Dr Helen Webberley Update
In Autumn 2016, I was invited to be a panel speaker at an event that the Mermaids charity was hosting in London. They had a very special guest, Dr Norman Spack from Boston, USA, who is renowned as a world leader in the care of transgender youth.
My talk was to follow that of Dr Spack. He is highly respected in the field of transgender healthcare and I remember feeling very apprehensive.
I was about to stand up in front of this room of people and explain that my model starts from a place of belief. This was very different to the UK model of care that I had heard was causing deep pain and distress, especially to younger gender diverse people. I was about to explain that my model didn’t rely on psychiatrists and that I understood that to deny or withhold care can cause untold harm. I was about to present my model of care, based on my experience as a doctor and what felt like endless self study on the subject matter.
But first I listened with baited breath.
My fears were completely unfounded. I, like everyone else who was listening in awe at this great man as he spoke, was spellbound by his words. I went up on stage at the end of his talk and hugged him. He spoke my language, his approach mirrored mine, he understood trans youth in the same way that I did.
I felt a sense of empowerment knowing that Dr Spack followed the same line of thinking as I did. I felt reassured that affirmative care was the right path to follow.
A lot has happened since that day. Fast forward to 2021, I am preparing for the Medical Practitioners Tribunal Service who will examine my practice and see whether I am fit to hold a medical license in the UK.
You see, while Dr Spack is applauded for his approach and his colleagues yearn to learn from him, in the UK I am referred to the GMC by my colleagues in trans healthcare who wholly disagree with my gender-affirmative approach and feel that I am a risk to patients.
During my preparation for the hearing this year, I came across a beautiful article that Dr Spack wrote in 2009. It mirrored my thoughts and feelings and inspired me to respond, in my words, about how I learnt from the best – trans people.
Dr Spack quotes one of his mentors, ‘You learn a lot by taking care of trans-adults, because you will see the effects of decisions that doctors make when treating or not treating these kids as adolescents.’
How true this is. Denying trans youth puberty blockers when they ask for them means they will have lifelong, significant physical changes to their body which will be with them forever. As adults, they will often see, and rue, those changes they were unable to correct with surgery, or those that remind them every day of their missed opportunity to prevent them.
Dr Spack writes, ‘I, like all pediatric endocrinologists, treat precocious and delayed puberty. Transgender patients who are on the cusp of puberty are in a phase of the most precocious puberty they never wanted and, with treatment, they can have the most delayed puberty they desire.’
Children with precocious puberty are treated with puberty blockers, children with delayed puberty are treated with hormones. So why do trans youth find it so difficult to access this same treatment? All we have to do is believe them, and understand the benefits of not having a puberty you are not ready for, and to have puberty at the same time as your school friends – and we have the basics of perfect gender-affirming care.
According to Dr Spack, ‘Since adolescents are in such a constantly varying emotional state, one wonders whether anyone should make medical decisions that may have lasting effects.’
This one made me smile as I imagine teenagers ranting and raving about life, social science and politics, (and cleaning their room). But in all seriousness, under 16s in the UK are able to consent to some pretty tricky medical interventions at times. Abortion, cancer care, life-threatening blood disorders. Yet a recent ruling found that trans youth may not have the capacity to consent to puberty blockers. But of course, we all know that teenagers are so up and down how can they make any sensible decisions? Yet they can when they need to. We just need to believe them and listen to them and put our own fears aside.
In his article, Dr Spack quotes the UK directly, ‘The British claim that 25% of children and teens whom they have counseled without hormonal therapy have changed their minds by age 16.’
Dr Spack goes on to say that not one of his patients in his clinic changed their mind about their affirmed gender identity, and the same is true of my practice. Not one of my patients regretted the care I gave them, or told me that they had got their gender wrong after all. Maybe the British clinicians that Dr Spack refers to get their diagnostic criteria wrong, or maybe they count their numbers differently?
Dr Spack makes a very interesting point when he says, ‘The more youths see psychiatrists compared to seeing psychologists or social workers, the more likely they will come out of that appointment with a psychiatric diagnosis other than, or in addition to, a diagnosis of GID, and will be put on medication.’
If you see a psychiatrist because the lack of acceptance of your gender is causing emotional problems, or stress or depression or sadness, anger or frustration – then you will be more likely to come out with a psychiatric diagnosis and be prescribed psychiatric medication. Instead, if you see a doctor who understands gender, and the effects of unaffirmed gender incongruence, and you are prescribed blockers and/or hormones, then you get better!
Dr Spack talks about the tragedy of suicide and self harm in patients who are denied care. He showcases the Dutch model by saying, ‘The Dutch do not see suicide with their treated population. If a Dutch family has a child with GID [Gender Identity Disorder], they know where to receive treatment, and they have conﬁdence that the child will be treated.’
I agree with this. GenderGP patients may arrive at the depths of despair, at the end of their tether, all hope lost. But soon their mood improves, they smile, they emerge from their bedrooms, they go back to school. They no longer rely on their gaming avatar to express their true gender, because now they can do that for real.
Towards the end of his article, the UK gets a special mention, ‘In contrast to the approaches supported by the United States, Belgium, and Amsterdam, our colleagues in Britain will not initiate treatment with medication until age 16. Their view is that, as conﬁrmed by animal studies, myelination of the brain is actively occurring through puberty. They argue that interfering with pubertal development potentially interferes with brain development, including gender identity formation. This, of course, is a theoretical argument, which unfortunately informs policy throughout the British National Health System. They do not do adequate studies to test this potential risk. In the United Kingdom, there is only one center in the country authorized to treat transgendered adolescents.’
Bearing in mind that he wrote this in 2009, not much has changed in the UK. Dr Spack criticises UK rigid protocols that differ to those adopted by the world leaders in trans healthcare. He criticises them for their lack of research to back up those differences. There is still only one NHS clinic, led by Professor Butler since his move to London in 2009. Professor Butler calls himself an International expert, yet his approach could not be more different to that of Normal Spack.
I agree with Dr Spack, gender-affirming hormones are the correct course of treatment in a young person under the age of 16 who is ready for that next affirmative step. Yet, in the UK I am suspended from medical practice because I followed my International colleagues rather than my NHS colleagues.
My Tribunal hearing is listed for July 2021. I will be able to take to the stage and I will bring Dr Spack with me – if not in person then certainly in spirit. He so inspires me with his knowledge, skills and attitude. Because he acquired them from the same place that I did. By listening to those who really understand what it is to need gender-affirming medication and ask for help that is denied.