My experience of working in an NHS gender service for children and adolescents
Between October 2017 and October 2018 I worked as a Clinical Psychologist in the Leeds clinic of the Tavistock Gender Identity Development Service (GIDS). I left GIDS because I had serious concerns about the ethics of the clinical practice of prescribing puberty blockers and cross sex hormones to children and adolescents.
In July 2019 I wrote an open letter about my concerns from working in the service: medium.com/@kirstyentwistle/an-open-letter-to-dr-polly-carmichael-from-a-former-gids-clinician-53c541276b8d
My professional experiences of working at Tavistock GIDS are documented in Hannah Barnes' book, 'Time to Think' Swift Press | Time to Think
Psychological interventions for young people with gender dysphoria
Since leaving GIDS in 2018 I have spent a great deal of time learning more about the broader context and the history of paediatric medical transition for children and adolescents with gender dysphoria. As a result of this investigation I have reached the conclusion that there is neither a robust evidence base nor a robust ethical framework from which to prescribe puberty blockers (GnRHa) and cross sex hormones to children and adolescents.
I also believe that changing a child's name and using different pronouns is a significant intervention that must be considered very carefully and that its incredibly important to find alternatives to breast binding for female adolescents. The couple of empirical investigations into the health impact of binding for adults have revealed a wide range of negative effects and there has not been any empirical investigation of the psychological and health impacts on adolescents.
I believe that the ethics of adult medical gender transition require separate consideration and I have not reached a conclusion on this issue yet. I believe that adults should be encouraged and supported to undergo extensive psychological exploration of their gender dysphoria and their wish to start medical gender transition.
I am confident that there are existing psychological therapy models that can be adapted to working with children and adolescents with gender issues. My approach is to understand what is contributing to their distress about their gender, their body and their relationships with others in the context of other significant aspects of their life such as attachment relationships, other mental health or neurodevelopmental issues, experiences of being bullied and so on.
I also believe that clinicians and therapists working with children and adolescents need to have a good understanding of the ever changing landscape of narratives about transgender and medical transition on social media in order to explore their adolescent client's beliefs about gender and medical transition. I encourage parents to be very engaged with their child's activity on social media and I think it is appropriate for parents to set boundaries on their child's social media use.
I fully support children and young people to experiment, play, take age appropriate risks and enjoy their self-expression using clothing, make up, language, theatre, creative pursuits and art. I support young people to give themselves time before making declarations about their gender or sexuality and to develop boundaries that enable them to protect themselves from peer pressure as well as the challenges, stigma and hostility that young people sometimes face in response to their sexuality or gender.
Detransitioned men and women
I have spent a good deal of time studying the public testimonies of detransitioned women and men and I have also started working therapeutically with detransitioned female clients. I have been able to develop a good understanding of some of the needs and challenges detransitioners may face. I am also open to discussing the possibility of providing more practical support for detransitioned people who are looking to challenge the medical and legal systems that they have been impacted by.
Myself and a colleague have a separate project dedicated to working with detransitioners: DETRANS FOUNDATION - Home
I am also concerned about the issue of detrans people with Gender Recognition Certificates not being able to have their birth sex reinstated on their birth certificates. Please contact me if you are trying to resolve this issue.
Dr Kirsty Entwistle (Clinical Psychologist) October 2023.
Recommended Reading:
MindEd Hub (2023)NHS England MindEd Resources for Parents of children with gender related distress
Pilgrim, D & Entwistle, K. (2020) 'GnRHa ('Puberty Blockers') and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression.' https://www.tandfonline.com/doi/full/10.1080/20502877.2020.1796257
Entwistle, K. (2020) 'Reality Check: Detransitioners' testimonies require us to rethink Gender Dysphoria.' https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12380
Michael Bailey and Ray Blanchard (2017) 'Gender Dysphoria is not one thing' 4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/
Peitzmeier et al. (2016) 'Health Impacts of Chest Binding among Transgender Adults' www.tandfonline.com/doi/figure/10.1080/13691058.2016.1191675?scroll=top&needAccess=true
Anna Hutchinson and Melissa Midgen 'The Natal Female Question' 17th Feb 2020 womansplaceuk.org/2020/02/17/the-natal-female-question/?fbclid=IwAR3r_IEd4VARdtF6DCv_EJT0bEBW9oHQ7nFCFDHAyTJOMRhhwfgLSg-xo7w
Between October 2017 and October 2018 I worked as a Clinical Psychologist in the Leeds clinic of the Tavistock Gender Identity Development Service (GIDS). I left GIDS because I had serious concerns about the ethics of the clinical practice of prescribing puberty blockers and cross sex hormones to children and adolescents.
In July 2019 I wrote an open letter about my concerns from working in the service: medium.com/@kirstyentwistle/an-open-letter-to-dr-polly-carmichael-from-a-former-gids-clinician-53c541276b8d
My professional experiences of working at Tavistock GIDS are documented in Hannah Barnes' book, 'Time to Think' Swift Press | Time to Think
Psychological interventions for young people with gender dysphoria
Since leaving GIDS in 2018 I have spent a great deal of time learning more about the broader context and the history of paediatric medical transition for children and adolescents with gender dysphoria. As a result of this investigation I have reached the conclusion that there is neither a robust evidence base nor a robust ethical framework from which to prescribe puberty blockers (GnRHa) and cross sex hormones to children and adolescents.
I also believe that changing a child's name and using different pronouns is a significant intervention that must be considered very carefully and that its incredibly important to find alternatives to breast binding for female adolescents. The couple of empirical investigations into the health impact of binding for adults have revealed a wide range of negative effects and there has not been any empirical investigation of the psychological and health impacts on adolescents.
I believe that the ethics of adult medical gender transition require separate consideration and I have not reached a conclusion on this issue yet. I believe that adults should be encouraged and supported to undergo extensive psychological exploration of their gender dysphoria and their wish to start medical gender transition.
I am confident that there are existing psychological therapy models that can be adapted to working with children and adolescents with gender issues. My approach is to understand what is contributing to their distress about their gender, their body and their relationships with others in the context of other significant aspects of their life such as attachment relationships, other mental health or neurodevelopmental issues, experiences of being bullied and so on.
I also believe that clinicians and therapists working with children and adolescents need to have a good understanding of the ever changing landscape of narratives about transgender and medical transition on social media in order to explore their adolescent client's beliefs about gender and medical transition. I encourage parents to be very engaged with their child's activity on social media and I think it is appropriate for parents to set boundaries on their child's social media use.
I fully support children and young people to experiment, play, take age appropriate risks and enjoy their self-expression using clothing, make up, language, theatre, creative pursuits and art. I support young people to give themselves time before making declarations about their gender or sexuality and to develop boundaries that enable them to protect themselves from peer pressure as well as the challenges, stigma and hostility that young people sometimes face in response to their sexuality or gender.
Detransitioned men and women
I have spent a good deal of time studying the public testimonies of detransitioned women and men and I have also started working therapeutically with detransitioned female clients. I have been able to develop a good understanding of some of the needs and challenges detransitioners may face. I am also open to discussing the possibility of providing more practical support for detransitioned people who are looking to challenge the medical and legal systems that they have been impacted by.
Myself and a colleague have a separate project dedicated to working with detransitioners: DETRANS FOUNDATION - Home
I am also concerned about the issue of detrans people with Gender Recognition Certificates not being able to have their birth sex reinstated on their birth certificates. Please contact me if you are trying to resolve this issue.
Dr Kirsty Entwistle (Clinical Psychologist) October 2023.
Recommended Reading:
MindEd Hub (2023)NHS England MindEd Resources for Parents of children with gender related distress
Pilgrim, D & Entwistle, K. (2020) 'GnRHa ('Puberty Blockers') and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression.' https://www.tandfonline.com/doi/full/10.1080/20502877.2020.1796257
Entwistle, K. (2020) 'Reality Check: Detransitioners' testimonies require us to rethink Gender Dysphoria.' https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.12380
Michael Bailey and Ray Blanchard (2017) 'Gender Dysphoria is not one thing' 4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/
Peitzmeier et al. (2016) 'Health Impacts of Chest Binding among Transgender Adults' www.tandfonline.com/doi/figure/10.1080/13691058.2016.1191675?scroll=top&needAccess=true
Anna Hutchinson and Melissa Midgen 'The Natal Female Question' 17th Feb 2020 womansplaceuk.org/2020/02/17/the-natal-female-question/?fbclid=IwAR3r_IEd4VARdtF6DCv_EJT0bEBW9oHQ7nFCFDHAyTJOMRhhwfgLSg-xo7w
