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Radio 5 Live interviewed trans adolescents and their families about the barriers to trans healthcare in the UK today. With Dr Polly Carmichael, service director of the Tavistock, they explore what it’s like to be a trans teen trying to access treatment via the NHS. You can listen here or read the full transcript below. 

 

Speaker 1:
Thanks for taking the time to download this BBC Radio Five Live podcast to search for other podcasts, you might like, click bbc.co.uk/fivelive, where you’ll also find our terms of use.

Adrian Goldberg:
Hello, my name’s Adrian Goldberg. Thanks for downloading the Five Live investigates podcast. This week, the transgender kids who say they’re being denied treatment on the NHS, because they’ve gotten private. More than a thousand children are on the waiting list. They’re facing long waits for consultations and treatments, but patients say they are being penalized for seeking help elsewhere.

Speaker 1:
This is BBC Five Live, available on the BBC iPlayer radio app. Five Live investigates.

Adrian Goldberg:
Good morning, and welcome to Five Live Investigates. My name is Adrian Goldberg. This morning, the children and young people facing up to one of the most incredibly difficult issues anyone could ever imagine the decision to change their gender because the one they were born into just doesn’t feel right. As if their lives weren’t difficult enough already, this program has discovered these kids are being denied treatment by the NHS because they’ve asked for help from a private doctor. One of the reasons they’re having to seek assistance is the record high waiting lists at the Tavistock and Portman trust. The UK’s only NHS gender identity service for under eighteens. There are currently 1200 kids on the waiting list and it’s taking them between six and seven months just to get a first appointment, never mind treatments. There again, just look at the explosion in demand. Seven years ago, the Tavistock had fewer than a hundred patients referred for assessment, by 2015, that number had shot up to 700, within 12 months, the number of referrals doubled to 1400 patients. And in the first 10 months of this financial year, they’ve already received nearly 1600 referrals. Some from children as young as three and four. As always, we want to hear your stories and comments, you can text us on 85058, email goldberg@bbc.co.uk, or on social media @BBC5Live. First, let’s hear the story of Cain, who is 15 years old. Cain was born a girl, but started to have doubts about gender identity a couple of years ago. Mum, Ally, who has been battling for hormone blockers to delay her child’s puberty takes up the story.

Ally:
He really flew into secondary school, he did really well year seven, year eight. Year nine, that’s when things sort of started to fall apart for him a little bit, his circle of friends, all began to be really interested in boys and lipstick and makeup and short dresses and high heels. And he just wasn’t. He was jeans, t-shirt, Minecraft. And around about that time, he became very low and he was, he began to be bullied for being different.

Interviewer:
When did he come to you and say, I want to face the world as a boy, as a man.

Ally:
He was 14. He just said to me, “mum, I need to tell you something. I think I’m in the wrong body. I’m transgender”. And apparently I said, okay, why don’t we go and get a cup of tea and some cake? And let’s talk about it. That was August, 2015.

Interviewer:
Once he’d spoken to you about this and you were obviously a strong, supportive mum, where did you go to next then?

Ally:
Went to my GP and she didn’t really know what to do. So she was very open about it. She was really good. And she said, leave it with me. I’ll find out and I’ll come back to you. So she came back to us a couple of weeks later and said, there’s actually a designated clinician at CAMHS.

Interviewer:
That’s the child and adolescent mental health service.

Ally:
Yes. And he was really good actually. And he explained that what he would do was he would make an assessment and then he would write a referral that would go to the Tavistock clinic in London, but it was an excruciating wait. And at 18 weeks to the day we were offered an appointment, which I think was six weeks after that. So we eventually, we got to the first assessment at the Tavistock satellite clinic in Leeds. And of course I’m thinking, well, of course, they’re going to give us home on blockers because that will alleviate the distress because he was already well advanced into a puberty that was distressing to him. So at the first appointment, we then learned that he couldn’t have hormone blockers until he’d had psychological assessment anywhere between three to six sessions, that would be at least a month apart. Now I really get that. I really get that there has to be an opportunity for Cain to explore his own sense of identity and work through that and have somebody to speak to. That was great. I couldn’t understand why he couldn’t have blockers while that process was going on.

Interviewer:
Because the effects of the blockers are reversible.

Ally:
Completely reversible, yeah. But now we were told that no, you can’t have hormone blockers until the psychological assessment is complete. So, okay. We went with that. What was difficult about that was that Cain had a very difficult period of social transition because once he’d spoken to me and I said to him, how do you want to move forward with this? And he said, “I’d like to start living as a boy”. So I’d written to the school. We went out on a, on a big shopping. I said, can I, can I have your best frocks? And we bought him clothes that he felt comfortable in.

Interviewer:
Young man’s clothes?

Ally:
Yeah. Boys clothes. At this point, he was having such a difficult time with the social transition. I began to really worry about his mental state. He was horribly bullied. He was the victim of hate crime, which were reported to the police. He had to come out of education. There were times when he was suicidal. So I would have to check on him like once an hour, once every half hour to make sure he was okay.

Interviewer:
So at this point then you became desperate to get ahold of hormone blockers.

Ally:
Yeah. Desperate to get my hands on some hormone blockers for him just to alleviate that distress.

Adrian Goldberg:
This is Ally telling us about Cain, who was born a girl, but now rejects that identity. This morning on Five Live Investigates, we’re looking at waiting lists for transgender treatment for children and claims by some parents like Ally, that their kids like Cain are being denied, access to NHS treatment when they go private. Ally says their decision to pay for a private prescription for hormone blockers to hold back Cain’s puberty was only made after they went to the UK’s main NHS center, the Tavistock, for a follow-up appointment.

Ally:
Actually the decision in a way was made for me. We did go to see the doctor at the private clinic. And she had said, get the psychological assessment. And once the specialist you’re seeing at Tavistock agrees that Cain can be referred for hormone blockers, come back and I will prescribe them. And actually it was the very next session that we went to, session five, we’ve waited nearly a year. And actually we went in and he’d already decided, “Actually, I do think Cain is trans. I think I can refer you for treatment”. And that was the point at which I said, how long is the waiting list? And he’d said at least three months, but during that session, he’d also said that Cain would have to undergo a physical examination. Somebody would have to look at him naked basically. And I remember that Cain broke down when he heard that, he sobbed. And he said, mum, I can’t bear for somebody to do that. And I think that was the thing that then nudged me over the edge. And I thought, no, I’m, we’re going to go and get the blockers privately.

Interviewer:
And you did?

Ally:
Yes, we did.

Interviewer:
What has the impact on Cain been?

Ally:
It’s been life-changing. Absolutely life-changing. It has given him time and space to think without being in constant distress, it’s allowed him to be more confident in himself. It was an absolute relief.

Interviewer:
What’s the situation now?

Ally:
The situation now is that I’ve told the specialists that we were seeing at Tavistock that we’ve gone privately for blockers. And I’ve been told in no uncertain terms, that that means that we’re not eligible to carry on being treated at Leeds.

Interviewer:
And that’s because you’ve gone private.

Ally:
Because we’ve gone private. Yes.

Interviewer:
How do you feel about that?

Ally:
I feel angry that we’ve, we didn’t have a choice. If we had waited that extra three months and we’d gone to the endocrinology department on the NHS and we would waited a year on blockers. At that point, Cain would have been closer to his 17th birthday than his 16th birthday, at which point he is technically considered an adult. He would then have been referred to adult services where there would have been another minimum 18 month to two year wait for any kind of cross hormone treatment, which is for him would be testosterone, which would give him the masculinizing features to his body. His voice would drop all those, that he basically would go through male puberty. So we would have been looking at him being 18, 19 before he gets to go through that puberty that he feels is his identity.

Interviewer:
So where is he now then? What’s his situation?

Ally:
We’ve been really fortunate in that we could afford to take him privately. We’re not minted. We, we managed to get that money together. Where he is now, he is much more comfortable with himself. He is, he’s actually falls under a category of being what he describes as nonbinary. So he doesn’t necessarily identify as female, but he doesn’t necessarily go all the way to being male, on the male spectrum. But he kind of falls somewhere in between. He’s both, he’s neither. He’s taking his time to really think about what this means for him. And he’s doing that because he’s got the hormone blockers. It’s been a battle, and I feel like the treatment on the NHS, the protocols are so rigid. They don’t allow for my child to be an individual.

Interviewer:
What do you think would have happened if you hadn’t been able to pay privately to get a prescription for the hormone blockers?

Ally:
Honestly, I’m not sure he would have made it. I think he would’ve tried to take his own life. I’m not sure he could have hung on and hung on and hung on, with the uncertainty and the not knowing whether he would get treatment, whether he wouldn’t get treatment. And that’s been heartbreaking.

Adrian Goldberg:
That’s Ally telling us about Cain. Cain is now getting hormone blockers paid for on the NHS, through the local GP, but that’s only after paying for a private consultation and initially paying for the prescription herself. And as we’ll hear, other trans youngsters have been denied treatment altogether and feel they were forced to go private because of long waiting lists. Now our reporter, Emma Ford, has been looking at this story for us. So Emma, just talk us through the figures on referrals and waiting time.

Emma Ford:
Well, Adrian, as you said earlier, there’s been a dramatic increase in the number of referrals to the Tavistock over the last five or six years. So if you look back in 2009-10, there were less than a hundred around 97. That number went up to nearly 700 in 2014-15. Then it more than doubled in 2015-16, where 1400 young people were referred to the services and this current financial year up to the end of January this year they’re up to 1600 referrals, which is a record high for them at the moment.

Adrian Goldberg:
It really is a phenomenal increase. And we’ll try and explore why this number of referrals has gone up so dramatically in such a short period of time. How long now are the waiting times?

Emma Ford:
It fluctuates. At the moment the Tavistock say it’s between six and seven months for a first appointment. And they’ve got currently about 1200 people on the waiting list. Two thirds of them have been waiting for more than 18 weeks, but crucially NHS, England guidelines say you shouldn’t have to wait more than 18 weeks to treatment. There is a target from referral to treatment time, which is set at 18 weeks.

Adrian Goldberg:
So what have NHS England said about that?

Emma Ford:
Well, they told me that because of this huge increase in demand funding for services and staffing to support them has been increased significantly. And they say they are continuing to work with clinicians at the Tavistock and Portman to increase capacity and reduce those waiting times as a matter of urgency.

Adrian Goldberg:
Okay, well we’ll hear from Dr. Polly Carmichael, who runs the Tavistock trust in a moment, but first, Susie Green is the Chief Executive of Mermaids, a charity that supports transgender children and young people and their families. Good morning to you Susie.

Susie Green:
Good morning.

Adrian Goldberg:
Susie. Let’s just explain a little bit more what we’re talking about here. You know, there’s some people listening in might be thinking, well, you know, what exactly is it, does it mean for a child to be transgender, to have what people say is body dysphoria?

Susie Green:
It’s a feeling of discomfort with your birth gender, and some children and young people do polarize and they say that they’re not female they’re male, or they’re not male they’re female. And other young people, certainly more teenagers, now are coming forward and saying that they don’t really fit into either. And, and that’s where the non-binary sort of comes in. And, and I think young people need you know, support to be able to express themselves authentically. And they need a supportive family to be able to allow them to think about who they are and where they go.

Adrian Goldberg:
And we heard Ally they’re telling us about Cain’s story. You know, the, the, the long wait for assessment, then an even longer wait then to be prescribed hormone blockers, feeling that they had no other option, but to go private, but then being told they were no longer eligible for the treatment offered by the one NHS center that is there to help them the Tavistock. How common is that problem?

Susie Green:
Quite common. And unfortunately, most parents don’t have the means to pursue private treatment. So therefore they have to just sit and wait until they are seen, until their child goes through assessment. But we know we’ve got over 900 parents on our parents’ forums and over 200 teens on our teens forum. And we know that those weights and the time for, for assessment causes an immense amount of distress.

Adrian Goldberg:
And what does it mean if you are a young person, who’s got this conflict about your gender?

Susie Green:
It just means that even for some young people, even getting up out of bed is difficult because you know that you walk outside into a world where there is still a huge amount of stigma and prejudice. So you’re not only dealing with your own feelings of not fitting and your body not being right, but you’re also dealing with external prejudice and external forces that, that make you feel like you know, as Ally said Cain was so badly bullied for being different. And if you add all of those things in together and then that your body is changing in ways that you feel to be extremely distressing, no wonder we have such a high incidence of suicide attempts and self-harm.

Adrian Goldberg:
We get comments like the one from the listener Martin, who’s got in touch with us this morning in Cheshire who says the NHS was not set up to cater for these “needs” as he puts them in inverted commas, children and pensioners who have genuine health requirements are our priority. What would you say to someone like Martin?

Susie Green:
I’d say, let’s look at, okay, so everybody who goes into hospital with an alcohol related disease, are you going to say to them, you brought this upon yourself, so therefore you’re not allowed? Anybody who smokes, are we going to turn them away from the doors because they’ve had illness related to smoking? Do you know something, the NHS should be there to care for people who need treatment and trying to put these, and again, you know, “needs” in inverted commas? Again, this is where the stigma, the prejudice comes in. I don’t see that anybody has a right to tell anybody else how to live and anything that will help somebody to become a, an effective member of society, happy and comfortable in their own skin and go on to lead a meaningful and happy life. Why is that an issue?

Adrian Goldberg:
Susie stay there, if you would, we’ll come back to you a little later on in the program, thanks for joining us this morning. Susie Green, who is the Chief Executive of Mermaids. Dr. Polly Carmichael runs the Tavistock and Portman NHS center. The UK’s gender identity service for under eighteens, and she is one of the UKs leading clinical psychologists in the area of transgender children. Polly, good morning to you. Firstly, your reaction to the story we heard about Cain and Ally?

Dr Polly Carmichael:
You know, obviously it’s very distressing to hear that they felt they had such a negative experience, but I think we have to hold in mind that the experience of gender dysphoria for young people is challenging, and this is a very complex area. I think sometimes some of the discussions can become focused on physical treatments, but in fact, the outcomes are much more diverse and assessment processes are important in terms of ensuring that young people have adequate time to explore their feelings and fully consent to treatment, if that feels appropriate.

Adrian Goldberg:
Sure, but Ally seemed a very considered and reasonable and thoughtful mum didn’t she? As well as been immensely supportive of Cain, she understood the need to take a fair deal of time before going through a more drastic process. But she was saying, you know, in the short term, hormone blockers, which delay the onset of puberty would give Cain more time to think about any other decisions perhaps around surgery and so on, but the delays in treatment one reason that that was prohibited but then even the, the prospect of paying privately and decided to have hormone blockers prescribed by a private doctor then mean that you’re no longer eligible for treatment by the Tavistock.

Dr Polly Carmichael:
Okay. So you’ve made two points that I guess one is around the process of treatment and the other is around access to care in terms of waiting lists and so on, and some people deciding that they would prefer to seek care outside the NHS. In terms-

Adrian Goldberg:
Well they feel, in some cases, that they have to, that that’s their only option. That was certainly the case with Ally and Cain.

Dr Polly Carmichael:
So I think in terms of the treatment process, it would be internationally accepted that we take a staged approach, and I can’t comment on particular cases and it wouldn’t be helpful, but I think with some young people, identity beliefs may become very firmly held and strongly expressed and they may give a false impression of irreversibility. And I think we have to hold in mind, you know, the decisions young people take around treatment are diverse, not all will decide to go forward and seek the blocker and perhaps subsequently cross-sex hormones. In terms of the blocker, we can become very blasé about physical interventions, but we’re intervening in young people at a critical period of their development around puberty. And so clearly it is important to have a proper assessment prior to doing that. And that does take some time, I think in terms of-

Adrian Goldberg:
Ally didn’t dispute that though, did she? She understood the need for careful assessment, but the point is that if you allow puberty to go on beyond a certain stage, there are certain physical features which become either irreversible or very difficult to reverse. Apply the hormone blockers, give the young person a little bit more time to choose before puberty sets in.

Dr Polly Carmichael:
I think that you know, intervening with the hormone blockers needs to be on the basis of a proper assessment. You know, the blockers in and on themselves have an impact on physical health and also an impact on psychosocial health. So it’s quite complex really in terms of, you know, one can’t simply say that the blockers do not have any effect at all.

Adrian Goldberg:
Let’s talk about the massive increase in the demand for your services. Where do you think that’s coming from?

Dr Polly Carmichael:
I mean, I think that’s a really interesting question. And the year before last we had a hundred percent increase in the number of referrals to the service, which was unprecedented and not to be predicted. It had been going up previously around 40% a year. This year it finally seems to be leveling off to around 20%. I think also interestingly, there are differences in terms of the young people coming forward, in that in the past many more assigned males at birth were coming forward. And now that has completely flipped and there are many more assigned females coming forward. So there are lots of discussions around, you know, how one might explain this. I think the most positive thing is that there is greater acceptance and understanding, and I think it can be nothing but positive if young people who are struggling with gender dysphoria feel that they are able to voice that and seek help for that.

Adrian Goldberg:
Okay, Polly, we’ll be with you again throughout the program, Dr. Polly Carmichael from the Tavistock center. Let’s get a word with Jane. Jane’s joining us this morning as well on Five Live Investigates. Hi Jane.

Jane:
Hello.

Adrian Goldberg:
What’s your story then?

Jane:
Um well, our story is very similar to Ally and Cain actually. My son who was assigned female at birth has never been girly ever. And we, we felt that we had our tomboy and that was fine until we hit puberty. And I had a very, very unhappy child. We, he knew a lot more about this than I did. And we seek help from our GP who was very helpful, but she wasn’t our regular GP. And since then, obviously our regular GP has taken over who doesn’t know really what she’s doing.

Adrian Goldberg:
And have you been referred to the Tavistock?

Jane:
We have. And I don’t know where the six and seven months wait comes in, I laughed at that. We’ve been waiting nine months.

Adrian Goldberg:
This is just for a first appointment?

Jane:
For a first appointment. And I will say, we’ve not even had a letter to say that my son is on their books, but I have called them several times to make sure,

Adrian Goldberg:
Have you had any support, any help during this time?

Jane:
Nothing, absolutely nothing.

Adrian Goldberg:
And this is obviously a massive feature of your son’s life of your life.

Jane:
It is, yes.

Adrian Goldberg:
What have you done then in the meantime? Obviously you’re a very concerned and supportive mum.

Jane:
Well, I’ve found Mermaids, who have told me everything that I needed to know one way and another, through other parents and things. I can’t champion them enough and,

Adrian Goldberg:
Have you made the decision as Ally did to pay for private treatment for hormone blockers?

Jane:
Yes, we were waiting far too long and we hadn’t, as I said, we hadn’t even had a letter to confirm anything. And my son was desperate, which made us desperate as parents

Adrian Goldberg:
Jane stay there. I want to bring back Dr. Polly Carmichael from the Tavistock. Polly, you know, you hear the desperation there of a, of a parent getting no help, no support waiting nine months for an appointment, fearing perhaps that she may no longer be eligible for treatment at the Tavistock later on for going private. But if they’re having to wait nine months just for an appointment, what are they supposed to do?

Dr Polly Carmichael:
I think it’s incredibly difficult and we take it very seriously, as do NHS England. I think there is a reality that the numbers went up so quickly. There was such a steep rise that any service would be hard push to manage that. I think there has been a significant increase in funding as we’ve heard, last year, and this again will happen this year. We have over 30 new staff this year, which has enabled us to bring the waiting lists down. Of course, you know, I wish they were not awaiting this.

Adrian Goldberg:
Sure, but then in the meantime an anxious and supportive parent like Jane then seeks private help, gets hormone blockers prescribed privately, but then risks losing the support that you might eventually be able to offer them.

Dr Polly Carmichael:
Okay. I think we need to clarify that if someone seeks hormone treatment outside the NHS and, and then wants to come back in to the NHS, if it’s within the protocol, then of course they can do that.

Jane:
I’m sorry, can I say something there? As I say, I’ve not been to the Tavistock yet, but I have heard from many, many parents who were told that if their child is to be taken on by the Tavistock, having already seeked attention elsewhere, then they are to come off of all of the prescribed blockers or hormones, whatever they’re on, for several months for the Tavistock to be able to do their own research, like blood tests and things like that, that to my son is going to be horrendous. I don’t think he could do that.

Interviewer:
Okay, Jane thank you, let Polly come back on that. Polly?

Dr Polly Carmichael:
Okay. I think, you know, clearly we have a process through our endocrine clinics in terms of ensuring the safety and wellbeing of young people, and that’s paramount. In terms of treatment that has been obtained outside the NHS, then if there are available, baseline measures, ongoing measures, identifying the physical impact of the treatment on the young person and details of the assessment that took place, of course, we will take that into account. So we really are not seeking to be punitive, but I think it is about young people’s best interests, ultimately, which is ensuring that if treatments have been implemented, that they’ve been done so in a way that is safe and then we can carry on forward.

Adrian Goldberg:
Polly, thank you for now, we’ll come back to you, Dr. Polly Carmichael from the Tavistock clinic, which helps transgender kids.

Speaker 1:
This, is BBC Five Live, available on the BBC iPlayer app.

Adrian Goldberg:
If you’ve just joined us, my name’s Adrian Goldberg, and this is Five Live Investigates. Today, transgender kids. These are children trapped in a body that looks different to the gender they feel they belong to. For many youngsters, it causes untold inner turmoil, but as we’ve been hearing, they’re often having to wait months for hormone blockers that delay the onset and development of puberty. And if they try and fast-track the process and go private, they can find themselves turned away from the one NHS center set up to help them, the Tavistock. For its part, the Tavistock is having to do with an unprecedented level of demand, been getting lots of comments coming in on this Kirsty Jane Crow on Facebook says: I am transgendered and I’ve lived without the benefits that would have been derived from early hormone intervention. Hormone blockers really help a young, transgender sufferer to fully explore their feelings and then give them the chance to live their life realistically, in their chosen gender. Jill Thorntons says being taken seriously is hugely supportive. Another listener though says: This is typical airy fairy brainwashed society that we live in today. Children are being brainwashed by deluded people who think this is normal. No wonder the NHS is in trouble. Another listeners saying: the alternative to not getting treatments is unpalatable. These children have the opportunity to avoid the damage of puberty. Let’s embrace that. Keep your comments coming, you can text us on 85058, email goldberg@bbc.co.uk, on social media @BBC5Live. Now, if youngsters do stick with the NHS system and go through the lengthy assessment process, they’ll have to take hormone blockers for at least 12 months. Only then might they be prescribed cross- sex hormones like testosterone, which helped develop your male characteristics or estrogen, which develops female features. At the Tavistock though, these are usually only prescribed to those who are aged around 16, but what if a young person and their family are adamant that they want this treatment earlier? Angie and 15 year old Charlie, who was born a girl, but identifies as a boy found, the only way was to go abroad and pay thousands of pounds for treatment themselves.

Angie:
This is Charlie at nursery, and this is like 18 months old, he’s sat there with a Fireman’s hat on and what have you. I mean, look how young he is,

Interviewer:
How old is he there?

Angie:
He would be about three years old.

Interviewer:
So he’s a little girl there, but he looks every bit the little lad doesn’t he with this fire helmet on.

Angie:
Yeah. I think that might have been the girliest jumper in that photograph there, what I’ve got away with. Charlie’s now 15, but I knew that he was different from a very early age, probably from him being able to talk to me. I just knew completely he was born in the wrong body. We didn’t actually do anything about it. We just let Charlie be who we wanted to be.

Charlie:
I went to my mum about 11 years old and just said, this is who I am. I need to be treated for it. And so we went to the doctors, they referred me to Tavistock and I got put on hormone blockers quite quickly, but they wouldn’t treat me for anything else.

Angie:
The next stage would, would have been if we’d have stayed in this country that he would have had to wait until he was 16 for the hormone treatments.

Interviewer:
So the Tavistock had accepted that he had gender dysphoria. He was being given hormone blockers, but he wasn’t being allowed to take the testosterone hormone that would make him look like a young man. Why not?

Angie:
Oh, every time I ask this question, I just get told it’s the protocol. I understand there’s got to be procedures in place. And obviously there’s kids out there that may change the mind or, in a case like Charlie, where it’s just so clear cut, it was just, it seemed cruel to make him work for them three years. We decided after long conversations and discussions in the family, that it was the right thing to do to take him abroad. He’d been on hormone blockers for nearly a year before we took him across to the states. And that’s what we did. We went privately and got him what he needed. When we came back to the UK, we was told that we’d gone against the protocols of Tavi and they completely just totally discharged him from their service. Being on testosterone, you need blood tests and making sure he’s on the right levels, blah, blah, blah. So we didn’t have access to the endocrinology, which obviously I had to sort out myself, which I’ve done, but more concerningly, that he didn’t have all the, or so they thought, he didn’t have that psychological support in place, which he still needed [inaudible]. He’s still a young person going on this journey, and that’s what I was most concerned about.

Interviewer:
How much did it cost you to go abroad and get testosterone prescribed?

Angie:
We did get further treatment last year, cause we’ve, we’ve gone on that journey as well. Had top surgery last year, in the summer. I think in total, if, if of all the private treatment we’ve paid about £24-25,000. It just doesn’t bear thinking about what would have happened if we haven’t, hadn’t spent that money.

Charlie:
Now, I feel like a completely different person. I don’t feel angry. I just feel happy. I just feel like myself and just made me feel more comfortable and more like me.

Interviewer:
Had you look at yourself, what kind of person do you present to the world?

Charlie:
Fully male. I don’t identify myself as trans. I just identify myself as male.

Angie:
They just need to treat people individually, that we need to help our young people through this. Yes, they’ve got to be cautious, but where they’ve got cases like Charlie, they should put things in place for them to help him, help him succeed in life. Like the journey is hard enough as it is.

Adrian Goldberg:
There you go. That’s Angie and her 15 year old son, Charlie, who went to the US for treatment and let’s get a word with Susie Green from Mermaids, the charity that supports transgender kids and their families. Susie, interesting point there raised by Angie saying, you know, she understands there’s going to be a degree of caution, there will be some people saying, well, you know, 15 is too early to be having such a drastic transformation in your, your gender identity.

Susie Green:
I think that you’ve got to give young people credit for knowing themselves. And certainly in, obviously in Charlie’s case, Charlie’s cross-gender identification started very, very young as did my daughter’s. I mean, we followed the same sort of pathway as Angie went through with Charlie, with my daughter. And I took her to the States and she got blocking medication at 13 and cross-sex hormones at 14. And it was a very clear cut, because she’s 23 now, so if it’s a phase, it’s a pretty long one. And she was very certain about who she was and the conversations that she had with the clinicians regarding future fertility, what this would mean for her, all were based around her competency to know, and to take into account all of those things. And she was deemed to be competent to make those decisions. And as her parent I supported her to do so. The other thing I would like to point out is I’m on the Facebook group with we’ve got a secret Facebook group and we’ve got a parents forum, and parents are very clearly saying on Facebook now in reaction to hearing this program that they have been told by the Tavistock that if they seek private appointment, then they will not get to see an endocrinologist. So although Polly was saying, it’s not punitive, in actual fact that is happening. So regardless of whatever is being said, parents are still being told they will be discharged from endocrinology if they seek private treatment.

Adrian Goldberg:
Okay. So thanks for your time this morning, Susie Greene from Mermaids, let’s bring back Dr. Polly Carmichael from the Tavistock clinic and Polly, whatever the language that we might use here, the parents clearly, Susie evidences there, feel that they’re punished by the Tavistock for, in their eyes, doing nothing more or less than the best for their children who are trans.

Dr Polly Carmichael:
Hopefully I can reassure in that it is absolutely categorically, not the policy that if people seek to undertake treatment elsewhere, then they will not be seen by the NHS, that’s not true. If people seek endocrine treatment elsewhere and wish to come back into the NHS, it’s as I stated previously. And in terms of psychosocial care, if people wish to access ongoing psychosocial care while seeking endocrine treatment elsewhere, then, you know, that that is part of our process. That’s fine. So I hope that helps to clarify.

Adrian Goldberg:
In the case of Charlie, for example Charlie was under 16. So the cross hormone treatment, the treatment that might make you more obviously identifiable as a man or as a woman, isn’t made available until around the age of 16 by the Tavistock, you know, Angie’s saying, she was clear from a very early age that Charlie was trans, Charlie then came to her and said, yes, you know I was born a girl, but I wish to be a boy, why are the protocols So apparently inflexible?

Dr Polly Carmichael:
Well, we treat everyone as an individual.

Adrian Goldberg:
But you do have protocols, don’t you, which, for example, say cross hormone treatment isn’t around, isn’t available until around the age of 16.

Dr Polly Carmichael:
It’s absolutely true. And I guess as an NHS service, we’ve always taken a balanced approach and looked at working in an evidence-based way. And there’s no doubt, you will know the evidence base in this area is exceedingly poor as the numbers have been so small. There are, I think we have to bear in mind that there, the context has changed dramatically and that there are very strongly held views. And I understand it, we’re working, you know, within an area that as you’ve heard causes huge anxieties for parents who only want to do the best for their children and to protect them. And I think, you know, we have to be careful not to feel that the only, you know, that the solution to this for all young people is to undertake physical interventions.

Adrian Goldberg:
Sure, and that’s, that’s a reasonable point Polly isn’t it. But I suppose that the way that the protocols work at the moment, it was suggested under the age of 16, as far as the Tavistock concerned, the more obvious means of changing your gender identity are not available to you at all.

Dr Polly Carmichael:
Well, the protocol is that cross-sex hormones are available from around the age of 16. We most likely will be looking at making them available around the age of 15, but under an ethically approved research project. I think, you know, we have to be really careful. We don’t have the long-term evidence for this. And we have to tread forward, you know, thoughtfully and with consideration. Young people are developing and changing as they go through puberty. There are issues, as Susie has mentioned, around consent around fertility, and I guess our clinical experience would be that, you know, we have absolutely no agenda regarding the outcome and of an individual’s gender identity, that is for them and we support whatever that is, but there is such change going on. Young people themselves are identifying in increasingly diverse ways, there are increasingly diverse wishes emerging around treatments, and I think we have to be thoughtful considered and tread carefully.

Adrian Goldberg:
Polly, thank you for now Emma, there’s some really interesting statistics around this, about the age of children these days, trying to access transgender identity services on the NHS.

Emma Ford:
Yeah. And if we look at the Tavistock’s latest figures for about 2015-16, when 1400 people were referred there, when you break those figures down, the vast majority, that’s more than a thousand, so well over two thirds are aged 14 or over. But if you look at the rest they’re also much younger children. So in that timeframe, there was around three children aged just three years old that referred, another five of them were aged four years old. And there were more than 150 who were referred between the ages of around five and 10, so much younger.

Adrian Goldberg:
Yeah, Polly, from the Tavistock, what, what can you offer a three-year old who is referred who has some kind of gender identity crisis?

Dr Polly Carmichael:
I guess we would most often meet with the parents at that age and not necessarily the young person. And I think for parents, sometimes, you know, they’re very worried about what’s the best way forward. And again, this is a very good example of how things are changing, and there isn’t a right or wrong here. You know, we simply don’t know what are going to be the long-term implications of the changes around the way in which people are managing gender dysphoria. But I think increasingly amongst much younger people there is full social transition and, you know, parents report that that’s very positive for young people. But as you’ve heard, there is also bullying, stigmatization, there’s often worry within families about acceptance within families. So I think it can be helpful to meet with parents at an early stage.

Adrian Goldberg:
Okay. In a moment we’ll hear from Becky in South Yorkshire, her child was born a boy called Nicholas now lives as a nine-year-old girl called Amber. Here she is, talking to BBC Yorkshire’s Inside Out program.

Amber:
Everyone supported me from me three and up. Year one’s and year two’s don’t know that I’m actually transgender.

Heidi Tomlinson:
How do you think you’ll be when you start high school and you maybe come up against people who don’t really understand why you are now a girl.

Amber:
Um a lot of friends know that I’m transgender. So they might actually help me. So they will explain to the people what transgender means, and then they might get it, and they might, like, understand they’ll think I’m regular person.

Heidi Tomlinson:
What’s the best thing about life now as Amber and not Nicholas?

Amber:
The best thing is that I’m actually really, really happy.

Adrian Goldberg:
There we go. That’s Amber, nine years old, talking to BBC reporter, Heidi Tomlinson Amber’s mum, Becky joins us now. Becky, you waited nine months for an appointment at the Tavistock. What kind of help were they able to give?

Becky:
Can I just touch on the referral times? It can take up to in excess of a year to get through to the service with the way that the referral process goes on, you go through your GP, they refer you onto child support services, CAMHS, and then you end up getting re-referred back to your GP. Then it took me eight months to get through to Tavistock, and walking through their doors, blockers was a major, major thing that we were aiming for, for Amber. And, you know, as soon as you get that information, it’s a game changer. I think there does need to be an interim service between the referral and actually getting your foot through the door.

Adrian Goldberg:
Some people listening to this, I’m sure Becky, though, will be astonished to hear talk of hormone blockers at such an early age. And I don’t mean to make light of what’s happened with your daughter and, and you know, her own wishes, but some people I’m sure listening to this will say that he’s simply too young to be making decisions about your gender identity.

Becky:
Well, the thing is for Amber, she just did not want to go the same way as her big brothers. She didn’t want to, they went from being young, small boys to six foot plus, hunky muscle mountains. And she is absolutely terrified that she would go the same way. She even developed an eating disorder, self-harm to an extent, it’s quite scary, but once you get through the door and you actually learn about the side effects of blockers it’s quite terrifying. You introduce them too soon, you could actually make things so much worse for your child, and the studies, we don’t have 30, 40 years’ worth of studies.

Adrian Goldberg:
Okay, well Becky, hold on there, if you would, I want to bring in Linda Blair, who’s a clinical psychologist, Linda. This has been a fascinating insight, I think, into the, you know, the numbers, increasing numbers of children and the increasing numbers of children at very young ages being referred to gender identity services. What do you make of it?

Linda Blair:
I’m not surprised gender is, is there are now 70 words for gender, something like that. It’s different now. And we have to accept that. Nonetheless, I’m completely with the Tavistock in terms of taking this slowly, I in my clinics have worked with people who now, nobody you interviewed today, but people who did rush into it and who bitterly regretted that rush and the disjointed,

Adrian Goldberg:
Rushed into what exactly?

Linda Blair:
Surgery,

Adrian Goldberg:
Into surgery.

Linda Blair:
The hormone treatment too early, not the blocking. And I think it’s really, really important to have the same group, if you can, caring for you all the way through and for it to be a very careful, long process. Some of the people I’ve worked with were very sure at the time, but, you know, thoughtful time sometimes makes them change. So I think you have to see it as a process. And I think early on in your program, the key was Kirsty who texted and said the important thing is to be taken seriously. That’s the important thing.

Adrian Goldberg:
Let me ask Becky, I mean, Becky, do, are you concerned at all that for Amber you know, hate to use this phrase, but again, it’s one that crops up on the text that, that this might be a phase that she’s going through?

Becky:
No, no, but you’ve definitely got to allow your child, the space to explore that. And introducing things like blockers too soon could actually [inaudible] her self-discovery. And I think that any treatment, especially hormone replacement treatment, just to touch on that, there is dangers of introducing that to young, and this is why they say 16, because once you’ve been on it for two years, they have to have surgery to remove. Like hysterectomies, full medical hysterectomies, who in their right mind would want to perform that surgery on somebody under 18 years old?

Adrian Goldberg:
Becky, you’ve obviously got a wealth of experience now, as a mom of this has, well, let’s talk about your experience though. Has, the Tavistock helped you come to an understanding?

Becky:
Amazingly yes, absolutely. The questions that I am asking, they can’t answer fully because the research papers are not published. That it’s, it’s all still under investigation. I am asking questions that affect my child’s long term future. 80% of, of transgender children revert back to their birth gender when they hit teenage years. I wanted to know how many re-revert back to their gender identity. There is nothing published.

Adrian Goldberg:
Well, that’s an interesting point. Thank you for joining us this morning, Becky, a very quick final word to, to you, Polly. Have you heard anything on the program today that made you rethink how the Tavistock operates?

Dr Polly Carmichael:
I’ve heard what said, and I, you know, I’m well aware of the distress. I think this is a hugely complex area, and I think it’s hugely positive to have these discussions as painful as they can be for all of us.

Adrian Goldberg:
Really appreciate your openness and your time this morning. Thank you. That’s Dr. Poly Carmichael from the Tavistock clinic, thanks to Susie Green from Mermaids and everybody is taking part in the program. Thanks for listening to the Five Live Investigates podcast. And don’t forget if there’s something you want us to investigate, you can email goldberg@bbc.co.uk

Speaker 1:
On digital and online. This is BBC radio Five Live bbc.co.uk/fivelive.

 

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