Today, I am angry – spittingly angry – with the NHS. With one ill-considered stroke of a bureaucrat’s pen they have put at direct risk the lives of some 160 or so children in the UK. At the same time, they have inflicted misery and shattered the tranquility of as many families.
On Tuesday, a controversial court judgement called into question the prescribing of puberty blockers to children aged 16 and under. This is not about that. There will be an appeal. The hope is that this aberrant ruling will be reversed, that the UK, instead of aligning itself with the likes of Russia and Hungary, will return to the consensus on treating transgender kids that has emerged over the years in the US, Australia, New Zealand, the Netherlands and Portugal. I could go on.
That, though, is not why I am angry. That emotion is reserved for the stupid, thoughtless, actual response from NHS practitioners. This not only goes way beyond what the court ruled, but also, in one fell swoop, pulls the rug from under the feet of those already taking puberty blockers.
Let me repeat that. With zero warning and, as far as I am aware, no care plan or risk assessment for those affected, GPs and others have stopped ongoing treatment. This is despite the fact that the official NHS statement acknowledged that the judgement allowed a brief period of adjustment, until 22 December, during which appropriate care and support should be put in place. However, evidence from those directly affected is that medical professionals, including GPs, have simply stopped treatment.
So as of Wednesday, children who felt safe – secure in having surmounted the many and various hurdles put in their way – suddenly found themselves unable to access treatment already prescribed.
Whatever happened to “first, do no harm”? I get – I really do – that the NHS must comply with the law. I also know, as must they, that abrupt withdrawal of treatment has consequences. Medical professionals understand that strict application of the law must be tempered with consideration for the welfare of the patient. They know that forcing individuals to “go cold turkey”, whether for illicit drugs, alcohol or nicotine has known adverse side-effects and poor outcomes. That’s why best practice is to support patients in a gradual withdrawal, rather than an abrupt one, and why medical professionals have, in the past, been prepared to defy the law in order to help their patients comply with it.
In the case of puberty blockers and Hormone replacement Therapy (HRT), the adverse physical and psychological effects are equally well-documented. We know, for instance, that women who suddenly have HRT withdrawn may become suicidal.
Or perhaps people think these women are just “weaponising suicide”. After all, that is the claim made by anti-trans campaigners whenever evidence of this same risk is pointed out in relation to trans children.
Although, in fact, the reasons for this outcome are well understood. Depression and suicidal ideation are closely linked to spikes in oestrogen and that is precisely what the withdrawal of puberty blockers will lead to in at least half of this cohort.
Trans people know very well what happens next. Within 48 hours of the NHS announcement, families of trans kids up and down the country were reported sick with worry as to what would happen next. If you want some idea of what this ruling means in actual, practical terms, I defy you to read these personal testimonies and not feel some compassion.
And yesterday, I learned of the first suicide attempt by a trans child. Not a cry for help. Not some playing around with a not-quite overdose. But a full-on spirited attempt to end their life which, had it not been for the prompt reaction of those present, would have ended in death or serious injury. Who knows what triggered this, but it happened shortly after the court ruling.
I asked the NHS earlier today what risk assessments they had done, what care plans they had put in place for these children. That body, so swift to issue new guidelines in response to a court case, has not yet responded.
That says it all. If you thought I was angry before, I am even angrier now. And praying that the next seven days will not see even worse news on this front.