Throughout Dr Helen Webberley’s MPTS hearing to date, one subject has come up time and again: who is qualified to treat transgender youth? The General Medical Council (GMC) alleges that Dr Webberley did not have the requisite qualifications to provide gender-affirming care to her patients, an allegation which Dr Webberley is contesting.
It therefore follows that any witnesses would be drawn from a pool of professionals who are, in fact, qualified. Indeed to draw ‘expert testimony’ from people with no experience or training in transgender healthcare might be considered a double standard, to put it mildly.
Unfortunately, to date, this seems to be the case. Professor Hindmarsh, for instance, was called as a witness on day six of the hearing despite having had zero involvement with any of Dr Webberley’s patients and, by his own admission, having not worked with a single transgender young person in 25 years. Further, none of the GPs called as witnesses by the GMC have any background, experience, or special interest in trans healthcare.
Even the expert witnesses for the GMC might, were they in Dr Webberley’s position, be found wanting. Take Dr Rob Agnew, called as an expert witness in his capacity as a paediatric psychologist (although he describes himself as a clinical psychologist working with both children and adults, rather than a paediatric specialist). As an expert witness in this matter, Dr Agnew should be able to provide testimony specifically relating to trans healthcare. It should be expected as a minimum that, if Dr Webberley is allegedly not sufficiently knowledgeable in trans healthcare, the witnesses providing expert testimony against her must be.
However, Dr Agnew does not appear to have any experience of providing gender-affirming care, to either adults or to children. As a professional expert witness, he lists his specialist areas as:
- Diagnosis and psychological assessment
- Neurological and learning disability – Autism
- Forensic/psychiatric patients, risk, treatability and capacity
- Complex and contested capacity assessment
- Disputed opinion regarding capacity or diagnosis
- Differential diagnosis/clarifying diagnosis
- Complex diagnostic issues
- Challenging reports where the psychological opinion may be invalid
- Challenging the scientific integrity of expert psychological reports
- Challenging the quality of psychological input
Nothing regarding gender identity services, gender dysphoria, or the practice of trans-specific medicine.
Let’s be absolutely clear – this is not an attack on Dr Agnew or his qualifications. Rather, it is a complaint against a system that allows one doctor to be prosecuted for providing gender-affirming care without the relevant qualifications while another is able to provide expert witness testimony against them despite lacking those same credentials.
In fact, the list of Dr Agnew’s qualifications highlights the all-too-common problem of gatekeeping in trans healthcare. Even well-intentioned clinicians might tell young trans people that they aren’t transgender – they’re autistic, or they’re depressed, or they’re confused. And while it’s reasonable to want to make sure that young people with mental health issues or developmental disorders are properly supported, this is no reason to delay affirming their gender identity.
As Felix Moore, a speaker at the Tavistock’s ‘Shapes of gender identity’ event in February 2021, said: “There’s no point in saying, ‘Well would they be trans if they weren’t autistic or is so-and-so’s trans identity just an autism thing … you’re saying how would you be different if you were a completely different person and I don’t have an answer to that. If I am trans because I am autistic that is only true in the sense that everything about me is because I am autistic.”
Likewise, to question whether a young person should receive gender-affirming care because they also have mental health issues is to deprive them of care when they are at their most vulnerable. For instance, more than half of all trans and non-binary people have been diagnosed with depression at some point. Mental health support should be provided, of course, but not at the cost of raising a question mark in relation to their gender identity. No cisgender person would ever have their identity called into question because of their mental health, so why should trans people be treated in this way? In fact, there is no consideration given to the possibility that the difficulty of accessing gender identity services might be a contributing factor in these mental health issues, and that they might be significantly alleviated by supporting the patient to access these services instead of keeping them out of reach.
We want a fair trial for Dr Webberley. But more than anything, we want the system of trans healthcare in the UK to be made fit for purpose. That begins by putting care provision in the hands of people who understand trans identity, and providing better training and education for those who don’t. There is a catch-22 in trans healthcare in the UK at the moment. There are no official training pathways for transgender healthcare and no NICE guidelines on the subject. The NHS’ own provision is governed by temporary service specifications, as opposed to formal standards of care. And this is how we end up with situations where endocrinologists and psychologists are called to give expert testimony on a situation with which they are only tangentially connected.