In the summer of 2015, and what seems a lifetime ago, my son announced over text that he was trans. I was, like almost every other parent of a trans child that I’ve spoken to since, shocked as hell. My life changed instantly and I embarked on a journey of learning everything I could about what being trans meant, and how to best support my child.
Things were easier then. We only had to wait for five months before his first appointment with the NHS Gender Identity Development Service, something which seems a pipe-dream now, where waiting lists have reached near three years.
It wasn’t perfect. We experienced variation between clinicians and their approaches, overwhelmed and over-stretched staff, plus incessant and unnecessary personal questions. It was noticeable that the whole service needed a radical overhaul. While my son was eventually able to access the puberty blockers he needed, it felt like a holding pattern until he reached adulthood.
Part of the problem was in the excruciating repetitive and unnecessarily personal questions. I remember my son counting on his fingers (and running out of hands) how many people he had had to speak to about deeply personal and invasive things, in order to jump through the hoops to get treatment.
There were more fundamental problems too – the same clinicians that assessed whether my son would be allowed to be referred for puberty blockers or hormones were also tasked with providing therapeutic support. It was clear to me and other parents I met in the service that young people were never going to fully open up to those they saw as the “gatekeeper”‘ to the medical support they needed. This meant that monthly or quarterly appointments would be so often filled with conversations that were never going to be helpful, as young people censored themselves, for fear that their medical support would be denied, delayed or discontinued.
I also heard stories from other parents with children experiencing significant gender-related distress, who were told there was no help for them. Conversations in private support groups were filled up with questions from parents trying to support dysphoric, depressed, and mentally spiralling teens, who had nowhere else to turn while on the several-years long waiting list. For those with teenage children, it became a race against time to try and find some solution before their bodies changed irrevocably. In desperation, some parents of trans teens sought private healthcare as their children entered into puberty.
I therefore welcomed the news earlier this year that youth gender services were to be decentralised into regional hubs, allowing trans and gender diverse young people to receive the care they desperately need in a timely manner. Yet when I read the NHS specifications, my heart sank.
The core of my concern is the seeming absence of any plan to educate or train the healthcare professionals within the NHS who will treat trans youth. As already observed by parents of trans kids, many GPs, and other medical professionals are wary, ignorant, or downright hostile towards supporting trans youth. Unless there is a widespread education programme in place to educate professionals, I fear that the level of quality support will be hit and miss, and could even be actively damaging.
The new specification also raises the issue of concurrent mental health issues and potential challenges presented by neurodiversity. It has been noted by a number of studies that there seems to be a high instance of young people with autism who are coming out as trans. In addition, anxiety, depression, self-harm and suicide ideation is significantly higher in gender dysphoric kids, than the general population.
I fear that the new NHS protocols will direct clinicians to diagnose and “deal with” those issues, before addressing their gender issues. I worry that in trying to protect itself from criticism from anti-trans lobbyists, the NHS is designing a specification that deliberately delays transition support. While it is positive that gender questioning youth are going to be supported in a holistic way, the service needs to be developed so that it doesn’t just rebuild the old model of healthcare gatekeepers.
Most alarmingly, I am deeply concerned about the threat of doctors and healthcare professionals potentially reporting trans youth and their supportive parents – merely for seeking healthcare while on the years-long waiting list for the NHS services.
The proposed specification warns that GPs will be advised to initiate “local safeguarding protocols” if children, young people and their families source puberty blockers or hormone drugs from unregulated sources or from online providers that are not regulated by UK bodies. This threat feels dangerously close to laws currently being put in place in some regressive conservative US states, where families have been reported to local services for providing care for their trans children.
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In an ideal world, I want to see the NHS backing affirmative healthcare – a position of believing trans youth when they tell you who they are – and supporting them in their wishes. Most importantly, I pray for a service that actually recognises that a child being trans is not a bad outcome.
Ultimately, I hope that all trans kids get, at the very least, the opportunity that my son has had – access to puberty blockers in a timely manner, a supportive GP and transition into adult services to allow him to continue his gender-affirmative healthcare into adulthood. Even better would be a service that learns from the mistakes that it has made, including pathologising gender-questioning kids, and forcing them to adhere to preconceived ideas of gender conformity to access vital healthcare.
If the NHS truly does care about trans youth, they need to start by listening to them and their parents.
The writer is a parent who lives in North East England.
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