Health Care for Trans Youth Is Under Attack in UK — and It’s Impacting the US

Fourteen years ago, Susan Evans left her job as a psychiatric nurse at the UK’s Tavistock GIDS clinic (the Gender Identity Development Service for child and adolescent patients) where she’d been working between 2004 and 2007. Her reason for leaving, she said, was her discomfort with the clinic providing hormone replacement care to older trans teens. She thought the clinic should be providing psychotherapy rather than “affirming” trans youth.

Following the British government proposing reforms for the Gender Recognition Act in 2015, a wide range of new anti-trans organizations were formed targeting different areas of trans rights, health care, sex education and inclusion policies in schools. Within this growing interest in organizing against trans rights and health care, twelve years after she left the Tavistock clinic, Susan Evans connected with a parent (named in the case as Mrs. A) who claimed she was concerned that her child might one day be referred to the Tavistock for treatment. Evans and Mrs. A, represented by a solicitor with a long track record of fighting against abortion care for minors and other religious right hot topics, set up a crowdfund for a judicial review of Tavistock’s referral service for trans youth, claiming that the clinic should not be permitted to provide trans-affirming care.

Many things about Evans and Mrs. A’s involvement in the judicial review were strange from the start. According to the court ruling, Mrs. A’s child had never actually been referred to the clinic, in part because, as Mrs. A admits, she has worked hard behind her child’s back to prevent any such referral, much less treatment. The judicial review proceeded apace without Mrs. A, focusing instead on Keira Bell, who as a young person was referred for puberty blockers by the Tavistock clinic.

In a decision that rocked the entire global network of trans-affirming care, the court agreed with Bell’s allegation that she should not have been able to consent to puberty blockers, finding that young people cannot consent to “experimental treatment.”

To be clear, puberty blockers, as part of a constellation of trans-affirming care for young people in adolescence, have not been “experimental” for several decades. The appropriate use of puberty blockers for trans minors is supported by the Endocrine Society, and all of the global professional associations for transgender health.

Yet the court ruled against trans youth rights, and its decision has already had a dire impact on health care.

Care Is Declining and Trans Youth Are Suffering

Although there is a “stay” in place for the ruling pending appeal, treatment for young trans people in England with anything other than counseling has been halted since the Tavistock ruling. GIDS was the only service of its kind in the National Health Service and elected immediately to cease all puberty-suppressing treatment for youth under 16 unless they have a court order to access such care. One parent who is a member of a group of GIDS service users told Truthout: “We are already seeing multiple negative impacts of this judgement on the group of 600 or so adolescents who have been directly affected. These include increased reporting of self-harm, and eating disorders. There are also reports from young adults who have had their medication stopped by unsupportive GPs who are reluctant to prescribe in what they see as a controversial area of medicine.” Another parent said, “Most importantly parents are concerned about the mental health of their children, some of whom had previously been self-harming and on suicide watch. The fear of them returning to this state has left many families in a state of anxiety.” Both parents asked to remain anonymous due to concerns about becoming targets for doxing and other threats. Meanwhile, a BBC report quoted an anonymous NHS clinician saying that parents are being left to deal with children suffering serious mental health fallout.

Separately from the report by parents above, we talked to a number of adult patients who are reporting additional difficulties accessing trans health care in the last year as health boards respond to the chilling effect of the case. One trans woman told us, “Although I had previously been on shared-care hormones [funded by NHS on the recommendation of a private specialist], after the Bell case, my GP stopped prescribing, telling me he was worried about the implications. Now I am having to acquire them entirely through private health care.”

Anti-Trans Advocates Are Ramping Up Their Fight

At a UK-based convening of anti-trans advocates, Susan Evans and her husband Marcus Evans, who served briefly on the board of governors at the Tavistock clinic, joined psychoanalysts, sociologists, historians, and activists to talk about the ramifications of the Tavistock case. Along with openly arguing that trans-affirming care should not be available to people under 25, attendees made several unscientific claims that parents are seeking trans-affirming care for their children so that they don’t need to “suffer adolescence.”

Marcus Evans, a psychoanalyst, claimed that “confusion and distress are an important part of adolescent development. And should be encouraged.”

Dr. Stephen Rosenthal is a pediatric endocrinologist and the Medical Director of the Child and Adolescent Gender Center at University of California, San Francisco. He told us that no one had ever come to him “suffering” from puberty itself. But youth are suffering from gender dysphoria–the condition of being forced to identify with a gender that isn’t their own. Puberty blockers, said Dr. Rosenthal, are used to ensure that a trans young person isn’t forced to go through the irreversible physical changes that endogenous puberty brings about.

To say that puberty should be suffered is to ignore the real suffering of trans kids whose gender was incorrectly assigned at birth, and who, without puberty blockers, will be forced to undergo an irreversible, painful physical and psychological process.

Anti-trans advocates’ win in the Tavistock case has inspired anti-trans organizations and networks within the UK to set their sights on further horizons. Groups like Transgender Trend, an organization that campaigns against LGBT-inclusive relationship and sex education to schools (and was allowed to contribute to the Keira Bell case as an expert witness), are now refocusing on targeting trans health care for anyone under 25. More extreme groups like Our Duty (a campaign of anti-trans parents who protested outside the court case with banners calling for the minimum age to be raised to 25) have called for the elimination of transition-related treatments altogether. These groups often promote each other, and their changes in policy goals were announced within a week of each other.

But the Tavistock ruling is not set in stone. While the GIDS clinic has suspended puberty blocker and hormone therapy for trans teens, there has been a stay on the ruling pending appeal. Additionally a number of groups have been granted leave to intervene in the appeal against the ruling on behalf of trans teens, including trans rights charity Gendered Intelligence and young people’s sexual health charity Brook, as well as medical organizations the Endocrine Society, and Leeds Health Trust. Meanwhile, grassroots are experiencing a renewed realization that the trans community cannot simply rely on professionalized NGOs and charities to push progress on trans liberation forward. Activists are reflecting on how to change course from a constant reaction to the ongoing attacks on the UK trans community.

In their piece on the current state of trans rights in the UK, Harry Josie Giles writes, “Trans healthcare in the UK is in crisis… Trans healthcare for under-16s has been brutally interrupted by a national moral panic. Prejudice against trans people in general practice is endemic … we should be campaigning for as much healthcare as possible to be shifted from behind the gate of the GIC and into general practice…. Organising needs to empower trans youth leadership.”

In the U.S., the Tavistock case has no legal impact, but has provided plenty of fuel for the fires of anti-trans advocates and activists, who cheered the decision. The ruling has already been cited in testimony in support of a Montana bill that would have banned trans-affirming care for youth. As of mid-February, more than three dozen anti-trans bills have been introduced across the U.S. since the beginning of the year, including 16 that would prohibit some level of trans-affirming care for youth.

The Tavistock case is not just a canary in a coal mine — it’s a blueprint for anti-trans organizations and networks across the world for how to undermine trans-affirming care for youth: Find a young person willing to say they shouldn’t have received care, and a judge willing to agree. With the high number of Trump-appointed judges and quite a few Republican-controlled legislatures, it won’t be a surprise when the blueprint is used in the United States.