers a lot earlier. We’ve been going for a year now. It’s every single month, all the way up to London, just to talk.
“At Lew’s age, people think it’s psychological and it’s all in the mind. It’s not. Deep down I know he’s a boy.
“We didn’t know about transgender, but when my mum went to the London clinic and they explained it, we’ve read up on it.
“The symptoms – you see them in him. What he wanted to do – changing his name, getting all his ID is in Lewis.
“He talks to us now, but not in depth, because talking about something you don’t want, and you can’t get rid of now, it’s hard.
“It just upsets him and then he starts crying, then we start crying because we can’t help him the way he wants us to.
“It’s too long to wait for the blockers. I just felt they weren’t listening to us there and then. They can get on with their own little lives, we had to go back on suicide watch for Lew because we were so scared when he kept saying he didn’t want to live.”
“As young people develop, their views can change and it is a delicate balance as to what is the most appropriate time to start cross-sex hormones.”
GIDS operates a strict counselling service over several months, where the child’s gender issues are explored by several people. After that there may be a referral to an Endocrine Clinic where blockers can be prescribed.
Waiting lists and strict requirements can make this a lengthy process, but Polly insists that is essential.
She said: “We don’t fully know the full psychological or long-term physical effects of the blocker – for example, whether it alters adolescent brain development.
“The blocker allows the young person time to consider their options before making decisions about irreversible forms of treatment.
“We are therefore only able to offer the blocker if the young person continues to meet with us for ongoing psychological exploration and support.”
This gets to the crux of the issue – it all takes time and, for Helen, waiting is what poses the real danger.
The changes puberty has on the body are so huge that if a child goes through them in the wrong gender, Helen insists emotional damage can be chronic.
This is especially the case for kids who have lived as the other gender at school – growing their hair, wearing unisex clothes – as sometimes they 'forget' that it isn't their birth gender.
On top of that, some pubertal changes are hard to reverse even with surgery – for example, the pitch of a man’s voice.
"The male to female when puberty starts; that lump sticks out of your throat, their brow furrows,” Helen said.
“If they get that blocker in time it means they don’t have to have that surgery in the future. It means they’ve got a really good chance of ‘passing’.
“If you’ve got a female to male, they’ve got these disgusting things hanging off the front of them. So if they’re not binding [their breasts] really strongly, they want top surgery.
“They should never have had [breasts] grow in the first place.”
Lewis, who was born female and called Libby, is 15 and has been visiting the Tavistock Centre for over a year.
He hasn’t been able to start blockers yet as it took him months to open up about his gender issues.
The thing he’s struggled with the most is the change in his body, with his sister Tara, 29, fearing for his life at one point.
“He was about 13, when puberty [started],” she said.
“Things started growing more and more and he hated it. Now he wears a binder to flatten them down.
“We’ve got our first appointment, which he’s very happy about, on the first of December to start [hormone blockers].
“He’s waited a whole year. We had some really stressful times; Lew didn’t want to live anymore.
“He’d sit up in his room and cry. He was saying, ‘Please can I get top surgery now, I hate my body.’
“We’ve been on suicide watch for Lew because we were so scared when he kept saying he didn’t want to live.
“It’s physical punches, head-butting walls. It’s mentally draining.”
Official figures show 50 kids a week are being referred to gender doctors in the UK, with the number of children visiting GIDS up by 24 per cent over the last six months.
Kids as young as four have been referred, and while some are showing signs of confusion, others are adamant they are born in the wrong body. Both Helen and Polly suggest changing attitudes towards transgender people, and greater acceptance, could be part of the reason for the increase.
Jo and Lewis’ family are in no doubt they fall into the latter camp, but many will wonder how they can be sure.
Could it be a phase? What damage is done if we treat kids with blockers and they change their mind?
“If you have someone who is female to male, very often the story starts at a really early age,” Helen said.
“They started rejecting all toys, or clothes, or hair, or friends of the ‘wrong’ gender.
“And everyone just thought, ‘Oh, tomboy. Oh, going to be gay,’ but it just gets stronger and stronger.
“Having said that, there are a group of older teenagers who find it difficult finding their place in life and perhaps they get into a group of LGBT people.
“There’s no length of story, it’s all more recent. And those are completely the wrong people to start medicalising.
“That long story, that never wavers, that suddenly gets worse as puberty starts and then gets desperate, that’s a really good indication that that person is going to continue to be transgender.”
Polly points out there isn’t just “one path” for transgender children, meaning their issues may manifest in different ways.
The clinical diagnosis for someone who is uncomfortable with the gender they were assigned at birth is Gender Dysphoria, but not everyone who experiences it feels they need the same treatment.
Some might want surgery, others don’t. This is why Polly and the GIDS team have such strict guidelines around prescribing blockers.
Then there are the physical changes some children try to make to their bodies.
They don’t just dislike their new shape; Helen’s seen kids who are covered in scars where they’ve tried to get rid of the parts they hate.
“So many cuts,” she said. “And we see them take paracetamol overdoses, we see children committing suicide. Proper, real, distress.”
All of this goes some way to explain how doctors know if a child is transgender, but it doesn’t answer the big question. How is it explained, given there is no medical basis for people being born in the wrong body?
“We’ve looked really, really hard for genes, brain patterns, anything," Helen said. "Any pattern that would give us a clue. We can’t find it.
“I don’t think we’ll ever find the gene that makes you transgender. I don’t think we’ll find the brain abnormality. I think this is a natural humane variant that we haven’t really realised before.
“It’s not you’re not transgender or are transgender, you’re just somewhere on the spectrum."
Despite how difficult kids like Lewis and Jo – and their families – find the process of NHS referral for gender issues, it’s all done to ensure no child gets treatment and then changes their mind.
Few would argue that is a bad thing, with Polly pointing out many who are referred to GIDS don’t end up having physical treatment.
She added: “Evidence suggests that young people who commence the blockers are likely to decide to move on to cross-sex hormones.”
But Helen looks at it differently.
“They don’t want to make a mistake. In case anyone changes their mind they make everybody go through very long and rigid assessment programs. That’s fine if nothing was happening in that time, but puberty is happening,” she said.
“Transgender charities and the WPATH – World Professional Association of Transgender Health – state very clearly that doing nothing is not a neutral option. It’s actually causing harm.
“Say one in 100 would change their mind – 99 have got to go through puberty just in case that one changes their mind.
“Don’t put 99 through hell to save one.”
If you are affected by any of the issues raised in this article, please call the Samaritans on (free) 116123 or 020 7734 2800.
*Names have been changed to protect anonymity
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