A visit to Parliament

We were very pleased to be given the opportunity to speak to a group of MPs and Lords about the harms to transgender patients by cross sex interventions.

Biology in Medicine was privileged to attend Parliament to speak at a cross-party discussion on the harms of gender medicine organised by a member of the House or Lords. Two of our number were speaking, and we were joined by two other clinicians and a manager who spoke powerfully and sometimes graphically about the harms to our patients and challenges that we face.

Much of what I said is reflected here, talking about the desperate harms I see to vulnerable people who believe they are the other sex, and believe they can become so.

I am a GP. I have worked in ordinary general practice for most of the 25 years since I qualified, and I currently work in an treatment centre, effectively a walk in centre. Sometimes I see a patient where the evidence of my eyes conflicts with the sex recorded on the notes, usually a young woman.

I also teach student doctors in clinical and communication skills and also in ethics and law. A female student I taught some years ago, stunning, short hair, gender nonconforming: that doctor now works in another department, and has a deeper voice and a beard. I am so sorry that this was the choice that young woman had to take.

There are 3 areas to talk about:

• Young adult transition

• Doctor moral injury

• The way trans is treated differently from every other condition in health.

Young adults do stupid things. They are still adolescent. They drive too fast; they get drunk after their exams and end up with a bloody face in my department; my friend’s son jumped off a bridge into the river and broke his back.

They declare themselves to be trans and get life altering interventions.

They are impetuous, and they certainly can’t imagine that old folk like us might know a thing or two. They need, though they don’t want, our protection.

So every time I see one of these beautiful young women come in to see me with facial hair growth, a flat chest and a deepening voice I want to weep for them; it breaks my heart: we didn’t protect her.

I’ve always thought I’d be better off being male, given my personality, but I am not. I’m female. And that is that.

We don’t otherwise do irreversible things to young people without a very good reason – they change their minds.

In any other sphere of medicine we only intervene if we have to, with the least restrictive options, doing the least possible to achieve a necessary goal to improve physical health, while also giving the most choice for the future. This is well established in medical practice, and in medical law.

There is a consent process to discuss the options including the option to do nothing.

We don’t remove breasts or testes unless there is a life-threatening cancer. Indeed we do our best to preserve them because it is negligent not to. We don’t carry out vasectomies and tubal ligation until that person has had the chance to have a family, and reversible options are discussed.

Unless that person declares they are trans.

At this point all professional and ethical logic goes out of the window. Medical safeguarding vanishes. Somehow the NHS, the medical Colleges and institutions, the GMC and even the UK legal system has supported these interventions even though they are objectively harmful.

This leads me on to the way that doctors are suffering from the moral injury of having to participate in harming our patients. It is horrific to find that demands are made on us to refer to gender clinics that we know will not counsel them effectively, that won’t explore where the gender incongruity comes from and will accept their gender in the affirmation model. It upsets me that I am having pressure put on me by my College (RCGP), the BMA and the GMC to accept that gender affirming care is appropriate and that with suitable “education” we could take on this prescribing and monitoring.

Actually, I am very well educated already, educated to know that a referral is harmful let alone the prescribing or surgical interventions.

These students are vulnerable. In the university town where I work we have a fairly high proportion of very bright and socially awkward students who might find it hard to fit in with their peers. They arrive in Freshers’ week, free at last from their parental love and protection. They can declare themselves to be trans, and get a grant from the students’ union to buy makeup or get a haircut or a chest binder.

The gangly young man who wasn’t “hench” enough, so he wanted to be called Lily. He had a session or two with a therapist who merrily declared him suitable to be referred to the Gender Identity Clinic. Here he was given spironolactone so he would grow the pair of breasts he craved. Or the strong young woman with short hair and men’s clothes who had a girlfriend but wanted to be straight.

This isn’t trans: this is fantasy.

This is extreme body modification condoned and funded by the NHS.

This is a medical response to social problems.

What happens when they realise their mistakes but it’s too late?

How do we protect these young people from themselves?

Where is the safeguarding?

What can we do when the medical organisations spout WPATH (self appointed but discredited World Professional Association for Transgender Health) as a credible source?

What can we do when our professional organisations refer to each other’s statements with no evidence at all? (not guidelines of course, so a doctor is left high and dry when the litigation starts)

What can we do when trans inclusive conversion therapy is outlawed leaving only so-called gender affirming care?

This needs to STOP now.

We have been failed by the NHS, the Colleges, the GMC, by the medical profession, and certain case law.

We need the DHSC and the NHS to say NO.

We need legal change to reverse the perversities of the law that demands trans interventions.

We need you, our lawmakers to help keep our young people safe.