Survey of Referrals to a Gender Identity Clinic.

This paper surveys 5 years of referrals to an Oxfordshire Gender Identity Service, up to 2009. Its well worth looking at this paper because it sheds light on  the typology of referrals.  It also raises the issues of informed consent, co-morbidities, sexual motivation and, crucially,  highlights the huge change in the sex of referrals.

See below for a brief summary of the methodology:

We have seen a dramatic shift from mainly male, in this paper,  to overwhelmingly  female in the decade since. Turns out biological sex is a factor. Current youth referrals are now 75% female. This is a striking change as highlighted by ex staff from the UK’s main Gender Identity Service (The Tavistock). Over 40 staff have left over a three year period, some after expressing  concerned about the response to this changing demographic. (Clips from an article in the Times of London. Full Article here.  (Paywall)  Feels Like Gay Conversion ⇓

As always, feel free to skip my commentary and read the entire paper yourself. You can find it here

This paper pre-dated the changes to the Diagnostic Statistical Manual; which no longer refers to Gender Dysphoria as a “disorder”.  Activists fought long and hard to change the way this condition was described, to remove any reference to “disorder.  The modern narrative is that our children are simply “assigned” the wrong sex at birth.  To develop a sense of Gender, at odds with your sex, is now presented as a normal/natural variation and hence de-pathologized.  Well worth reading Dr Ann Lawrence (Transsexual) on the politics behind this change. (Will add link when Dr Lawrence’s website is back after maintenance)

• The above paragraph emphasises the rarity of this condition and the high incidence of co-morbidities in the community; i.e.  the existence of other mental health issues in the Trans community. Axis 1 disorders are at the most acute level and include schizophrenia and depression.  The paper is authored by psychiatrists who were specifically focussed on concurrent and historic, diagnoses of mental health issues.

Other notable features were the low rate of funding approvals for surgery, the rise in self-medicalisation, the prevalence of mental health issues and a disturbing finding of clients who admitted to paedophilia.

As with many other papers the rates of referrals, from those with a diagnosed autistic spectrum disorder, is also noticeable.  The authors note that, in the main, their sample did not differ significantly from the findings of other research. They do note, however, the mental health issues were slightly lower than in other findings.  The youth of the female subjects is noted.

Below is a breakdown of how many of the subjects were already accessing hormones obtained over the internet, without any medical oversight. Over 50% had either a current or pass mental illness.  Depression was the most common diagnosis.

This study is to look specifically at psychiatric diagnoses so it is striking that none had a formal diagnostic interview.  The authors  conclude that comorbidity is, therefore, likely to be underreported.  It would be interesting to see if the location in a student population influenced the rate of young females presenting at the service.  ( I do wonder if there will, eventually, be a retrospective review that draws comparisons to females who succumbed to anorexia. My own personal experience was that it impacted, highly motivated/academic females at a disproportionate rate)

Reading the quote below it is refreshing to see reference to issues of capacity to consent in relation to those on the autistic-spectrum.  For those of you on twitter it is instructive search   “top surgery” and see how many openly proclaim “autistic” in their personal biography.  I also signpost you to the  #WeAreNotConfused hashtag. This was started to refute any notion that the high prevalence of Autistic youth, with Gender Dysphoria, was an issue of concern.  A response which was a reaction to the open letter by JK Rowling which you can read here.

Expressing concern about the high number of autistic females suffering from Gender Dysphoria is not deemed an acceptable opinion within the field of Gender Identity Specialists.

The reference to paedophilia  in this paper also triggers push back on social media.  It would be interesting to know exactly how this information came into the possession of the clinicians undertaking the assessment.  It would seem that this must have relied on a personal disclosure based on the wording below:

This is an unmentionable subject on twitter as it has echoes of the association of paedophilia with gay males.  Gay activists were quite right to push against such an insidious narrative.  At the same time Safeguarding101 is DO NOT  create a priest class, who are beyond reproach.  It is not that priests became paedophiles.  Its that paedophiles became priests.  Remember this when people push aside safeguarding concerns because transphobic.  

To finish I am going to include this clip again.  Pay attention.  Reasons for non-referral were that the person was deemed not to be ready, or homosexual or having an autistic-spectrum disorder.

Now watch last night’s Newsnight segment here:  Tavistock  Ask yourself what has happened to make clinicians throw caution to the winds in the last 10 years?