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Dr Bouman, President of WPATH appeared today as a witness for the defence. His clear understanding of trans people’s needs and his empathetic approach won the hearts of all the readers today.

Mr Jackson QC attempted to get Dr Bouman to agree that trans healthcare for youth is different to that for adults but Dr Bouman was having none of it. Dr Bouman said, “I fail to see what the difference is between a 15 year old coming to us and us saying no and a day later when they are 16 we can say yes to hormone treatment. The diagnostic criteria is the same for an 11, even 10yo, once they are in puberty, diagnosis is the same but moreover than that, treatment is virtually the same too.”

Dr Bouman said that he has been reading transcripts from the hearing and that he was puzzled and confused by the testimony of the other experts saying that they consider these patients less complex once they are aged 16-17, when it is the same no matter what the age.

 

 

Dr Bouman said that after having reviewed the case notes of Patients A, B and C he would have done what Dr Webberley did. He added that, what he’s seen of Dr W’s service, is that it works very similar to his in Nottingham, “We provide all info to the patient and family, we provide an info sheet and consent form, ask them to think about it again, come back with questions if they need and to sign consent form”.

 

 

Dr Bouman said there is no evidence that seeing a patient one or two times or 10 times leads to a better outcome. “They haven’t woken up one morning and gone to ask for hormones, we’re talking about how this has been going on for many years sometimes from the age of three or four. Their suffering is so severe some would be rather dead, to see them more times – six or eight times, if they’re trans I don’t see any specific advantage of carrying on for 6 months to a year as was the case with Dr Kierans.”

Dr Bouman pointed out that people don’t get less trans the more times you see them and that it’s relatively simple to know when someone is trans and the treatment is also simple. Dr Bouman said when he heard Dr Kierans evidence he found KOI’s mandatory wait periods shocking.

 

 

When asked about consent, Dr Bouman indicated that he takes consent on the first meeting and stated that there is not much difference between a 12 year old and a 16 year old in this regard. Referring to patient A, Dr Bouman said that both patient A and his mother had been investigating hormones for a long time and knew what they were agreeing to.

 

 

Dr Bouman said that his service in Nottingham doesn’t resemble Dr Agnew’s description of it and that Nottingham is not an MDT model as that model doesn’t serve patients best. Dr Bouman described MDTs as being “extremely inefficient and increases waiting time.” He said that Nottingham offers a one-stop shop to meet all the patient’s needs.

 

 

Explaining his patient demographic Dr Bouman said that 85-90% of patients were so straightforward that they are able to prescribe for them after the initial assessment. Dr Bouman said, “I have so much experience and if patients have made a social transition, happy in their role, why on earth would I want them to come back and have to see someone else?”

 

 

When asked about Nottingham processes Dr Bouman said, “Most patients want to come for medical intervention. Most don’t want to talk for hours but if they do, that’s what we do.” In relation to training, Dr Bouman said that many of the endocrinoligists that came to Nottingham had to be trained in how to treat trans patients as they “knew nothing” about trans people.

 

 

Dr Bouman said that he questioned Dr Kierans ability to call herself an expert in gender identity care given how few patients she had seen, (which the tribunal later heard was only 36 patients started on hormone therapy over a seven year period.)

 

 

Dr Bouman’s evidence repeatedly called for a more compassionate approach to trans people and to trans healthcare, he said that trans people face enormous discrimination every day and that we have a long way to go to ensure that trans people are treated equally to cis people. He said that he sees people who are in such severe distress that they want to take their own lives, and that it is important to remember that hormone treatment alleviates that distress.

 

 

Dr Bouman strongly condemned the practice of cutting someone off from NHS care if they seek healthcare elsewhere, saying that it is “barbaric and terrible”. He said that he tells his patients that they can always come back to him but GIDS imposing the condition that patients not see anyone else, puts parents and patients in a very difficult position.

 

 

Dr Bouman sounded exasperated as he indicated the efforts he had gone to over the years to try and improve conditions for trans youth and adults, and the resistance he faced from those in charge of services. “I’ve tried so many times to meet with the lead clinician there and I’ve never had an email back. If I meet the lead clinician at a conference and asked why we don’t work together for the benefit of patients, she will say ‘it is so complicated’ I said Polly, you know once the patient is one day older they come to us’. My point here is there was no interest – at all – from Tavi to work together to collaborate to think about new service models whatsoever.”

 

 

When asked about the examinations required before putting a child on blockers or hormone therapy, Dr Bouman said that while endocrinologists want to focus on the minute details and synchronised pubertal development, the key factor for Dr Bouman is treating the severe dysphoric distress rather than worrying about a one to two centimetre difference in height.

 

 

Dr Bouman said that patient C’s distress was caused by the difficult position he was put in by the NHS for using Dr Webberley’s service. He praised Dr Walters for recognising the harm that would have come to patient C had he been taken off the dosage of testosterone as prescribed by Dr Webberley.

In response to Mr Jackson QC’s questioning about the appropriateness of prescribing hormones for adolescents with ADHD, Dr Bouman said the condition doesn’t impact seriously on treatment and “is not as complex as some people believe it to be.”

 

 

Like Dr Webberley, Dr Bouman said he came to trans healthcare after seeing how terribly discriminated against trans people are. “I’d never seen anything like it. People should be treated equally – this is why I became involved.”

 

 

Dr Bouman was the final witness for the defence. The testimonies of patient A and Mrs A will be read into the record and then next week both sides will give their closing statements.