LAST year, the Conservative government banned puberty blockers as it said they carried an ‘unacceptable safety risk’, but the Labour government has now launched a trial that will give any number of children as young as nine access to the controversial drugs. Critics say the trial has ‘no ethical grounds’, is essentially a way to circumvent the law and that we already know the benefits, which do not outweigh the risks.
The University of York carried out a systematic review of puberty blockers and found no evidence that they improved body image or gender dysphoria. It found limited evidence for positive mental health outcomes. The Cass Review, an independent study of NHS identity services carried out by Baroness Hilary Cass, a British paediatrician, and former chair of the Academy of Childhood Disability, identified that they can harm brain development, reduce bone density and fertility, and stunt growth in height and genitals.
Campaigner and psychotherapist James Esses says we already have all the information we need on the effects of puberty blockers on children’s physical, social and emotional well-being. He said: ‘I don’t think there are any grounds for puberty blockers whatsoever.’
At great personal cost, he is one of a few therapists fighting back against the ‘dangerous ideology and indoctrination of primary school children’. As a student psychotherapist, Mr Esses was expelled from his master’s course for what his college, Metanoia Institute in Ealing, west London, described as ‘gender-critical views’.
He said that gender dysphoria should be treated as a ‘mental health issue’ and that the issue ‘generally resolves by itself and children eventually settle into themselves’. He added: ‘It is a biological fact that people cannot change their sex. The majority of children taking puberty blockers, over 90 per cent, go on to take cross-sex hormones, so it’s a slippery slope in that respect.’
Numbers of children exploring transition are rising. An analysis of GP records in England in 2021 suggested that more than 10,000 under-18s had a diagnosis of gender dysphoria. In 2011, there were fewer than 200 cases.
Mr Esses says the rise is partly down to social media and advertising, as well as promotion in schools. Being transgender is being pushed in a nefarious way, as though being straight is boring.
‘One of the first things I saw when I started speaking out about this was a primary school workbook which had all the various flags for sexuality and gender identities, all colourful and sparkly. Where it said straight and cisgender (identifying with the sex you were born with), there was no flag, just a blank page. Next to all these sparkly rainbow flags it looked boring, dull and stale. You can imagine a young person looking at that saying, “I don’t want to be that boring, straight person”.’
The Pathways study, commissioned by the NHS with support from the National Institute for Health and Care Research (NIHR) and conducted at King’s College Hospital, London, will cost the taxpayer £10.7million and will run until January 2031. An unlimited number of children could take part. Its aims are to ‘build the evidence base on the care needs and development of children and young people with gender incongruence’.
Mr Esses said: ‘For me, it’s antitherapeutic. When somebody is suffering from a mental health condition, the answer to that is not to reaffirm delusional thinking that has no basis in reality. People cannot change their sex and as much as these young vulnerable people may want to do so, they cannot; it is biologically impossible.
‘The answer is explorative therapy and an attempt to get people to reconcile themselves with the bodies they’ve been born into rather than medication and irreversible surgery.’
The Tavistock Centre was closed a year ago over concerns that it adopted an ‘unquestioning affirmative approach’ to underage transgender patients. No counselling was offered to children or teenagers struggling with gender identity, replaced instead with drugs such as puberty blockers which were unquestioningly prescribed to under-18s.
Tavistock, under the NHS Tavistock and Portman Trust, was the only option for young people claiming gender dysphoria. The decision to close it came after the 388-page Cass Review said the current model of care left young people ‘at considerable risk’ of poor mental health and distress, and that one clinic was not a ‘safe or viable long-term option’.
It is true that we do not know the long-term impact of the drugs. Cass said this is because none of those prescribing them did any meaningful follow-up. Tavistock’s Gender Identity Development Service (GIDS), saw 9,000 children but failed to follow up any of its patients in its 35-year history. So, the obvious answer is not a new study, but to find those children and review how they fared.
Instead, the government will open six new specialist centres next year that it says follows the Review’s advice. They will be ‘holistic centres’, but treatment is not defined, and therapy is not mentioned in the announcement. They could become the only way children can access puberty blockers, which halt the normal process of growing up. The image is that they provide a pause until the child is ready to face what, for some, is the challenging time of transitioning from child to adult.
To be effective, they should be prescribed before children reach puberty, ideally between the ages nine and eleven. Mr Esses said: ‘We are dealing with very young children here which raises concern about informed consent. Not only are they vulnerable children, they’re vulnerable children with a mental health diagnosis. The thought that they can consent to medication that could bring about irreversible harm to them is utter madness.’
Research has shown that if children start to live as though they are the other sex, they are far less likely to reconcile themselves with their own body. As neural pathways develop in the brain, children are more able to absorb new ways of thinking, being and doing. As they grow older, those neural pathways become more fixed as neuroplasticity slows down. Mr Esses said: ‘The more you tell a child they can change their sex the less likely they are to become comfortable with who they are. Far from resolving issues surrounding gender dysphoria, if anything they increase, and children become more desperate to transition using hormones and irreversible surgery.’
According to the organisation Stats for Gender, classrooms, the media, social media and diversity training sessions have been fed a diet of misinformation in terms of statistics. Claims including ‘41 per cent of teenagers who want to transition will commit suicide if denied cross-sex hormones’, ‘cross-sex surgeries are no more dangerous than wisdom teeth removal’, or ‘1.7 per cent of people are born neither male nor female,’ often fall apart under close examination.
For example, between 2010 and 2020, four patients out of 15,000 were known or suspected to have committed suicide. Two were receiving treatment at GIDS, while two were on the waiting list. This gives a suicide rate of 0.03 per cent, in keeping with young people battling other mental health issues.
Many teenagers feel uncomfortable as they go through puberty, especially girls who must deal with increased sexual attention as they develop breasts. It is tempting to skip the phase and come back when emotionally ready. Puberty blockers offer a silver bullet, except puberty cannot simply be put on hold.
Mr Esses said: ‘While the rest of their peers will be progressing through puberty, and they won’t, that’s going to make them stand out more and can bring about great feelings of isolation and being othered. It also cements the notion in the child’s brain that there’s something wrong with them and there’s something wrong with puberty, that’s why it needs to be paused, rather than that it’s a natural part of human development. Doing nothing is often the best treatment, sometimes in combination with explorative therapy.
‘Gender dysphoria is a delusion closely linked to other conditions like body dysmorphia. The way we treat mental health conditions is through therapy, it’s not through medication and surgery. For things like depression and anxiety we may use medication, but not irreversible surgery. Gone are the days of us performing lobotomies in this country. Surgically amputating healthy genitals is no different in my view.’
