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Dr Klink returned to the hearing so that Dr Webberley’s counsel could cross examine him, during which time he admitted to having given gender-affirming hormones to a 13 year old patient. Dr Klink also said that the dosage of testogel that Patient A was prescribed by Dr Webberley was the correct dose.

Paediatric Endocrinologist Dr Klink appeared on day 19 so Mr Stern QC could finish his cross examination. The GMC had delayed his appearance so that Dr Klink could read through the reports provided by the defence – reports from the President of WPATH Dr Bouman, and Paediatric Endocrinologist Dr Schumer. Mr Stern QC asked Dr Klink if he had read through the statements, “Predictably there are differences of views between you and the experts?” he asked. Dr Klink said there was but agreed that all of them work from the same WPATH guidelines.

Mr Stern QC suggested that the Dutch model is moving towards a “narrower view” of the WPATH guidelines, citing the Dutch Endocrine Society’s suggestions that the only people capable of prescribing puberty blockers and hormones are paediatric endocrinologists or specialist endocrinologists. Dr Klink said he was aware of this but not involved in writing it and was unsure when it would be implemented.

 

 

Dr Klink was at pains to make clear that his views are widely held in Europe and that the American Doctors have a different way of doing things. Mr Stern then asked Dr Klink to look at the records of Patient A.

 

Background on Patient A

Patient A was a 12 year old transgender boy when Dr W saw him. He had been accessing Tavistock and UCLH, and had started puberty blockers to suspend puberty at age 11. He and his mother had asked to commence gender-affirming hormones so he could start puberty and male development, but Professor Butler had explained that their clinic protocol did not allow this until age 16. He and his sister had started puberty together but his had been suspended so he would not to go through the development of female secondary sex characteristics. His sister’s was continuing and she was developing normally. Patient A was in ‘stealth’ which meant that nobody outside of his home knew that he was transgender, everyone knew him to be a boy. He was distressed about not having the opportunity to start puberty until age 16, distressed that his sister was developing ahead of him, and very worried that this would ‘out’ him to all his friends at school.

His mother was worried about his mental health, self-harm and suicide and was contemplating taking him abroad for treatment. She sought the support of Mermaids who signposted him to Dr Webberley. Dr Webberley started him on a low dose of testosterone (a quarter of a Testogfel sachet) to slowly induce male puberty. Patient A had been fully assessed and diagnosed on the NHS, his diagnosis was clear and he had the support of his family. Patient A’s mother described the Tavistock as “disappointing”, and CAMHS as “useless and insulting”. She also lodged a formal complaint about Professor Butler of UCLH.

Patient A’s mother wrote a letter for GenderGP when her son was 14. In it, she said,

“I will not go into the detail but I can tell you, without any doubt, that had we continued along the prescribed pathway outlined by the NHS, which dictated that my son would need to wait until the age of 16 for gender-affirming hormones, he would not be around today.”

 

 

On day 19 Dr Klink indicated that upon reading the evidence of Patient A’s case, he had no concerns that Patient A would change his mind. Mr Stern asked Dr Klink to look at the UCLH records from Prof Butler stating that the patient was capable of capacity and consent. Dr Klink agreed that Patient A had the capacity to consent to blockers. But was critical of the UCLH consent and capacity records. Mr Stern reminded him that he was not there to pass judgement on Professor Butler’s care but he did have a duty to give his true opinion, especially as Dr Webberley’s practice is being compared to Professor Butler’s. Dr Klink said that consenting to blockers and consenting to hormones were “two different treatments with two different consequences”.

 

 

Dr Klink said that “even liberal organisations say 14 years is the minimum age to prescribe gender-affirming hormones to, but then went on to say that he himself had prescribed gender-affirming hormones to a 13 year old. Mr Stern asked how such “exceptional cases” would be assessed and Dr Klink said that there would be somatic reasons and distress that would factor. He then added that had his team assessed Patient A he did not think Patient A would have been prescribed GA hormones. Dr Klink said that the starting age needed to be re-thought and that there were a lot of reasons to suggest 14 might be a better starting age.

 

 

Dr Klink was critical of Dr Webberley having prescribed Tesogel sachets but, crucially said he agreed with the dosage she prescribed. This is important as Professor Butler claimed that Dr webberley gave an inappropriate dose (an “adult dose”) to Patient A. Professor Butler claimed this had caused him to progress through puberty too fast and had stunted his growth. (Patient A – now an adult – is the same height as his twin sister.)

 

 

Dr Klink agreed that Dr Webberley’s notes on patient A were a “very full, detailed analysis” and that for Patient A, being on testosterone was “a positive experience”. Mr Stern QC read reports from Patient A’s mother where she says that the family avoided contact with the Tavistock and UCLH as they were worried they would find out he was on Testosterone and discharge him from their services and remove his access to NHS blockers (which is what eventually happened).

 

 

Dr Klink said he felt the onus was on Dr Webberley to make contact with UCLH and the Tavistock to keep them informed. Mr Stern QC suggested to Dr Klink that a Dr would need patient consent to talk to other practitioners but Dr Klink appeared to disagree. Mr Stern then discussed Patient A’s return to Professor Butler at UCLH and the radiology test that was performed on Patient A. The radiology information showed that Patient A’s bone age was 13yrs 0mths (Patient A was 12yrs 5months at this time).

 

Background on Patient B

Patient B was a 16yr old trans boy at risk of self-harm and suicide. He had been under CAMHS for some years where he said he “felt unheard”. He had changed his name by deed poll and was waiting to be seen by the NHS adult trans services. He felt that his gender identity issues were not being addressed by CAMHS and was desperate to start gender-affirming hormone treatment. He saw Dr Weberley and at 17 was prescribed Testosterone by her. The hearing previously heard that patient B and his mother were more than happy with the care that Dr Webberley provided and after their bad previous experience, were reluctant to re-engage with GIDS.

Mr Stern introduced Dr Webberley’s detailed notes regarding the background of Patient B which Dr Klink said had not been originally supplied to him by the GMC when he wrote his report. Dr Klink noted the consent forms and he stated that the shared care plan and follow-up Dr Webberley had provided was all good practice.

Dr Klink finished his testimony there and will be returning in early September so that Mr Stern can continue his cross examination.

Day 20 Dr Dean was supposed to have been appearing but for unknown reasons Dr Dean has been delayed until Tuesday 31st August. The rest of the morning was taken up with procedural and scheduling issues to do with Dr Kierans and Mr Gale.

Day 19 saw more humiliation for the GMC after their expert witness admitted he had prescribed gender-affirming hormones to a 13 year old and also that he agreed with the dosage of testosterone that Dr Webberley had prescribed Patient A. Professor Butler previously testified that Dr Webberley had given Patient A an incorrect dosage of Testosterone. With one of the GMC’s own expert witnesses saying he agrees with Dr Webberley rather than Professor Butler, it is hard to see how this allegation can continue to stand.

 

Photo by George Becker from Pexels