Trans Children’s Healthcare, the facts

Image by Kyle on Unsplash

This is a response piece to Colm Keena’s article in the Irish Times, published on Saturday June 26th, entitled “Gender Distress, a growing struggle”.

Keena informs the reader that the, “purpose of this article is not to challenge the concept of transgender identity but rather to highlight that there have been significant changes internationally in recent months affecting how young GD patients are being treated, and intense debate as to what might be the best way to respond to the needs of young people with GD.” However, in the piece, Keena focuses on several talking points that bear some similarity to those published in a post on the gender-critical website womensspaceireland and on posts published on Gript, described by Wiki as an Irish far-right website.

To explore the subject, Keena references and quotes from a number of people, one is an adult trans woman and member of WPATH, Vanessa Lacey. A linked article interviews trans adult Ronan Burke (it’s unclear if Keena wrote that piece). No trans children or parents of trans children are interviewed or quoted.

Oddly, for a piece about trans children, Keena doesn’t quote anyone who works with trans children in Ireland. He references, interviews, or quotes from Paul Moran and Donal O’Shea who are part of the Irish Gender Service who deal with trans adults and who; the article states, disagree with WPATH on how to treat trans people. The World Professional Association for Transgender Health (WPATH), is a non-profit, interdisciplinary professional organisation devoted to transgender health. Comprised of health professionals from around the world, WPATH members engage in clinical and academic research to develop evidence-based medicine and to promote evidence-backed, best practice guidelines for the healthcare of trans and gender-nonconforming individuals.

Two of the top hospitals in the world, John Hopkins, and The Mayo Clinic follow WPATH guidelines and there are many Medical Professionals who work in the top 10 hospitals in the world who are also members of WPATH, including professionals from Massachusetts General Hospital, Cleveland Clinic and Charité-Universitätsmediz in Berlin. WPATH have spent four decades collecting research on transgender medicine and healthcare.

US Psychiatrist Stephen Levin features heavily in Keena’s article. Levin previously gave evidence for the “Alliance Defending Freedom”, a right- leaning conservative Christian organisation that believes that “aggressive pro-abortion and LGBT activists” are “targeting churches and creative professionals. They’re also targeting our children — and they’re lying about it.”

Levin also testified in the Bell v Tavistock case. Lisa T Mullin shared a screenshot of him admitting he has no evidence except ‘anecdotes’ and ‘the internet’ that psychotherapy can stop someone from being trans.

Another expert cited is Christopher Gillberg who Keena describes as a “global expert on autism”. As Barrister Jo Maugham pointed out, Professor Gillberg was involved in a major scandal in Sweden involving the shredding of evidence relating to people with ADHD. Gillberg also told the Swedish Parliament in 2019 that treating, “young women who want to become men is one of the biggest scandals in medical history”.

Former psychiatrist and so-called “whistleblower” David Bell, who has never worked with trans children, also features in the article, despite a review by Tavistock finding that his concerns about the service “had no substantive basis”.

Next up in this piece on trans children is another “expert” (who also gave evidence for Bell in the Bell v Tavi case), Neil Evans, who is a Professor of animal health. His study of the effects of Puberty Blockers on sheep was taken up by the Christian Institute which describes itself as “committed to the truths of historic, biblical Christianity.” Keena references this same sheep study in his article.

Someone who has done research on puberty blockers and trans children is Child Psychiatry Fellow of Stanford Medicine, Dr Jack Turban. Dr Turban was lead author of a study that found that trans children who received puberty blockers during adolescence have a lower risk of suicidal thoughts as adults than those who wanted Puberty Blockers but could not access them.

Rew, Young, Monge and Boguka conducted a critical review of various studies on puberty blockers (read it here), and found that positive outcomes from the use of puberty blockers were, “decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.” (None of this research is mentioned in Keena’s article).

Bell v Tavi

Keena repeatedly refers to the Bell v Tavi case, but neglects to mention the subsequent AB case, which partially reversed the Tavi ruling and found that parents can legally consent to treatment with puberty blockers on behalf of their children under 16. Keena also skims over the Bell v Tavi appeal, which last week heard that the ruling was based on “partisan” evidence and that if “the rules of evidence” had been applied the High Court would “almost certainly have rejected it for a number of reasons”.

The Use of Puberty Blockers

Puberty blockers have been used for over 30 years in many countries and for a variety of health issues affecting both adults and children. For over 20 years puberty blockers have been the standard medication for children with precocious puberty. Their use with other cohorts, including cis children, has never been controversial. For some reason when trans children are prescribed the same medication, it is cause for two-page newspaper articles.

The Lancet recently published an excellent statement that addresses many of the issues Keena’s interview subjects raise:

“Disproportionate emphasis is given to young people’s inability to provide medical consent, a moot point given that — like any medical care — parental consent is required. Supplanting parents with the law for this decision presumes that a parent living alongside their child cannot grasp what is best for them, despite often witnessing many years of struggle. Driving this consent narrative is the anxiety evoked by focusing on the minority who regret transition (estimated as 1% of adults who had gender-affirming surgery as adolescents).”

“Social conservatives in the USA, UK, and Australia frame gender-affirming care as child abuse and medical experimentation. This stance wilfully ignores decades of use of and research about puberty blockers and hormone therapy: a collective enterprise of evidence-based medicine culminating in guidelines from medical associations such as the Endocrine Society and American Academy of Pediatrics. Puberty blockers are falsely claimed to cause infertility and to be irreversible, despite no substantiated evidence.”

The Lancet piece finishes with a line that is also pertinent to Keena’s Irish Times piece, “While those pushing the legislation claim to protect children, their arguments lack the voices of trans youth and their health providers.”

Joy bringer, writer, podcaster, mother of 5, colourful fashionista