The discussion about trans children, young people and their family in the media at the moment is incredibly unfair.
A lot of us in the trans community and our allies have pointed out the similarity to section 28. When we do, we are told we are being ridiculous, that no-one wants anything of the sort, that all these keyboard commentators want is to be sure gender dysphoric young people are receiving the ‘right support’.
None of them seem to be prepared to say what the ‘right support’ might be. However, there has been vocal and sustained criticism of:
- Children and young people being referred to specialised NHS services (e.g. periodic hysterical headlines over rising referrals)
- Children and young people using private health services
- Parents who support their trans children
- Schools introducing policies and training on supporting trans children
- The establishment of trans-specific youth groups by charities
- The inclusion of trans young people in general provision youth activities
- Trans young people seeking out other trans young people, either in friendship groups at school, or online.
That seems to me to rule out every remotely feasible approach for a child or teenager to be able to discuss and express their feelings with other people and to feel that their feelings are being listened to and respected. The only options it implicitly leaves on the table are some form of conversion therapy (now rejected as harmful by NHS England, NHS Scotland and most reputable therapy bodies), or some form of section 28, don’t ask don’t tell kind of structure, where kids are expected to keep silent and hide who they are until they are 18. Virtually every queer person I know of my generation, brought up under section 28, will tell you that this is not a good option. It’s horrible to live through, and it seriously affects mental health.
A variant on this is to suggest that the commentator isn’t ruling these options out, they just want more evidence. Which is another sneaky tactic, especially when it is being applied to community activities such as peer support. In the first place, you can’t get evidence on anything until you try it. There is no way to measure the effectiveness of a youth group or an anti-bullying programme that doesn’t involve setting up such a project and collecting data. Saying you can’t set up support groups without evidence creates a catch-22 that is impossible to resolve, and leaves people who need support right now waiting indefinitely. Secondly, there have already been evidence reviews. I’m not going to list them all, but the American Academy of Pediatrics recently issued guidance recommending affirmative care, including support for the child to express their identity in schools and other social settings. Australian guidelines published in the Lancet reach similar conclusions. The WPATH standards of care, which all gender clinics in the UK (and most other parts of the world) work to, specifically says that it is the role of professionals to help kids and their families access peer support and receive support in schools. This is upheld in the service protocol for the Gender Identity Development Service, which says the service aims to build children’s resilience in peer relationships and schools, including by offering peer support activities. The Tavistock and Portman website specifically encourages parents to seek out peer support for themselves and their children.
Ah, says the desk top commentator, but these recommendations aren’t based on good enough evidence. What we need is top quality evidence, preferably a gold-standard multi-site double-blind randomised control trials. Now, I’m all for high-quality research evidence. And yes, we do need more of it in trans health. But this line is disingenuous and unfair. Firstly, it is notoriously difficult to run RCTs of things like peer support groups. They’re never going to be double-blind: people know if they’ve gone to a support group or not. And there’s a notable tendency for the people in the control group, the ones who you haven’t offered peer support to… go out and find it for themselves. They may even find something better than the intervention you designed. In which case, your comparison between the two groups is useless. There are also serious ethical issues with withholding an intervention when the evidence already available suggests it is likely to be helpful. So in effect, research on support groups is always likely to be based around evaluating a programme, probably with strong weight on service user perspectives as to whether it was helpful, rather than a quasi-experimental design. Secondly, this insistence on data is holding support for trans kids to a much higher standard than anyone else. If a charity working with kids with epilepsy, or kids with cerebral palsy, or kids with anxiety said that they wanted to set up a support group for those kids and their families, would anyone be demanding to see their peer-reviewed evidence? Or would we all basically accept that if the charity thought it would be useful, and there was a clear demand from the kids and their parents, then it’s probably a nice idea. We accept that peer support is beneficial in every other area of health care, youth work and parenting support – why should this be an exception requiring a special level of proof?
There’s also a significant issue throughout discussions of trans healthcare – and especially for children – of conflating different aspects of support. News stories and social media commentators often jump around randomly from peer support to social transition to medical interventions, often deliberately obscuring what is being discussed and for what age of child. Hence proposals to run a coffee morning or a youth group get bundled up into discussions about medical interventions. And again, trans charities are consistently held to a much higher standard than anyone else. If an epilepsy charity pointed out that treatment protocols in the US and Canada and Australia were different to those in the UK, and seemed to be having better results, I doubt anyone would think it unreasonable for them to campaign for a review. They might or might not be successful – NHS resources are tight, there may be medical considerations the charities haven’t fully taken onboard – but we would accept their right to ask. And I also doubt anyone would think that such a campaign should be a bar to the charity also running support groups.
For those who are genuinely approaching this issue from a place of wanting better info on how to support kids: great. Do something proactive and positive, preferably following some respectful listening to the kids themselves about what they want and need. Lobby for more investment in health services and community services and yes, in research too. Encourage commissioners and providers and educators to learn from best practice around the world. Champion anti-bullying programmes in schools (we don’t need an RCT to agree bullying is bad, right?) But if all you are doing is making widespread, scattergun criticism, and your criticisms are solely directed towards resisting any provision of any kind of support, then take a long, hard look at yourself. Are you really wanting to help trans kids? Or, in your heart of hearts, are you really just wanting to make them go away, to stop yourself having to see or hear any more about a group of children whose distress you can’t empathise with and whose assertions of need contradict your worldview. And if you suspect that may be a bit of what you’re feeling, if in fact you can’t honestly imagine yourself getting behind any kind of model of support… step back from this. Or at least be honest enough to say that actually, you don’t want to support trans kids at all.