Safeguarding children: we are all Cassandra now

According to the myth, Cassandra was cursed by Apollo to see the future but for her prophecies never to be believed. She was castigated as a liar and a mad woman. We know the feeling.

We are concerned that children in Wales are being put at risk by gender ideology. We have spoken out collectively and individually. We have spoken out as members of political parties, as teachers, health professionals, social workers, company directors, consultants, academics, researchers; as mothers, sisters, grandparents; and as ordinary women concerned about the misogynistic and sexualised world that children are growing up in.

We have been ignored – including by politicians we have campaigned for and worked alongside. We have been dismissed as bigots and transphobes, told to educate ourselves by young men barely out of school. We have been bullied out of jobs and online groups. We have lost friends and sleep; we have been forced to deal with social media attacks, real life threats, and the distress that accompanies a gender critical awareness.

But, like Cassandra, we are speaking the truth, and we will continue to do so.

The evidence to support our position, and our concerns, continues to pile up on all sides. The danger posed to children and young people by gender ideology is real and demonstrable. Yet politicians in Wales continue to ignore us, and the evidence we send them. This makes them culpable.

For example, the international Society for Evidence-based Gender Medicine recently translated and reviewed guidelines from the Finnish gender identity service – the world leader in this field.

Their overview concludes that:

The 2020 guidelines represent a strong signal that the pioneers of pediatric medical transition are concerned about unintended harm to the growing number of gender dysphoric adolescents presenting for care.

They point out that the guidelines “…warn of the uncertainty of providing any irreversible ‘gender-affirming’ interventions for those 25 and under, due to the lack of neurological maturity.”

Equally worryingly, the guidelines raise concerns that puberty blockers

…may negatively impact brain maturity and impair the young person’s ability to provide informed consent to the subsequent and more irreversible parts of the Dutch protocol: cross-sex hormones and surgeries.

We have contacted politicians, the Chief Medical Officer for Wales, and the Director of NHS Wales with evidence of “the growing international concern about the unexplained sharp rise in adolescents presenting with gender dysphoria, which is occurring in increasingly complex developmental and mental health contexts, and often without a childhood history of gender-related distress.”

We have shared previous SEGM reports with politicians in Wales, and sent every MP and the Welsh Cabinet our paper on Conversion Therapy. We have told them that there’s a very real danger that a ban on so-called conversion therapy for children identifying as trans would make ethical therapy for gender non-conforming children illegal.

We are not alone. The LGB Alliance, Transgender Trend, Safe Schools Alliance and the Thoughtful Therapists group echo these concerns. In their ‘first do no harm’ statement, the latter group state that “many therapists are currently afraid to work with clients who have gender-related issues for fear of prosecution, or accusations of conversion therapy.”

They point out that there are

…many contributing factors and comorbidities in the client group who identify as trans/non-binary including internalised homophobia, autism, childhood trauma, self-harm, eating disorders, excessive use of the internet and social media. A growing number of young gender non-conforming individuals who present to therapists as trans have a distressing level of internalised homophobia and are seeking to repress their same-sex attraction.

A so-called ‘conversion therapy’ ban, as currently proposed in the draft legislation, would prevent these young people from receiving the therapeutic care and support they so desperately need. Let us be clear: conversion therapy – an attempt to alter the sexualities of same-sex attracted people – is abhorrent. We condemn it without reservation. Recommending a ‘watchful waiting’, therapeutically-led response to young people who feel uncomfortable with their bodies and the gender roles pushed upon them by a sexist society is not the same thing as conversion therapy. Nor is challenging the routine medicaliation of psychological distress in young people. Forcing same-sex attracted people into heteronormativity has absolutely nothing to do with medicalising gender non-conformity. The comparison is innaccurate and dangerous.

Our concerns have been dismissed. Welsh Government is determined to continue to champion ideologically-led practices which Carl Heneghan, the director of Oxford’s Centre for Evidence-Based Medicine called ‘an unregulated live experiment’ on youth.

Heneghan reviewed the evidence-base for the treatment of gender dysphoric minors, referencing correspondence from senior health professionals which refers to the use of puberty blockers for gender dysphoria a “momentous step in the dark”.

The correspondence set out three main concerns:

  1. young people are left in a state of ‘developmental limbo’ without secondary sexual characteristics that might consolidate gender identity;
  2. use is likely to threaten the maturation of the adolescent mind;
  3. puberty blockers are being used in the context of profound scientific ignorance.”

Heneghan stated that:

“…treatments for under 18 gender dysphoric children and adolescents remain largely experimental. There are a large number of unanswered questions that include the age at start, reversibility; adverse events, long term effects on mental health, quality of life, bone mineral density, osteoporosis in later life and cognition. We wonder whether off label use is appropriate and justified for drugs such as spironolactone which can cause substantial harms and even death. We are also ignorant of the long-term safety profiles of the different GAH regimens.”

His conclusion, and that of his co-author, is alarming.

The current evidence base does not support informed decision making and safe practice in children.

The Finnish Health Authority agree. They have stated that the treatment guidelines for gender-dysphoric young people will not be revised until research is undertaken to:

“…explain the recent sharp rise in adolescents presenting with gender dysphoria; determine whether transgender identities in this population are stable or will evolve; assess whether gender-affirming treatments are able to improve health outcomes of those who present with co-occurring mental health problems, including improvements in depression and suicide; and quantify the rate of regret.”

We call on the Welsh Government and Health Minister Eluned Morgan to review policy and practice to align with these guidelines and to ensure that gender non-conforming children in Wales receive appropriate and evidence-based care rather than that which is ideologically driven.