With the Tavistock v Bell appeal upon us, trans healthcare is back in the news. While this is a clear opportunity to communicate the facts around the care of younger trans people, it is also an opportunity for misinformation to rear its ugly head. We can’t always prevent misinformation around trans healthcare, but we can stop it spreading if we stay aware of the evidence, bust the myths and guide people towards the facts.
The latest article to blow into the storm of misinformation comes from the Daily Mail, and concerns Sonia Appleby, a safeguarding officer at the Tavistock whose tribunal is currently underway. Although the subject – the safeguarding of vulnerable children – is an important one, more often than not the article misrepresents the facts. Ordinarily, at GenderGP, we avoid giving oxygen to anything that doesn’t affirm and support trans people, but this is a great illustration of how the facts get twisted – and how we can untwist them.
Let’s start at the beginning. The Mail describes how Appleby claimed she was ‘unable to fulfil her role as a Named Professional for Safeguarding Children’. This is a common theme in reporting around trans healthcare, and particularly in the case of young people. We all understand that children need to be protected, so when the papers say that trans healthcare is a safeguarding risk it’s easy to believe what we’re told.
However, the risk to children is actually far greater if this care is withheld. The Lancet – one of the most respected and widely distributed medical journals in the world – has published an article outlining how attempts to ‘protect’ children by restricting gender-affirming care in fact increase the risk of poor mental health, suicidality, and other negative outcomes.
NHS England provides its own safeguarding policy, including specialist guidelines for children and adolescents. This policy stresses the need to balance the safety of children with their wants, to be aware of factors like Gillick competence, and to be knowledgeable about current and emerging practices around safeguarding. All of this is indicative of a need for NHS services like the Tavistock to work together with services like GenderGP to ensure the best outcomes for trans young people, rather than to try and further prohibit care.
Another common area of misinformation in reporting around GenderGP, and around trans issues in the UK in general, is the General Medical Council (GMC) investigation into Dr Webberley. The investigation has become synonymous with the struggle for access to trans healthcare in the UK over the past five years, but the facts about how and why it happened are often misrepresented. The Mail article refers to ‘a string of complaints around her work with her trans patients’. But if we unpack exactly what those complaints were, we can find that A) None of them came from her patients; and B) The work in question was in line with international standards of care.
The Mail suggests that Dr Webberley’s work failed ‘to follow the approach favoured by NHS doctors.’ This kind of narrative is quite common: the implication is that doctors are breaking from the NHS and providing poor care. However, while Dr Webberley was not following NHS protocols, she was following – just as GenderGP still does – international guidelines set out for clinical practice by The Endocrine Society and the World Professional Association for Transgender Healthcare (WPATH), as well as the Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents.
Another common misconception, often propped up in the news, is that puberty blockers are ‘ethically dubious’ or otherwise unsafe or experimental. Despite the fact that the above guidelines advocate for puberty blockers, and their use is supported by all medical research, complaints seem to come up time and time again. It’s important to rely on the medical evidence around these claims, rather than personal opinion.
In fact, even the Mail had to include a quotation from Professor Simona Giordano, director of medical ethics at the University of Manchester, saying that ‘There is nothing unethical with interfering with spontaneous development when spontaneous development causes great harm to the child. Indeed, it is unethical to let children suffer, when their suffering can be alleviated.’ To counter some of the most common misconceptions, GenderGP has put together a series of puberty blocker myth-busters with evidence-based, medical sources.
Appleby also said that ‘concerns were raised with the [General Medical Council] about Dr Webberley if she was in fact giving out prescriptions ‘off-licence’’ The British Association of Psychopharmacology (BAP) has stated: ‘The reasons for and implications of off-label prescribing, including the potential clinical benefits/risks and medico-legal implications, are often poorly understood by both patients and prescribers.’ In this article this lack of understanding is exploited and used to suggest that the prescriptions in question were dangerous or legal, when in fact off-licence prescribing (also called ‘off-label’ or ‘unlicensed’ prescribing) is a crucial part of healthcare.
Because patient numbers are small in transgender healthcare, it is not profitable for drug manufacturers to license medications specifically for their use. As a result, a great deal of medication in transgender healthcare is prescribed off-licence. This situation isn’t unique to trans healthcare; off-licence prescribing is also common in other underrepresented groups, such as children and the elderly. One really common example of off-licence prescribing is the group of medicines known as oral contraceptives, sometimes referred to collectively as ‘The Pill’. These are licensed for use as contraceptives, but are frequently prescribed for the treatment of painful periods, endometriosis, and other conditions.
Appleby also suggests that there is a lack of guidance for the management of patients who are using private healthcare to bridge the gap during long wait times for NHS gender identity services. The way this is written – ‘clinicians did not have a procedural reference as to how to manage private clinicians prescribing’ – once again makes it sound like Dr Webberley, and subsequently GenderGP, are working at odds with the NHS. What the article fails to mention, as is all too often the case, is that the NHS has extensive guidelines for sharing care between NHS services and private care providers, and that the GMC itself has advocated for the use of bridging hormones during the wait for NHS gender identity services. In fact, the GMC has highlighted how bridging hormones can reduce the danger of self-harm or suicide and reduce the number of people pursuing dangerous self-medication. This kind of misinformation doesn’t just affect members of the public, it runs the risk of misleading GPs and other healthcare professionals about the services they can provide.
GenderGP is happy to make shared care arrangements and work with GPs and other healthcare professionals to ensure service users are properly supported at all times. To say that patients waiting years for NHS treatment shouldn’t access private care is to deny them the support they need.
As we can see from the Mail article, the full facts about trans healthcare are sometimes left out to make for a more controversial story. This is why it is important to fact-check by referring to guidelines, policies, and medical evidence behind a story.
It’s only going to become more important as the Tavistock v Bell appeal and Dr Webberley’s GMC hearing approach. Undoubtedly, there will be lots of chatter around transgender-related issues in the coming weeks. We can counteract the sensationalist narrative by always thinking: What are the facts? Where are the sources? And most importantly: What is going to get trans people the best care possible?