The UK's National Health Service (NHS) is reforming its Gender Identity Development Service (GIDS) at the Tavistock Centre in London following the findings of an independent report that alleged that its practices "were not safe" for children and young people. The center has been under investigation since psychotherapist Marcus Evans, a former member of the Board of Governors, resigned in 2019 claiming that the minors needed "more therapy and not just 'affirmation' and medication."
In an article published in Spiked, Evans echoes the results of Dr. Hilary Cass' independent study from February of last year. She recommended a radical change in GIDS methodology. Following the publication of the report, the NHS announced that it would close the Tavistock Centre and that other regional centers would be created to "ensure that the holistic needs" of patients are fully addressed, following the study's recommendations.
Taken a long time, many articles, interviews documentaries a judicial review & now a book. But finally this issue is where it needs to be @hannahsbee Group of clinicians at Tavistock raised ‘serious concerns’ over functioning https://t.co/EAv19VHdYG via @YouTube @sueevansprotect
— marcus evans (@marcuse99903226) February 18, 2023
8,000 minors awaiting gender affirmation treatment
One of the main points, already criticized by Evans in an earlier article in Quilette explaining his resignation, is the abusive use of puberty blockers, with hardly any follow-up and prior study of the patients. Both Cass and Evans insist that the use of these drugs does not have enough of an experimental basis to ensure that their benefits outweigh the harmful effects they cause in the long term. In fact, another major complaint is the lack of long-term follow-ups in patients, especially when they are no longer teenagers and have to come to terms with the consequences of a sex change.
The number of minors and young people requesting to undergo gender affirmation or sex change procedures has multiplied exponentially in recent years. In 2019, Evans stated that the number of appointment requests had increased by 400% since 2014. Currently, the psychotherapist, who criticizes the Tavistock Centre for remaining open and operating under the same protocols a year after the report was published, says that there are about 8,000 people on the waiting list.
Pressure on therapists
In 2019, Evans resigned as a governor of the center due to pressure on therapists to prescribe drugs and to identify minors by the gender identity they claim to have, without further inquiry into their family, physical or psychological situation or even whether they had any other type of previous psychiatric pathologies. Evans left his position after the center's management decided to ignore letters from several parents complaining that their children had been fast-tracked through GIDS without any serious psychological evaluation. He also said that the center disregarded a doctor's report who expressed having serious ethical issues with the center's procedures in this regard.
As a governor of the Tavistock Trust, I personally witnessed attempts by the Trust’s management to dismiss or undermine both Dr. Bell’s report, which he submitted in late 2018, and the letter from parents. This included accusing Dr. Bell of fictionalizing the case studies he described, questioning his credentials, withholding his report from certain governors, and preventing him from attending a meeting to discuss the Medical Director’s response to his report.
Pressure on patients to undergo surgery
In Dr. Bell's letter, the expert criticized "inadequate clinical assessments, patients being pushed through for early medical interventions, and GIDS’ failure to stand up to pressure from trans activists." These complaints were raised in 2005 by former center employee, and Marcus' wife, Susan Evans, who was concerned about the speed with which children were being referred to the medical track. The way in which the center's management ignored these complaints led the psychotherapist to resign in protest.
2019 feels like an age ago but thanks to @SkyNews for covering this. https://t.co/vK0ev9fJdC
— marcus evans (@marcuse99903226) February 18, 2023
Tavistock is still open with the same protocols
Evans said this did not change the Tavistock management's understanding of the gender dysphoria situation or the way they dealt with it. According to the expert, the main problem with GIDS is that "Many of those at GIDS remain committed to a shared set of beliefs about gender and identity, which define how they see themselves in relation to the rest of the world. They believe themselves to be part of a progressive group with virtuous principles. And they are determined to hold on to these beliefs, even in the face of evidence that challenges them."
Judicial setbacks haven't made the center reconsider its practices. They have made it clear that Tavistock does not follow up with children who have undergone gender reassignment treatment, not even those who have undergone gender reassignment surgery. There hasn't been any additional research on the long-term effects. Also, at the request of the court, they were forced to acknowledge that they do not perform studies on patients that would reveal other possible previous conditions such as those within the autism spectrum.
Therapists fear they'll be accused of being transphobic
Evans believes this is because "GIDS feared what the research and follow-up might have revealed. From my own experience, I know that many who undergo gender reassignment can endure significant subsequent struggles."
According to the psychotherapist, this is not a simple mistake, but a problem of imposing ideological beliefs on a group that won't question them. In fact, Evans points out that, although many experts share his views, they refuse to come forward for fear of being labeled bigots or transphobes and being attacked for violating human rights. This is something that some physician groups, such as the American Pediatric Association, have helped to promote by encouraging physicians to recognize the sex that minors identify with.
Too often, clinical work has been based on ideological beliefs about gender. It has too often promoted short-term solutions-for example, puberty blockers for psychological pain problems. This approach has long-term costs. It means that young people are consenting to medical pathways that have serious long-term implications.
Journalists interviewing me after my resignation in Feb 2019, often asked why I was the only clinician who would go on record questioned what was going on? Only a few others would speak, all anonymously, until Kirsty Entwistle @thetimes @hannahsbee https://t.co/Tt8FibTVsN
— marcus evans (@marcuse99903226) February 26, 2023
Increase in suicide attempts among patients with regrets
However, in his extensive professional experience, Evans stated that "young people presenting with gender dysphoria – a sense that there’s a mismatch between their biological sex and their gender identity – usually have complex comorbid difficulties. They could, for example, also be on the autistic spectrum, suffer from anxiety disorders, have a history of trauma or of physical problems," says the specialist, who claims "it is dangerous to focus solely on gender identity issues."
This is so dangerous that, during his time evaluating people who had attempted to take their own lives or had suicidal gestures, he discovered that many of them reached that point after regretting having undergone a sex change. "A number of my patients had gone through gender-reassignment surgery, and often were angry at the loss of their biological sexual functioning. They also were aggrieved with psychiatric professionals, who, they believed, had failed to adequately investigate the underlying psychological difficulties associated with gender dysphoria," Evans said.
I observed that patients who had a history of serious and enduring mental illness or personality disorder sometimes would also develop gender dysphoria. A common theme in their presentations was the belief that physical treatments would remove or resolve aspects of themselves that caused them psychic pain. When such medical interventions failed to remove their psychological problems, the disappointment could lead to an escalation of self-harm and suicidal ideation, as resentment and hatred toward themselves was acted out in relation to their bodies.
Desire to fix their existential problems with surgery
Many of these people, Evans insists, want to believe that all their feelings of doubt, conflict and confusion stem from gender dysphoria and have a medical solution: sex change. Evans radically disagrees with this and warns therapists to study patients carefully: "But a child’s certainty about suffering from gender dysphoria does not justify putting said child on a medical pathway. On the contrary, an individual [who is] highly certain about needing a specific medical intervention – and one with such long-term consequences – should be seen as a red flag."
The transition from childhood to adulthood has always been turbulent. It is a period of great social, physiological and psychological change. And it can lead to an individual feeling that his or her body and mind are out of control. This is one of the psychological attractions of reducing all of one’s problems to the issue of gender and seeking out a medical intervention like a puberty blocker. It stops the developmental process that accompanies so much turbulence. However, there is little evidence to suggest that such an intervention helps in the long run.
Young people "do not need gender services"
Something that has not been taken into account in GIDS, according to Evans is the following: "I would argue that the model of care on offer at GIDS does not meet young people’s needs. They don’t need gender services; they need good children and adolescent mental health services (CAMHS). These services take a holistic approach. They look at the individual in the broadest possible sense and assess his or her psychological state, including comorbid conditions and family dynamics."
Evans criticizes therapists who impose "their idea of what is “normal” on a patient who believes he or she is trans." According to the expert, the therapist "must resist the temptation to suspend curiosity, uncritically accept the patient’s presentation at face value, and then act as an “affirming” cheerleader for life-changing acts of transition." Evans also stated that "the goal of exploratory therapy should be to understand the meaning behind a patient’s presentation in order to help them develop an understanding of themselves, including the desires and conflicts that drive their identity and choices."
"Tragic long-term consequences"
In fact, Evans said that gender-affirming therapies will eventually lead to an "opioid-like" crisis due to physicians who only say "yes" to patients instead of helping them and saying "no" if necessary.
Practitioners understandably want to protect their patients from psychic pain. But quick fixes based only on self-reporting can have tragic long-term consequences. And already, a growing number of trans “desistors” (also known as detransitioners) are seeking accountability from the medical professionals who’d rubber-stamped their trans claims. And in 2019, when a formerly trans-identified British woman named Charlie Evans went public with her desistance, she was contacted by “hundreds” of other desistors, and formed a group called The Detransition Advocacy Network to give them a voice and support in a contentious environment that has been dominated by dogmatic trans ideology.
