Hormones in children: we can no longer remain silent

Sweden, Finland and the UK put the brakes on hormones for minors. In Italy they continue to be administered and the number of cases is not known. But it is no longer possible to remain silent. Interview with British psychiatrist David Bell, one of the first to sound the alarm
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For the last couple of years in Italy, too, it is possible to administer puberty blockers to minors with so-called non-compliant behaviour. Therapy takes place on simple medical prescription. After years of treatment and an exponential increase in cases, In the UK a court ruling has been needed for a few months. Sweden recently stopped hormone therapies for minors. In Arkansas these treatments have been outlawed. At Finland psychological and non-pharmacological therapy is recommended.

Data on the number of Italian girls and boys treated with puberty blockers are not known. It is urgent that they be made public. No less urgent is a policy of risk-disclosure. It is not acceptable that the effects of puberty blockers are described as perfectly reversible. That is to say, if and when treatment is discontinued because the child has changed his or her mind, development will resume normally. Several studies show that the effects of these drugs on tissues, particularly bone tissue, are irreversible, as is the appearance of secondary sexual characteristics, and that there is a high risk of infertility. British psychiatrist David Bell was among the first to raise the alarm, paying a very high price. Here is a recent interview with him.

Talking to David Bell gives an idea of how it might feel to be his patient. At 70, his energy puts me to shame. He cycles everywhere. His schedule is full. I have rarely interviewed someone so busy (there are days when he emails me several times, each message more urgent than the last). But ask him a question and he is unlikely to jump in and answer it. Certainty is not a given. His open-mindedness is that of a much younger man. Above all, he is so calm: a reassuring presence. There are times during our conversation when it is hard to believe that we are discussing experiences that must have caused him so much anxiety and even, at times, a little fear.

Bell, distinguished psychiatrist and psychoanalyst, is the doctor who in 2018 wrote a controversial report on the activities of the Gender Identity Development Service (GIDS), a clinic of the Tavistock Foundation and Portman NHS in north London, where he worked from 1995 until his retirement earlier this year. GIDS, the only clinic of its kind in the UK, is sspecialising in the treatment of children with gender identity problems and in recent months it has been in the news more than usual. Last December, a High Court judgement stated that children under 16 are unlikely to be mature enough to give informed consent to the prescription of puberty blockers. (drugs that delay the development of secondary sexual characteristics in patients, in theory allowing children to transition more easily to their desired gender identity). This ruling, following a judicial review initiated by the 23-year-old woman Keira Bell - born a woman, she was prescribed GIDS blockers at the age of 16 and now regrets her transition - she has indeed reduced medical intervention for children with gender dysphoria. (The Tavistock presented appeal which will be discussed in June. David Bell will be heard in what is technically called an intervention on appeal, i.e. he will be allowed to testify).

Bell's report anticipated High Court concernsand today Bell feels comforted by the sentence. "It was stunning," he says, "because it was very strong." As he read it, he was struck by details such as the lack of data, problem he himself had raised (GIDS was unable to produce for the court any data on the results and effects, whether desirable or adverse, in children prescribed puberty blockers; nor could he provide details of the number and age of children prescribed them). But it was also a painful experience: "I was concerned that we had strayed so far from the value of care. And he is amazed that the ruling has had so little effect on the GIDS organisation. "Normally heads would roll," he says.

Keira Bell fuori dall'Alta corte dopo la sua recente sentenza sui bloccanti della pubertà.
Keira Bell after the High Court ruling. Photo: Facundo Arrizabalaga / EPA

Whatever the court's verdict may be, it cannot change the fact that the organisation to which Bell has devoted most of his working life has not respected his rights as a whistleblower. Nor has it extinguished the debate on medical treatment of trans children - If anything, the discourse has become more radical - and that is why he is talking to me now. This is the first time when he speaks in detail about his experiencesof how he came to write his report and of the serious consequences that this had for him. His retirement means that the threats of disciplinary actions towards him are over. He is finally free to say what he likes.

Writing the report, he says, was a a matter of conscience. In 2018, 10 GIDS employees spontaneously raised their concerns with him.. They were more or less a third of those working there at the time. He had no choice but to act, and he would do so again. But it was not easy. Instead of being grateful to him for being warned of a potentially dangerous situation, the trust went on the defensive almost immediately. He tried to shut him up, initiated proceedings against him. Was he scared? Yes and no. "I thought I was doing the right thing," he says. "I never doubted it, and most of my colleagues in the adult department supported me. The real betrayal was not on my part but on the part of the trust that had a duty to whistleblowers. But the thing that makes you sleep at night is a good lawyer. To pay for it, he launched two crowdfunding appeals.

How, exactly, did they try to silence him? The GIDS leaders said to the Observer to be proud of their service, which provides high-level support and assistance for young people struggling with gender dysphoria. They strongly denied that they had taken any action against Bell for his initiative. They said they had a duty to safeguard their staff, who had suffered appalling personal harassment, and had taken a number of actions to protect them.

In the months following the delivery of Bell's report, a book for which he had written an introduction was removed from the Tavistock library. When he spoke at a conference on de-transition in Manchester, a GIDS staff member went to spy on him. Eventually he was told that he was not allowed to write or speak in public about anything that was not directly related to his SSN employment.which seemed strange to me ... and if I was going to write an article on the psychology of King Lear should I have asked for permission? "(his lawyer informed him that the ban was contrary to the terms of the contract).

The story begins in February 2018, someone knocked on Bell's office. "They usually came to me when they had problems," he says. Having worked as a consultant at the Tavistock for more than 25 years he was one of its most senior doctors: for 10 years he was in charge of its science programme; in 2018 he was also governor of the trust's elected staff. Of the 10 GIDS staff who would speak to him over the next seven months, only the first saw Bell at the Tavistock; the others, who were talking about intimidation, were worried about not being seen. What did he think of what they had told him? "My blood was cold. Everyone had the same concerns. One or two were seriously upset. "

Il Tavistock Centre nel nord di Londra.
The Tavistock Centre, north London. Photography: Alamy

Among these concerns was the fact that the children who attended GIDS often seemed to be tried and sometimes did not share their parents' sense of urgencythat senior staff had spoken of 'simple cases' of children who were to be put on puberty blockers (no case of gender dysphoria, Bell noted, can be called simple); that some were given the indication for treatment after only two appointments, and were rarely seen afterwardsSome people thought that GIDS took too long to achieve its objectives. inexperienced (and inexpensive) psychologiststhat the doctors who had spoken of homophobia in the unit were told that they had 'personal problems'. One told Bell that an eight-year-old boy was referred to an endocrinologist for treatment. "I couldn't go on like this ... I couldn't live like this any longer, knowing the bad treatment of children," said another.

Were you surprised? What did he know about GIDS before these conversations? (The clinic, founded in 1989, had grown enormously in a short time. In 2009 it had seen 80 patients. By 2019 this figure had risen to 2,700. "This is a good question. It started as a small service, then became nationally funded; a contract with NHS England meant a guaranteed income. It was strange. You could see that everybody knew about it and yet nobody wanted to see. In the adult department there was a feeling that it was better not to know what was going on there because maybe we wouldn't like it if we did.

Bell wondered what he should do. "In July I met with the hospital management. I told them I would write a report. They said: OK. While I was writing it I contacted GIDS. I needed to know some basic things: the number of patients they had seen; their gender; what psychiatric problems they might have had". He received no answers. "Then I received a rather unpleasant letter from Paul Jenkins, chief executive of the trust. He said that GIDS was very busy and its staff did not have to answer me. Was it GIDS that didn't have the data, or did he not want Bell to have it? "Both."

In September, Bell sent his report to Jenkins and Paul Burstow, chairman of the board. For unspecified legal reasons, he says, they had prohibited him from sending it to the board of governors, which oversees the council. "It was then that I got myself a lawyer.says Bell. His lawyer told him that, on the contrary, a failure to send it would be judged as fault in the event of any future legal action taken against the trust. When he did so, however, he received what appeared to be a note 'very hostile and threatening'. by Burstow. However, the report was discussed at the next board meeting, where it was agreed that a review of GIDS would be conducted by Dinesh Sinha, the trust's medical director. Despite this, in November 2018, Bell received two letters threatening disciplinary action. One of the reasons given was 'bullying'. He was not told who had been bullied. He was also asked not to speak to Sonia Appleby, the trust's director of child protection, again. 

During Sinha's review, Bell asked for assurances. He wanted to make sure that those who had spoken to him would be able to state the facts safely, that their anonymity would be protected. But he received no response. Bell wrote to GIDS staff, reminding them of their right as NHS workers to speak confidentially. The trust's review delivered its report in February 2019. Bell was initially not allowed to see it. He was later given 30 minutes to read 70 pages. "Data was still missing ... but the inappropriate involvement of trans ideological groups in the work of the service was acknowledged ... Bell's report was later leaked to the press. "This disturbed me until I read the article," he says. "The reporting was accurate. I started to think it was a good thing....

At the beginning of 2020, procedures were set up to undertake a 'new' project.disciplinary action against Bell. "The reasons referred to my whistleblowing activities," he says. Meanwhile, Bell announced that he would retire, as planned, in June 2020. Then the pandemic struck and he decided to postpone his departure until January 2021....

Last January he retired as planned, just one month after the Keira Bell ruling. A lawsuit against the trust had long been expected.... "It was inevitable," he says. But the Keira Bell ruling has not eased his worries. Whatever the outcome of the appeal, Bell believes more questions need to be asked, particularly about the increase in the number of girls presenting at the clinic (three quarters of patients are now girls; in the past the gender balance was closer to 50:50) . "We don't know why this is happening": He is concerned that too much emphasis is placed on gender and too little on sexuality -" children are often gay"- and continues to be anxious about comorbidities such as anorexia, autism and history of trauma. "Some children are depressed. They say the cause is their dysphoria, but how do we know? And why don't we try to treat them first? "

Bell is not against puberty blockers per se - "A doctor should never say never" - but he believes that stopping puberty scares the child even more: "The child will never want to stop taking hormones and 98% now keeps taking them. There could be dangerous collusion on the part of the doctor. The body is not a video. You can't just press a pause button. You have to ask yourself what it really means to stop puberty". It should be possible to manage the distress of a child suffering from gender dysphoria in a less interventionist way until he or she is an adult and can make a decision.This is where the problem lies. He has no doubt that some patients will want and need to make the transition in the future. But, he says, not all children with gender dysphoria are trans... ". Gender dysphoria clinics should be part of the Child and Adolescent Mental Health Services (CAMHS) and available nationwide," she says. 

Given his political position - he describes himself as a 'Jew who supports Corbyn' - Bell was very shocked by the reluctance of the left to confront these issues. "They think it's a matter of showing themselves to be liberal rather than caring about children's health. Mermaids e Stonewall [charities for transgender children and LGBTQ+ rights] have instilled a fear of even listening to another point of view'. It is surprising that the left is unwilling to consider the role played by big pharma. In the US, a journal that published an article on the effect of puberty blockers on suicide risk had to reveal that one of its co-authors received a salary from the manufacturer of another drug.

When it appeared on Channel 4 News Earlier this year, Bell was asked if he feared he was on the wrong side of history. "I've often asked myself that question," he says. "Psychiatry has a sad history. Homosexual men were given behavioural therapies and so on. But history is not always right. What matters is the truth. I hate the weapon of victimhood, the fact that the fear of being seen as transphobic now prevails over everything'. The current campaign to ban so-called gay conversion therapy, he said, could become a Trojan horse for trans activists who will use it to pressure any doctor who does not immediately confirm a young person's declaration of their identity. For Bell not being able to talk openly about these things is tyrannyis just another form of repression. "It's about circulating light and air," he says. "It's about free thinkingThis will result in better outcomes for all young people, transgender or not.

original article here (translation by Marina Terragni)

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