GIRES Response to Liz Truss Statement to Women and Equalities Select Committee

Summary (see full version below)

Ms Truss, in her recent statement to Women and Equalities Select Committee, focused on the priorities to be taken forward by the now severely depleted Government Equalities Office. This is a worrying step in itself, especially for those minority groups who have fought hard to achieve legislation that specifically protects them.

GIRES stands shoulder to shoulder with other members of the trans community in its quest to prevent the societal pressures created by the Covid 19 pandemic, being exploited as an opportunity to undermine the rights of certain groups within this community.

Ms Truss has singled out two particular topics that affect our communities. The first is the protection of women’s spaces which, sadly, may hide a subtext that could result in the exclusion of trans women from these spaces.

The second topic is the apparent support of gender diverse children and young people by Ms Truss, in giving them more time to make decisions. The unstated, but clear implication, is that this ‘support’ would involve delay in offering medical relief. This would negate the current safety measures in place for this group, by failing to address their immediate discomfort. This relief enables them to make carefully considered decisions on the best way forward. Delaying such medical support for young people would have the opposite effect to that intended.

GIRES believes that MPs generally would benefit from a better understanding of the needs of young service-users and their families, as well as accurate information regarding the treatment protocol and the checks and balances therein.

Full Response to Liz Truss Statement

Ms Truss, in her recent statement to Women and Equalities Select Committee, focused on the priorities to be taken forward by the Government Equalities Office (GEO). The GEO is currently severely depleted following redeployment of many of its (now-former) staff. This has the potential to undermine the rights of particular minority groups. The precise intention of Ms Truss’ remarks remains unclear, and there is fear in the trans community that she intends to implement policies that would undermine hard-won rights. GIRES stands shoulder to shoulder with the trans community in seeking to prevent the societal pressures created by the COVID 19 pandemic being exploited as an opportunity to undermine the rights of certain groups within this community.

Single-Sex Spaces

Medical Care for Children and Young People

Summary of Key Points

References

Single-Sex Spaces

Determination to ‘protect women’s spaces’ sounds benign but, in practice, a policy additional to those already in place regulating access to women’s spaces would lead to the exclusion of trans women from appropriate facilities, on the basis that they could theoretically be predatory men, despite a striking lack of evidence to support this assertion. Who would decide, and when, and how, a possibly masculine-looking woman was a predatory man? Such a man, if they harassed or assaulted women, even if armed with a Gender Recognition Certificate (GRC) would still be acting illegally, not due to their presence in these facilities, but to their behaviour. GRCs are therefore irrelevant in these circumstances.  Providing scrutiny at the entry to any spaces reserved for use by women would be impractical. Thus, all women might be required to show evidence by way of a birth certificate or GRC. This would undermine the privacy and dignity of all women; it would breach the UK Human Rights Act (Article 8, 1998) and the Equality Act (2010), as well as the Gender Recognition Act itself (2004).

Ms Truss’ statement also implies that protections for women’s spaces do not exist, but they do:  Schedule 3 of the Equality Act allows for discretion in situations, such as ‘refuges’, where cisgender women may be accorded a degree of separation, from a trans woman, if  this could be shown to meet the criterion of being ‘proportionate to a legitimate aim’

Medical Care for Children and Young People

The additional statement, made by Ms Truss, to the effect that under 18s need to be ‘protected from decisions that they could make, that are irreversible in the future’ reveals a misunderstanding of the checks and balances in current treatment protocols (a). The introduction of any additional delay to the current procedures would inevitably lead to a rise in depression, self-harm and suicidality in this group (b). It would literally put lives in danger. The international Standards of Care (c) state that not intervening to interrupt an unwanted puberty, ‘is not a neutral option’; in other words, it would cause entirely-foreseeable and, therefore, inexcusable harm to the mental health of the child (b). Transgender young people are not inherently mentally ill – gender incongruence (the mismatch between gender identity and sex assigned at birth) is no longer classified as a psychiatric or psychological disorder by the World Health Organisation, (d) reflecting this fact. However, failure to meet their needs would cause serious mental health issues (b).

Currently, before accessing medical intervention, the competency of patients under 16 years of age must be established. In the UK, competency is assumed from age 16, (e) and young people under that age are required to be ‘Gillick competent’ (f). This is achieved by following the ‘Fraser’ guidelines (g), by which clinicians must ensure that young people can give ‘informed consent’ for their treatment, that is, they understand the positive effects of treatment, but also the potential side-effects which may be negative. They have to be demonstrably competent to understand, for instance, issues such as the potential loss of fertility and the value of cryopreservation of gametes (sperm or eggs) to retain fertility. ‘Gillick competence’ does not necessarily require parental agreement but, in practice in the UK, young people must be supported by a parent, or other person(s) with Parental Responsibility (PR) to access gender-related treatments (h).

Children are not treated pre-puberty; they must experience Stage 1 of puberty (the initial influx of sex hormones) and Stage 2, (initiating the physical development of secondary sex characteristics). If this development causes gender-related distress to intensify, then temporary relief, by introducing hormone-blockers, may be appropriate. This intervention is not experimental (i). This medication is used routinely, under licence, in cases of precocious puberty in younger children, with no adverse long-term effects on bone density or brain development; (j) the treatment does not trigger gender transition.  This period of temporary relief provides a therapeutic interval during which young gender diverse people have an opportunity for less-troubled reflection on future choices; the treatment thereby enables them to make better decisions. Gender diverse young people need an ‘affirmative’ approach in terms of supporting their gender expression and medical interventions where necessary. This does not ‘push’ them down the path of transition, whereas a negative approach that seeks to persuade young people that they should conform to the expectations associated with their birth sex, is, effectively, ‘reparative therapy’(k), a milder form of ‘conversion therapy’; both these therapies are regarded as bad practice; they undermine the self-esteem of children and young people, and may trigger self-harm and suicidality.

The fact that some, apparently gender diverse, children evolve as lesbian, gay, bisexual or, occasionally heterosexual and cisgender, and therefore decide, of their own volition, not to proceed with physiological interventions, demonstrates that starting such treatment does not lead to social transition continuing irrevocably into adulthood (l). The checks and balances in the current protocols are thereby shown to be successful in supporting appropriate decisions by these young people.  Surgery, for those that need it, is not undertaken until adulthood. The treatment is in the best interests of the child, not only for its immediate remedial effects on mental health, but particularly because it is a significant safeguard against making bad decisions. Delaying such medical support for young people would have the opposite effect to that intended.

If a young person is not transgender, the physical effects of blocking treatment are, at that stage, reversible; the treatment may be stopped, thus allowing phenotypic puberty to resume. If they are transgender and hormone blockers were withheld, the distressing physical changes they experience would be irreversible, or only partially reversible through surgery. The mental health of these young people should be supported by an affirmative approach so that they are respected, listened to, and heard. They benefit from this approach; they are happier children and become more stable and contented adults (m).

Summary of Key Points

  1. Transgender children and young people (CYP) are not mentally ill;
  2. CYP are required to be legally competent (informed consent) to access medical treatments;
  3. CYP are required to experience early stages of puberty to assess their reactions;
  4. Hormone blockers prevent unwanted development, and are reversible;
  5. Hormone blockers are used in precocious puberty without
    on-going negative effects;
  6. Unwanted pubertal changes are not fully reversible;
  7. Gamete storage can preserve fertility;
  8. Withholding support risks imposing the discredited practice of reparative therapy on trans CYP; and
  9. CYP are not able to access gender-affirming surgeries until adulthood;
  10. Early treatment does not ‘push’ young people down the path of long-term transition; some pull out, for example, because they are LGB rather than transgender. This demonstrates that ‘checks and balances’ are effective and far safer than denying the identities of transgender CYP by withholding treatment and social support.

References

(a)  NHS Standard Contract for Gender Identity Development Service for Children and Adolescents

(b) See, for example, ALC De Vries, JK McGuire, TD Steensma et al. (2014) Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment, Pediatrics, 2014 – Am Acad Pediatrics

(c) World Professional Association for Transgender Health

(d) https://www.bbc.com/news/health-48448804

(e) The Family Law Reform Act 1969 also gives the right to consent to treatment to anyone aged 16 to 18.

(f) Gillick v West Norfolk and Wisbech AHA AC 112 ((HL)) 1986 – originally applied to contraception, but now widely used for other medical interventions.

(g) GP Notebook: Fraser guidelines

(h) NHS Children and young people -Consent to treatment

(i) Giordano S, and Holm S (2020) “Is puberty delaying treatment ‘experimental treatment’?” International Journal Transgender Health.

(j) Eun Young Kim, (2015) Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty, Korean Journal of Paediatrics.

(k) Ashley, F. (2019). Homophobia, conversion therapy, and care models for trans youth: defending the gender-affirmative approach. Journal of LGBT Youth, 1–23.

(l) Temple Newhook et al (2018) “A critical commentary on follow-up studies and ‘desistence’ theories about transgender and gender non-conforming children; International Journal of Transgenderism. Vol19

GIRES research award;

(m) see also Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, 137(3), 1–8.

GIRES Response to Liz Truss Statement 20200603 PDF (233 Kb)

 

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