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Fear of being labelled a bigot should not silence discussion of gender transition

Michael Kelly



Questions: Professor Donal O’Shea has concerns some patients are being “coached” to fast-track their way to gender transition. Photo: Steve Humphreys

Questions: Professor Donal O’Shea has concerns some patients are being “coached” to fast-track their way to gender transition. Photo: Steve Humphreys

Questions: Professor Donal O’Shea has concerns some patients are being “coached” to fast-track their way to gender transition. Photo: Steve Humphreys

Of all the radical social changes in Ireland in the last decade, from same-sex marriage to abortion, the legislative shift that has received the least attention is around gender.

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Probably, that's because - in reality - confusion around gender identity is traditionally something that affects a relatively small portion of the population.

That is not to take away from the seriousness of the issue for those affected or the very real problems that people - particularly young people - who identify as transsexual experience in terms of mental health and other spheres of their lives.

Ireland now has one of the most radical gender recognition laws in the world where a person whose body is physically male, who is male down to the last fibre of their DNA, can now self-declare as female and the State will change all of that person's official documents to recognise them as their preferred gender.

At the same time, there has been a huge increase in the number of people - including children - being referred for specialist medical interventions to realign their gender.

In Britain, the National Health Service (NHS) announced last week it was launching an independent review of the use of puberty blockers and cross-sex hormones in children and young people.

In 2009/10, a total of 40 girls were referred by doctors for gender treatment in Britain. By 2017/18, that number had soared to 1,806 - an increase of 4,500pc. Referrals for boys have risen from 57 to 713 in the same period. Last year 45 British children referred for NHS treatment were aged six or under, with the youngest being just four.

One hundred Irish children have been sent to the UK's main gender treatment facility between 2016-2019, according to statistics.

The Tavistock Gender Identity Development Service clinic has been under the spotlight after clinicians resigned saying they believed children there were being incorrectly diagnosed with gender dysphoria and offered treatments.

Marcus Evans, a former governor of the trust which runs the centre, claimed the facility is too quick to give young people sex reassignment treatment.

He claimed young people are being fast-tracked into medical treatment to transition without adequate counselling.

The NHS review comes as the UK High Court is hearing a landmark case aimed at stopping doctors prescribing "experimental" puberty blockers and cross-sex hormones to children who wish to undergo gender reassignment.

The Tavistock centre is being sued over concerns that young people are being given "experimental treatment" without adequate assessments.

The case is being brought by a woman known only as Mrs A, the mother of a 15-year-old autistic girl who is on the waiting list for treatment at the service.

Keira Bell (23), who was given hormone blockers and cross-sex hormones as a teenager at the clinic, has now also joined in the action. Her case contests the way in which consent is obtained by the clinic for the treatment of children. Ms Bell has since de-transitioned.

The case could have serious implications for the issue.

Charlie Evans (28) was born female but identified as male for nearly 10 years before de-transitioning. She now runs a support group and recently claimed on Sky News she has been approached by "hundreds" of young transgender people who are seeking help to return to their original sex. Sue Evans, who worked as a therapist with children at Tavistock, claimed in a recent interview she feels clinicians come under "political pressure which is taking children much quicker towards a 'one solution'".

She said that while she does believe there is a "small minority of children who - ultimately - for them this is the answer and this is going to help them. But when children come as adolescents it's a difficult time and there is massive psychological change going on."

Last year, Ireland's leading endocrinologist, Professor Donal O'Shea, said he was concerned vulnerable patients were being "coached" on how to outwit a psychological evaluation to gain access to hormone treatment and gender-related surgery.

He warned that, in his view, some advocacy groups are prepping patients to fast-track their way to gender transition - without undergoing an appropriate mental health assessment.

"I have had a number of patients who have told me they have been coached in the answers to give so that they give the 'right' answers to psychologists and psychiatrists who will be asking them questions before receiving hormone treatment and gaining access to surgery," Prof O'Shea said.

"And I have been told by patients who have had hormone treatment, who have had surgery, who are now unhappy with their decision, that they have been instructed by patient advocates not to report this because it would be bad for the wider community," he said.

If these patients are correct, it's outrageous to think advocacy groups are putting political and ideological concerns ahead of the needs of vulnerable people.

The idea that someone who regrets gender treatment would feel coerced into silence to avoid letting the side down is also shameful.

Gender treatment - particularly for children - is a massive and often irreversible life-changing event. We should be able to ask questions about the huge rise in referrals in recent years and what may be behind it.

Officials and clinicians in Ireland should look closely at the review being carried out in the UK and see what lessons can be learned here.

We often - not always fairly - look back on previous generations and charge them with an inability to discuss sensitive social issues. It would be a shame if questions around gender and some of the ideological underpinnings went undiscussed because people are afraid of being labelled as a transphobe or a bigot.

Irish Independent