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The 21st day of Dr Webberley’s MPTS hearing resulted in an unknown delay and as a result, an adjournment. Day 22 saw Mr Stuart Gale, managing director of Frosts Pharmacy appear as a witness for the GMC. Frosts Pharmacy is an online pharmacy for whom Dr Webberley worked from May 2014 to January 2017. After Dr Webberley had stopped providing services for Frosts, the business was investigated by the CQC.

 

 

It is hard to fathom how confusing, inconsistent records are being presented as evidence by the GMC in the same hearing where Dr Webberley is accused of inadequate record-keeping – especially as it is the GMC’s failure to act in time that led to years worth of records being destroyed before they could be used as evidence.

Mr Gale also attested to Dr Webberley’s care and concern for her patients, he said that she was very good at staying in touch with her patients and on checking in with them.

 

 

After Mr Gale, Dr John Dean took the stand. Dr Dean is chair of the NHS Clinical Reference Group (CRG) for Gender Identity Services and Clinical Lead for The Laurels – the gender identity clinic in Exeter whose notorious wait times have ballooned to exceed four years. Although Dr Dean’s work at the Laurels did not feature in his testimony, we feel it should not be ignored. It seems more than a little unreasonable that the GMC should call him as an ‘expert witness’ against Dr Webberley’s care provision when, under his own management, thousands of young trans people have been denied that care.

 

 

Talking about his own expertise, Dr Dean described GP training as limited to the ‘common’ problems of children. We wonder whether Dr Dean is the right person to speculate about the training available to GPs and the limits of their knowledge, given he has not practiced as a GP for 22 years. He went on to say that, during his time as a GP, he did not see a single child presenting with gender dysphoria. We don’t want to cast aspersions as to Dr Dean’s medical knowledge or the quality of his practice – after all, he himself said that he wouldn’t feel comfortable diagnosing gender dysphoria – but this says more about evolving perceptions of gender identity in the past 20 years than it does about whether or not children present as trans. 

 

 

In 1999, when Dr Dean was last practicing as a GP, there were substantially fewer resources relating to transgender people in general, let alone trans young people. It’s hardly surprising that he didn’t think he saw children presenting with gender dysphoria when research into and awareness of gender dysphoria was more scarce. In fact, in his role as clinical lead of the Laurels Dr Dean is not involved in the provision of gender-affirming care to children and adolescents under the age of 18.

 

 

The next day Dr Dean would drive home this point even further, saying that despite having seen only 10-15 trans patients in his career as a GP (all of them adults) that he moved into managing the GIC due to his experience in urology and interest in sexual health. This is a similar trajectory to the one that Dr Webberley followed – although she actually treated patients with gender dysphoria. When asked if he thought his experience was relevant, Dr Dean said that his predecessor seemed to think it was. 

 

 

If Dr Dean hasn’t seen any cases of gender dysphoria in children, and hasn’t ever been involved in their care, then why is he making expert judgements about medical care for trans children at an MPTS hearing? Why is he in such a position of authority over these services? And why is he allowed to support the allegation that Dr Webberley lacked the necessary capabilities to provide gender-affirming care, when he has demonstrated clearly he has less specialist knowledge than her? 

 

 

Thankfully the guidelines for gender-affirming care for young people have evolved since 1999, and we now have access to standards like the WPATH Standards of Care and the Endocrine Society clinical guidelines. But if Dr Dean is still operating on a perception of trans youth that was developed in the 90s, it is very troubling indeed.

 

 

Day 23 began with Dr Klink returning for cross-examination. So far Dr Klink’s testimony has been complicated: although he is an expert witness for the GMC, and is ostensibly testifying against Dr Webberley, a great deal of his evidence thus far has supported her decision making. For instance, under cross-examination by Mr Jackson, QC, he agreed that Dr Webberley’s evaluation of the patient was sufficient to support a diagnosis of gender-incongruence. He also supported the dosage of testosterone gel in the treatment of Patient A – in direct contradiction to Professor Butler who claimed it was “an adult dose”.

Some of his expert testimony seemed to be conflicted – particularly on the subject of informed consent. Dr Klink tried to make the argument that informed consent was generally not a good approach for providing gender-affirming care for children, claiming that they cannot understand well enough to make that decision. However, he then went on to describe a situation where a 13 year old girl was prescribed hormones as an exceptional case. He said that this was because she was tall and was concerned about her fully grown height, and so oestrogen treatment was started earlier than usual. He went on to justify this by saying that the clinic knew her well. It’s hard to see how this is different from Dr Webberley’s treatment of Patient A, an exceptional case where early hormone treatments were indicated based on the patient’s own desires and extenuating mental health history.

 

 

To make matters even more confusing, Dr Klink went on to say that, had he been in Dr Webberley’s position, he would have sought to manage Patient A’s distress via psychological intervention rather than hormones. This kind of testimony fails to acknowledge the very real experiences of trans youth like Patient A, whose poor mental health was aggravated by the failure of institutions like CAMHS and the GIC to recognise his needs. 

Nor does it acknowledge the demonstrable connection between access to gender-affirming care and positive mental health outcomes for trans youth. The kind of approach Dr Klink was advocating for with Patient A puts up barriers to medical care for vulnerable young people.  A strange position for Dr Klink to endorse, given his own testimony that there are no serious medical concerns caused by the use of gender-affirming hormones in adolescents.

 

 

Dr Klink is aware of the problems facing trans and non-binary people – especially children and adolescents – in the UK. He said so himself. And so it is a little baffling, both to us and to the community following the trial online, when he seems to support the same approaches and models of care that caused those problems. He seems to agree that there is a need for flexible, individual-centred provision of gender-affirming care. He even said in his closing remarks that he hopes this hearing will bring about a conversation around the lowering of the age for hormone intervention. Of course, we would welcome such a conversation. But it won’t happen while people like Dr Webberley are threatened with the loss of their careers for trying to effect change, or while people like Dr Klink continue to support the systems that keep change from happening.