On Keira Bell and Access to Hormone Blockers

I’m currently in the middle of writing a dissertation about how trans people in the UK access medical transition and how it needs to change. This is not the change I am asking for. The waiting list for the Tavistock and Portman Gender Identity Development Services (GIDS) was already disgustingly long (averaging about 34 months). Today, after a ruling from a court case won by a detrasntioned woman and the mother of an autistic gender-questioning child, GIDS has “suspended new referrals for puberty blockers and cross-sex hormones for the under 16s” (NHS spokesperson, The Guardian, 2020). 

Speaking as someone who is autistic, has sort of detransitioned, and has been a patient at both children’s and adults’ gender identity clinics in the UK, I’m highly disappointed. 

Firstly, this feels like another in a long string of misrepresentations of hormone blockers. Hormone blockers don’t do anything permanent. They essentially just pause puberty, giving a young trans or gender-questioning person more time to consider their options. That’s it. It gives a young person time, while relieving them of dysphoria in the present and, potentially, the future. By taking this away, even more unnecessary stress and dysphoria will be being felt by gender-questioning young people all over the counrty. 

Puberty blockers aren’t a “devastating experiment” (Bell, 2020), they’re vital healthcare for incredibly vulnerable young people. Keira Bell, the aforementioned detransitioned woman who won this court case, says that “This judgement is not political” (Bell, 2020) and that’s complete nonsense. The personal is political. Basic healthcare is political. Stopping kids from killing themselves is political. 

It’s a big fucking deal to come out as trans, especially for a child. If they’re sure enough about their gender that they feel able to verbalise it, then they should also be considered mature enough to be able to give informed consent about a non-permanent hormone treatment. Clinical psychologist, Diane Ehrensaft, says that “if we can facilitate a better life by offering these interventions, I weigh that against there might be a possibility that they’ll change later, but they will be alive to change” (Louis Theroux: Transgender Kids, 2015). I would much rather have a few people who have detransitioned, than a bunch of people who wanted to transition but weren’t allowed to (and so will be at a much higher risk of harming themselves).

This court case, which was seemingly based on one person’s experience, has made sweeping generalisations about the needs of gender-questioning young people across the country. Keira Bell made decisions for herself that she now regrets, but that doesn’t mean that other young people should be punished for someone else’s irrelevant mistakes. Bell also only started taking hormone blockers at the age of 16, so why should this new ruling be making such huge decisions about gender questioning people under the age of 16? 

Bell does then go on to say she “would like to personally call on professionals and clinicians to create better mental health services and models to help those dealing with gender dysphoria” (Bell, 2020). I agree with this wholeheartedly. Ultimately, if someone regrets medically transitioning, that’s because they weren’t given the appropriate mental health support before, during, and/or after transitioning. However, she finishes that sentence by asking healthcare professionals to help gender-questioning young people “to reconcile with their sex” (Bell, 2020). Medical transition may not be the only way out of gender dysphoria, but neither is being forced into the sex you were assigned at birth. 

The report of the 2015 US Transgender Survey found that that only about 8% of people who medically transition go on to detransition. So, even if every young person who is given hormone blockers is then deciding to continue their medical transition, the vast majority of them won’t go on to regret that decision. This is not to say that detransitioning/ detransitioned people should be ignored because they’re such a small minority. The subject of detransitioning is a whole other essay that I very nearly wrote, but in short, our (both trans and cis people’s) perceptions of detransition encompasses only a very small part of what detransitioning can be. Detransition is an unnecessarily taboo topic within the trans community and we need to be having new conversations about it in order to reframe it within and outside of our community. The same study also found that only 5% of that 8% detransitioned because they realised they were cis. Take a moment to process that with me. This is groundbreaking information that almost no one is talking about. Only 0.4% of people who medically transition realise that they were cis all along. Detransition and regret are not the same thing. 

By the time I was seen by GIDS, I was 16 but had already gone though most of puberty so decided against bothering with hormone blockers. However, at the age of 17, I started taking hormones but stopped after about six months. I feel incredibly conflicted about sharing my complicated history with taking hormones at a young age, because I don’t want my experiences to stop someone else being able to access the same thing at the same age. If I was to have the choice to go back and take testosterone all over again, I probably wouldn’t bother. I don’t think it relieved any more dysphoria than it caused. I dont think it was worth the hassle for me. I wouldn’t describe my present feelings about this choice as regret because I know it is what I needed at the time. I’m at peace with the negative affects it had on me because I’m in a good place with my mental health and I’m in a supportive environment. 

From my research into the experiences of those who do regret their medical transition, it often happens because they had separate mental health issues, and fell into toxic parts of the trans community that uphold the belief that medical transition is the only thing that can make you happy. Using transness as an excuse for self hatred is not always the same thing as genuine gender dysphoria. 

Detransition also happens because sometimes gender can be fluid. Your gender right now shouldn’t have to invalidate a previous gender. Changing your mind doesn’t mean you aren’t sure. 

Gender-questioning young people need psychological help, not assessments. They need transparency and honesty. They need direct, sensible, helpful, knowledgeable advice about their options, not tests to pass or hoops to jump through. They need to be able to make their own informed decisions about their bodies. They need things to happen quicker not be suspended. They need healthcare and they need it now. 

Bibliography

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