Hannah Barnes’s book about the rise and calamitous fall of the Gender Identity Development Service for children (Gids), a nationally commissioned unit at the Tavistock and Portman NHS Foundation Trust in north London, is the result of intensive work, carried out across several years. A journalist at the BBC’s Newsnight, Barnes has based her account on more than 100 hours of interviews with Gids’ clinicians, former patients, and other experts, many of whom are quoted by name. It comes with 59 pages of notes, plentiful well-scrutinised statistics, and it is scrupulous and fair-minded. Several of her interviewees say they are happy either with the treatment they received at Gids, or with its practices – and she, in turn, is content to let them speak.
Such a book cannot easily be dismissed. To do so, a person would not only have to be wilfully ignorant, they would also – to use the popular language of the day – need to be appallingly unkind. This is the story of the hurt caused to potentially hundreds of children since 2011, and perhaps before that. To shrug in the face of that story – to refuse to listen to the young transgender people whose treatment caused, among other things, severe depression, sexual dysfunction, osteoporosis and stunted growth, and whose many other problems were simply ignored – requires a callousness that would be far beyond my imagination were it not for the fact that, thanks to social media, I already know such stony-heartedness to be out there.
Gids, which opened in 1989, was established to provide talking therapies to young people who were questioning their gender identity (the Tavistock, under the aegis of which it operated from 1994, is a mental health trust). But the trigger for Barnes’s interest in the unit has its beginnings in 2005, when concerns were first raised by staff over the growing number of patient referrals to endocrinologists who would prescribe hormone blockers designed to delay puberty. Such medication was recommended only in the case of children aged 16 or over. By 2011, however, Barnes contends, it appeared to be the clinic’s raison d’etre. In that year, a child of 12 was on blockers. By 2016, a 10-year-old was taking them.
Clinicians at Gids insisted the effects of these drugs were reversible; that taking them would reduce the distress experienced by gender dysphoric children; and that there was no causality between starting hormone blockers and going on to take cross-sex hormones (the latter are taken by adults who want fully to transition). Unfortunately, none of these things were true. Such drugs do have severe side effects, and while the causality between blockers and cross-sex hormones cannot be proven – all the studies into them have been designed without a control group – 98% of children who take the first go on to take the latter. Most seriously of all, as Gids’ own research suggested, they do not appear to lead to any improvement in children’s psychological wellbeing.
So why did they continue to be prescribed? As referrals to Gids grew rapidly – in 2009, it had 97; by 2020, this figure was 2,500 – so did pressure on the service. Barnes found that the clinic – which employed an unusually high number of junior staff, to whom it offered no real training – no longer had much time for the psychological work (the talking therapies) of old. But something else was happening, too. Trans charities such as Mermaids were closely – too closely – involved with Gids. Such organisations vociferously encouraged the swift prescription of drugs. This now began to happen, on occasion, after only two consultations. Once a child was on blockers, they were rarely offered follow-up appointments. Gids did not keep in touch with its patients in the long term, or keep reliable data on outcomes.
A lot of this is already known, thanks largely to a number of whistleblowers. Last February, the paediatrician Dr Hilary Cass, commissioned by the NHS, issued a highly critical interim report into the service; in July, it was announced that Gids would close in 2023. But a lot of what Barnes tells us in Time to Think is far more disturbing than anything I’ve read before. Again and again, we watch as a child’s background, however disordered, and her mental health, however fragile, are ignored by teams now interested only in gender.
The statistics are horrifying. Less than 2% of children in the UK have an autism spectrum disorder; at Gids, more than a third of referrals presented with autistic traits. Clinicians also saw high numbers of children who had been sexually abused. But for the reader, it is the stories that Barnes recounts of individuals that speak loudest. The mother of one boy whose OCD was so severe he would leave his bedroom only to shower (he did this five times a day) suspected that his notions about gender had little to do with his distress. However, from the moment he was referred to the Tavistock, he was treated as if he were female and promised an endocrinology appointment. Her son, having finally rejected the treatment he was offered by Gids, now lives as a gay man.
As Barnes makes perfectly clear, this isn’t a culture war story. This is a medical scandal, the full consequences of which may only be understood in many years’ time. Among her interviewees is Dr Paul Moran, a consultant psychiatrist who now works in Ireland. A long career in gender medicine has taught Moran that, for some adults, transition can be a “fantastic thing”. Yet in 2019, he called for Gids’ assessments of Irish children (the country does not have its own clinic for young people) to be immediately terminated, so convinced was he that its processes were “unsafe”. The be-kind brigade might also like to consider the role money played in the rise of Gids. By 2020-21, the clinic accounted for a quarter of the trust’s income.
But this isn’t to say that ideology wasn’t also in the air. Another of Barnes’s interviewees is Dr Kirsty Entwistle, an experienced clinical psychologist. When she got a job at Gids’ Leeds outpost, she told her new colleagues she didn’t have a gender identity. “I’m just female,” she said. This, she was informed, was transphobic. Barnes is rightly reluctant to ascribe the Gids culture primarily to ideology, but nevertheless, many of the clinicians she interviewed used the same word to describe it: mad.
And who can blame them? After more than 370 pages, I began to feel half mad myself. At times, the world Barnes describes, with its genitalia fashioned from colons and its fierce culture of omertà, feels like some dystopian novel. But it isn’t, of course. It really happened, and she has worked bravely and unstintingly to expose it. This is what journalism is for.
Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children by Hannah Barnes is published by Swift Press (£20). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
