[00:00:00]
Basia Cummings: Hello, it’s Basia here and you’re listening to The Slow newscast from Tortoise. Last year, we set out to tell the story of an institution that found itself at the centre of a fierce battle over trans healthcare and rights. The journalist, Polly Curtis spent months investigating what had really gone on at England’s only NHS clinic, which treats children and young people who are questioning their gender.
[00:00:24]
Helen Webberley: I would start from an acceptance that there are individuals who, for the course of their life, will continue to identify in a particular way.
Polly Curtis: But are there also individuals who won’t?
Helen Webberley: Absolutely.
Polly Curtis: How do you know the difference between the two if you’re making a decision to refer for puberty blockers?
[00:00:52]
Basia Cummings: In the tavistock. Inside the Gender clinic, polly set out to answer a question is it right to give puberty blockers and hormones to trans children? But over the course of the six part series, a more complex picture emerged.
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Polly Curtis: And maybe the whole story of what went wrong at The Tavistock tells us something bigger about the ideological age we’re living in, where these battles are dividing generations and breaking families, and how these arguments at the extremes don’t allow for the truth, which is nearly always in that grey area.
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Basia Cummings: The series was set against the news that the service was closing.
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Woman: I was in the kitchen looking at my phone, talking to other parents, and we were happy. We’re very happy.
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Man: I saw the breaking news notification and I just thought it felt like a punch in the garden.
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Basia Cummings: News that was welcomed by the Tavistock’s critics, but a source of despair to those who saw it as a lifeline because it was the only route for young people to seek treatment for gender dysphoria on the NHS. Since that announcement, the deadline for a new service to open this spring has come and gone. So there’s a kind of limbo. But there’s one aspect to this story that we didn’t cover in that series, and that’s the role of private medicine. It’s been there all along, but now, in this limbo, it’s an even more important story to tell. This week on The Slow newscast, polly investigates the world of private providers treating young trans people. Over to Polly.
[00:02:49]
Polly Curtis: The story of The Tavistock’s Gender Identity Development Service is the story of an institution operating in an evidence vacuum and engulfed by a culture war. First, the clinic stood accused by trans rights activists of being too slow to treat young people with puberty blockers and hormones. Then it stood accused by some of its own clinicians of rushing untested treatments. The truth is that both those things happened depending on the Tavistock clinician. You saw some prevented treatment, people felt they needed some, fast tracked it too quickly. All were tasked with an impossible judgement. How do you clinically assess whether a young person will still be trans in years to come, or whether it’s just a staging post in their development? There was no rulebook and without any decent evidence, some of those judgments became a leap of faith. Internal tensions at the clinic spilled out into the open and landed the Tavistock’s centre stage of the furious row over trans healthcare. But there’s another complicating factor to the story of the Tavistock. It’s always been there on the margin and it keeps on coming up.
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A TIF: I tried going privately for my testosterone.
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Patient: It was taking so long. I’d looked at going private with Gender GP.
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Polly Curtis: Often it’s just a throwaway line in the conversation.
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A TIF: And what happens in Practise is people go to a private route, it doesn’t stop something from happening, it just stops it from happening in a way that it’s actually financially accessible.
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Polly Curtis: As the waiting list for the Tavistock grew, more teenagers paid to go private. And when a judicial review of the Tavistock service halted treatment for a time, it became the only route. Staff at the Tavistock could only watch on.
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GIDS clinician: Their body was starting to masculinise and the parents decided to seek treatment privately. So they sought treatment through a private provider.
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Polly Curtis: Because you hadn’t referred them?
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GIDS clinician: We weren’t in a position to refer because of the judicial ruling. I knew the family young person for many years and we had done the sort of extended assessment. It had been extended a bit longer because actually, I didn’t think that the child was sufficiently mature enough, I think, to make a decision.
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Polly Curtis: Time is one of the big tensions in this story. For teenagers whose bodies are developing according to their birth sex, it can become a race against the clock to access treatment. Currently, the Tavistock is taking no new patients and the first new services aren’t due to be up and running until the autumn. Patients can be added to the waiting list, but they’re likely to have to wait years before they’re seen. If you’re looking for specialist help right now, there is nothing on the NHS and the private sector is stepping in.
[00:05:49]
Helen Webberley: I’m not that savvy on the whole business side. But I said that …
Polly Curtis: You described yourself as a businesswoman.
Helen Webberley: I know, but I’m not. I’m a doctor. At the end of the day, I’m a doctor. Peddling in business.
[00:05:59]
Polly Curtis: In the limbo between NHS services, I wanted to investigate where people are going for help now and how the Peddling private sector is stepping in. Most of all, I wanted to know whether these services are safe, because when the NHS falls away, who can you trust? One parent describes it to me as the Wild West.
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Helen Webberley: Hello. One more.
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Polly Curtis: Helen Webberley is 56 and lives in central Cardiff with her husband and one of their five adult children. Do you want us to leave our shoes here?
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Helen Webberley: No, it’s fine.
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Polly Curtis: She’s welcoming, warm and relaxed.
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Helen Webberley: My name is Dr Helen Weberley. I’m a GP and a gender specialist. I live in Wales and I’m the very proud founder of Gender GP.
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Polly Curtis: I expect her to be more wary of journalists, given some of the highly public and contentious battles she’s fought over the course of our four hour long conversation. She is open and passionate rather than guarded in her telling of her story.
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Helen Webberley: I love being the kind of person that will sit on the edge of the bed and hold that person’s hand and say, I understand this is really scary for you and I’m going to do all I can to help you and your family.
[00:07:26]
Polly Curtis: Helen Webberley trained as a GP, but was always more interested in how people felt than in complex diagnoses. She says she always has to look up the right prescription, but she can read her patients like a book. She had no specialism in gender. It all started for her in 2015, when a patient walked into her surgery in Blanau in the valleys of South Wales.
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Helen Webberley: One day a person came in who looked, to all intents and purposes, like a man and we chatted and then they came back another week later and I noticed, well, this time I noticed that they were wearing a bra and they had pink nail varnish on. And we chatted and then next time there was a few more female attributes that they presented with. And I was like, So you want to take female hormones, like to grow breasts and things like that? And she was like, yes, that’s what I want to do. And I was like, wow, that’s just wow, that’s just goodness. I couldn’t kind of get my head around it, that that would be something that I could possibly do or that somebody or that would be right, really.
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Polly Curtis: She did the research and learnt about the adult service at the Tavistock. But looking at her patient, who’d never left Wales before, she thought they couldn’t manage the journey to London, let alone repeat visits.
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Helen Webberley: So I said, let’s I’ll do it. I said, I’ll do it’s fine. I just knew it was the right thing to do, so I did it and it really helped her.
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Polly Curtis: As I talk to Helen Webberley, I’m struck by how she’s so sure her instincts are correct that she just knew it was the right thing to do. Even early on, when she knew so little about treating gender dysphoria. She’s a million times more certain than the director of the Tavistock Clinic, Polly Carmichael, who told me much of their job was about managing uncertainty.
[00:09:24]
Polly Carmichael: The service was and continues to be about, which is, a sort of genuine curiosity and not having all the answers and managing the uncertainty about the outcomes for these young people.
Polly Curtis: Helen Webberley prescribed cross sex hormones for her patient. Did it feel like an important moment in your life?
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Helen Webberley: Definitely. I’ll never forget her, never forget that gratitude. I never forget the way something so small that I could give this person would mean so much and make such a difference.
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Polly Curtis: Helen Webberley strikes me as a restless soul she’s always looking for something new to get her teeth into. She also says that she has an entrepreneurial streak.
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Helen Webberley: And over the years, I’ve tried all kinds of things. I bought some commercial properties and there was a cafe in one of them and I’m like, okay, I’m going to run a cafe. And then there was one time I was like, okay, I’m going to buy some brown furniture on ebay and I’m going to do it up and sell it for loads of money. I bought a campervan and I made a little website called Hire Me. If I look back, I was waiting for some kind of idea that would come through.
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Polly Curtis: Helen Webberley tells me she loves new technology and in 2015, she’s drawn to Telemedicine and the burgeoning world of private online Practise. So she builds a website to share her medical knowledge. She adds diagrams and information to help people better understand a whole range of conditions. There’s a page about HRT, and then she adds a page for transgender healthcare, based on what she’s learned from that first patient.
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Helen Webberley: The way it feels like in my head is that I made it on that day, and then when I woke up the next day, it’s like, oh, my goodness. It’s almost like it’s like a massive snowball has just rolled down the hill. And now it’s huge.
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Polly Curtis: By luck or algorithmic design, that page starts to rank very highly on Google search for trans healthcare, and it’s the first thing that came up. It’s getting thousands of hits.
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Helen Webberley: People were emailing me and reading the stuff that I was writing, and so I took this page off there and I made a new website specifically for transgender information and care and called it Gender GP.
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Polly Curtis: And that’s how Gender GP is born. A trick of an algorithm, just at the point where there’s a huge surge in the numbers of young people seeking help for gender dysphoria. As the emails pour in, dr Webery starts consulting privately with them and prescribing the hormones they say they need. There were no alarm bells going off in your head thinking, Is this right?
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Helen Webberley: It’s not at all. It just felt fine. It felt, I’m a doctor, I have a medical degree, I have a licence to practise medicine.
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Polly Curtis: Was it exciting?
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Helen Webberley: Tremendously exciting, to have people say, oh, my God, you’re the first person that’s ever understood me, the first person who’s ever listened to me. I’ve been to see so many people, and you’re the first person that’s ever made me cry with happiness rather than cry with sadness. And all my patients were telling me that. And what I was noticing with these transgender patients is it was just immensely rewarding. The fear at the beginning of the consultation and then the joy at the end of the consultation when they’re just, like, crying with relief. I mean, just amazing job satisfaction.
[00:12:41]
Polly Curtis: It sounds like an almost intoxicating experience for Dr Webberley. She was hooked. Initially, she only sees adult patients, but that changes in late 2016. Can you remember the first child who came to you?
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Helen Webberley: 100%. It’s like these marker moments, isn’t it? And I was in a taxi on my way to theatre with my sister. We were going to see an amateur dramatics production in Manchester at Theatre. And I checked my phone for my emails and there was an email from a 16 year old and he said, Hello, Dr. Webberley. I’m transgender. And I know that you help people and I know that I’m only 16 and I wonder whether you’d help me. And I was like, oh, my God, now what am I going to do? And I showed my sister and I said, oh, and she’s a schoolteacher, actually. And she was like, oh, Helen, you can’t. She said, that’s just taking it too far. These are children, these are young people. That’s just too much. You can’t do that.
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Polly Curtis: But Helen Webberley is not one to shy away from a challenge. In fact, she runs towards it.
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Helen Webberley: So I saw him in my clinic and I was like, yeah, you are a boy. You got a few girly attributes going on there, but you’re a boy in and out.
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Polly Curtis: She prescribes the testosterone he and his mother are asking for .
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Helen Webberley: These trans masculine people who’ve got a female oestrogen hormone profile, and you give them the testosterone profile that their body is craving for and it just unleashes life like you’ve never seen it.
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Polly Curtis: That idea that someone’s body might crave the hormones of the opposite gender is highly contested.
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Helen Webberley: Their emotions start matching their identity and then when they get their first crack in their voice or their first hair on their chin, it’s just like Christmas all at once. It’s truly phenomenal to watch it develop. As a doctor.
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Polly Curtis: When I was talking to the staff at the Tavistock, they told me that they start by accepting that what a young person is feeling is real, rather than questioning it. That’s what they mean by an affirmative approach. It seemed to me that, at least in theory, this was a tactic designed to build trust with a young person before taking them on a more exploratory therapeutic journey, which might last several years before the start of any medication. Of course, the reality at the Tavistock was that things varied enormously. Some clinicians accepted their patients gender identity at face value. Others were more probing. At Gender GP It’s clearly very different. She says she never doubts what her patients say to her. She won’t question their experience.
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Helen Webberley: Counsellors, psychologists, therapists are all vital parts of this, but I saw that they were being used to do the assessment, the assessment of whether you are transgender or not. And I’m like that’s such a waste. Why don’t we believe that they are transgender and then use those psychologists and counsellors and therapists to help somebody in their journey? And if in that helping somebody in their journey, it actually becomes clear that they’re not transgender at all. We haven’t lost anything, we haven’t cut anything off or changed anything. We’re just working through it and actually that’s never happened.
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Polly Curtis: Helen tells me this a few times, that nobody who’s been treated by Gender GP has ever changed their mind, that circumstances change but identity doesn’t.
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Helen Webberley: We’ve never had anybody who hasn’t been transgender. There have been people who have said, I can’t do this, I’m going to stop. Never had someone who’s changed their mind. You know that horrific thing that people are so scared about? I’ve just not seen it.
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Polly Curtis: So when you talked about that first teenager who came to you and when you first met them, your response was, you’re a boy. Was that an assessment?
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Helen Webberley: It’s a belief, it’s a confirmation.
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Polly Curtis: She’s telling me that at Gender GP, diagnoses are made on belief rather than clinical judgement. The first teenager Dr Webberley saw was 16, but the child who changed everything for her was 12 and came to be known as Patient A. Patient A was referred to Helen Webberley by Susie Green, who at the time was chief executive at the trans young people charity Mermaids. Today, Susie Green works in fundraising for Gender GP, raising money for people who can’t afford treatment. Patient A was born biologically a girl and had a twin who was also a girl. But for as long as everyone could recall, patient A had presented as a boy. Patient A was already being treated by the Tavistock and had been prescribed puberty blockers. But under their rules, they would have to wait until they were 16 to get the cross sex hormones to start their puberty as a boy.
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Helen Webberley: And this 12-year-old sitting in front of me was the most boy thing I’ve ever seen, if you like. And he was saying, when can I have my puberty? When can I have my puberty? And GIDS was saying, when you’re 16, not to be 16, definitely not to be 16. And it’s like, I can’t wait that long. So that’s why they came to see me. As soon as I saw him, I’m like, I’ve never seen it more obvious, kid, that needs to start puberty now.
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Polly Curtis: The most boy thing I’ve ever seen. Is that enough? It feels flimsy to me to diagnose someone in this way. It also assumes rigid gender stereotypes in which girls are girly and boys are boyish.
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Helen Webberley: Otherwise, when? 13? 14? 15? 16? What’s going to happen? This kid would not have made it. He definitely wouldn’t have made it. You know, Mum was saying that he would she didn’t think that he would make it properly, like suicide make it if we didn’t do something. And I believed her. And so we treated, so I treated, I treated him. I knew it was a brave thing to do, I knew it was an unusual thing to do, but it felt absolutely the right thing to do, but it was the one that started all the trouble.
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Polly Curtis: The trouble came thick and fast. In 2017, Helen Webberley was prevented from practising medicine by the General Medical Counsel, the GMC, over her treatment of Patient A and two others. In 2018, she got a criminal conviction for operating a medical practise without a licence. So Gender GP moved its registered office to Hong Kong to escape UK regulations. It’s now registered in Singapore. In 2022, her husband, Dr Michael Webberley, was struck off by the GMC for what they described as a catalogue of failings over how he treated young people and prescribed puberty blockers and cross sex hormones. The GMC also found he’d failed to adequately assess patients. Then, in March this year, the High Court rejected a previous ruling against Helen Webberley, which had found that she had failed to give proper advice to a patient about the impact of hormonal treatment on their future fertility. In that judgement, Mr Justice Kay was clear that his decision was in no way a verdict or endorsement of the work of Gender GP.
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Judge Kay (voiced by an actor): The sole focus of this appeal has been the quality of the Appalache clinical practise in relation to one patient, patient C. This appeal does not raise any wider issues about the wisdom or otherwise of administering puberty blockers to the younger age group who wish to undergo interventions for gender reassignment with full parental agreement.
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Polly Curtis: Throughout the GMC battle, Gender GP has been operating without Helen Webberley, using remote therapists and doctors to carry out consultations. But now she is free to practise again.
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James Barclay: I think what I’ve seen is more and more young people who’ve been accessing treatment through the through the private sector.
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Polly Curtis: The arrival of Gender GP back in 2015 was felt inside the Tavistock.
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James Barclay: I’m just trying to think when it first became more aware, I mean, it began, it seemed to begin around sort of 2015, 2016 sort of time.
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Polly Curtis: That was when Gender GP launched.
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B: Was that apparent to you that that was happening?
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James Barclay: Yeah.
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B: Conversation internally about that.
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James Barclay: I think the conversation around that was, is this provider working within the agreed guidance? And if they were working within that guidance, I suppose that sort of led us to think about, well, what, what were they doing, what was, what were the assessments?
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Polly Curtis: James Barclay is a senior clinician at the Tavistock Clinic. He’s always struck me as a measured and honest voice in this story, so measured that he’s careful about how he responds to questions about the more troubling elements of private trans healthcare.
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James Barclay: We have our model of work. It can kind of cut across that, I suppose, because I think we like to sort of take quite an exploratory assessment and evaluate approach, quite a steady approach, and private lives have a different model, really. And I think there’s a bit of a worry about is sufficient time given to that sort of approach, to really exploring things there’s. So much ground to cover, I would say, in the work. I suppose I’d ask, how does another clinician reach an informed view, a safe view that this is an appropriate step to take?
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Polly Curtis: As the waiting list for the Tavistock grew, james Barkley was seeing something new patients arriving, already on medication, obtained privately. Suddenly, the Tavistock wasn’t the only route to puberty blockers in town, which is.
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James Barclay: Quite a tricky situation to navigate because the family are coming with good intentions. They’re trying to do their very best. Their young person what they’ll say they’ve exhausted all the attempts and trying to support the young person, keep the young person going. It’s usually a sign of how desperate, I think, that people feel.
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Polly Curtis: Gender GP can’t or won’t tell me how many patients they’ve treated since they started. They confirmed there are currently nearly 10,000 patients on their list. More than a thousand of those are below the age of 18. Their website promises a multidisciplinary team approach. There are information gathering sessions, follow up discovery sessions and optional counselling, all of which is done online. Doctors working for Gender GP prescribe the medication privately, but they do sometimes work with NHS GPs to advise on drug regimes. Pharmacists can decline to honour private prescriptions, but Gender GP says it has a network of providers willing to work with them.
Polly Curtis: Getting hold of the medication isn’t the only challenge for private patients. Some need to find someone to give them injections or they need to learn to do it themselves. And all need regular blood tests to monitor for side effects. Then there are the costs. I’ve got their price list up on my screen. So it starts with a £195 setup fee. There’s a monthly subscription of £30 pounds and then sessions range from £30 to £65 an hour. Remember, Gender GP has around 10,000 patients on its books right now, so if they were all to pay that monthly subscription, that’s a monthly revenue of £300,000. Then there are the prescription costs. Those range from £28 for three month supply of Oestrogel to £40 pounds for one month supply of Testogel. Puberty blocking injections come at about £270 pounds for a three month supply. Helen Webberley says she’s never had a complaint from anyone she’s treated. I’ve spoken with parents who have accessed drugs privately and watched as their children’s bodies changed over months and they felt relieved and happy for them. But others are worried about what’s happening.
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Sarah: Mother’s Day last year, she just turned 17 and we were at a cafe having breakfast together with me and my son.
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Polly Curtis: Sarah’s child is one of those who has used Gender GP. Sarah is not her real name and she’s voiced by an actor.
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Sarah: Then she hit me with this on trans thing and my preferred name is Jack, but you don’t have to call me that until you feel ready. And my pronouns are he and I just kind of I didn’t know what to think, really. I just kind of looked at her and I said, well, okay, thank you for telling me. And I can see that you’re quite nervous about telling me, that’s okay. But you need to give me time and I’ve got questions that I’d like to ask you about later.
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Polly Curtis: Sarah’s instinct at that breakfast was to stay calm, process the news and work out how she felt, but more importantly, how her child really felt. It turns out that she didn’t have the luxury of that time.
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Sarah: What I didn’t know is that about three days after that, she went with her dad onto Gender GP online and she would have known about that appointment. She didn’t tell me anything about it and her dad didn’t tell me anything and that would have been planned for weeks.
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Polly Curtis: Sarah had been separated from her children’s father for a while by that point, and their estrangement made it even more complicated.
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Sarah: So they hadn’t done blood tests, they hadn’t done anything, except for the fact that she just got onto this Gender GP appointment on teams and spoke to a counsellor who, after an hour, told her she had gender dysphoria and that she could have testosterone.
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Polly Curtis: That private prescription for testosterone followed, and although Sarah only found out about it later, by April last year, her child has started regularly applying the hormone gel. Sarah doesn’t support this treatment route and it’s led to a breakdown in her relationship with her child.
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Sarah: I feel really bereft. Every morning I think about her and I wonder what she’s doing with her day and where she is and what she’s going to be doing and what colour her hair is, because she was forever changing it to different colours and how she’s feeling mentally. And then that turns into frustration because I can’t do anything to help her. And unquestionably, she’s suffering. And that frustration then rolls into anger towards Gender GP for what they’ve done to her and how they’ve manipulated. I can’t even go there. I’m just completely enraged. They’ve been instrumental in me losing my child, losing my young woman, and physically and mentally, they’ve damaged her.
[00:28:16]
Polly Curtis: It’s clear that Helen Webberley is proud of the work of Gender GP, but to me, the service she describes is hormones on demand, not by any form of assessment, when the reality is that for some young people, they will develop differently in the future. To not have any system to help them think through how they are feeling, that feels wrong.
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Helen Webberley: People always ask me, well, how many do you turn away? And I’m like it’s not like that. They can’t get to you quick enough. They’ve done all their soul searching, they’ve done all the questioning, they’ve done all their fighting at home. They’re so ready for the next step.
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Polly Curtis: Even if they’re teenagers, when so much can change?
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Helen Webberley: They don’t change, though. The only thing that changes is their desperation and desire to be confirmed and affirmed in their identity that’s the thing that changes their identity doesn’t change.
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Polly Curtis: Helen Webberley is so sure that the young people she sees have gender dysphoria, a diagnosis that means extreme unease because the gender they identify with doesn’t match their biological sex. But everything I’ve learned tells me it’s such a hard call to make. How can you be so confident, particularly when the treatment involves hormones which cause irreversible changes to growing bodies? For Helen Weberly, whatever the arguments, it’s a risk worth taking.
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Helen Webberley: Maybe for some of them it was wrong. Maybe they went back and lived in their birth gender, maybe they weren’t transgender at all. But what we mustn’t do is make every single transgender person in the world suffer, just so that we cis people are not protecting ourselves thinking, oh, my goodness, what if we made a mistake.
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Polly Curtis: On one of them? In her mind, Helen Webberley is not providing an alternative to the NHS. Gender GP is the service for this patient group.
[00:30:09]
Helen Webberley: I mean, we’ve been doing their work, basically. Gender GP has been doing the work of that the NHS Tavistock Clinic should have done. And actually…
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Polly Curtis: It’s also been treating the patients that GIDS felt shouldn’t be treated.
[00:30:21]
Helen Webberley: Yes, well, they have been treating the patients that GIDS should have treated and they’ve been treating the people that GIDS, that are waiting for GIDS to decide on whether they will treat or not.
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Polly Curtis: She insists that her service is safe, despite the lack of evidence of the long term impact of the drugs, or whether young people who medically transition might come to regret it later.
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Helen Webberley: The narrative is that there’s no research, there’s plenty of research out there to show that gender affirming care in young people is the right thing to do, that social transition gives young children a better opportunity at school. This research is all there.
[00:31:01]
Polly Curtis: But there are no long term studies to follow people up. It’s still too new. So I think what I’m struggling with is how you can be so sure that this is right for the vast majority of your patients. You can hear my frustration here, but this debate about evidence is frustrating and misleading too. When Helen Webberley says there’s plenty of research, there are small scale studies, but none that look at the long term impact on young people simply because they haven’t been around long enough to do that research.
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Helen Webberley: What we do know is if you say no, that child gets worse, it gets more distressed and more distressed and more distressed. And then when you see them at 13, the knives have started coming out and the cuts have started coming out and they stopped going to school and they haven’t got any friends anymore because they’ve left their social groups and the family is being torn apart by this distressed child. Or you look at the ones that you say, yes, I’m going to believe you and I’m going. To give you an injection which stops your puberty to give us some time. And those kids carry on going to school and they do well and the family unit survives and the knives don’t come out. That’s what we know.
[00:32:09]
Polly Curtis: I can’t square what Helen Webberley is saying with everything else I’ve learned about this story, which is that not all children who struggle with their gender identity are trans, but some are. I don’t dispute that that is true for some young people, but I’ve met young people who it’s not true for that things happened in other ways and they did desist or they did decide that there were actually other bigger issues in their life that needed tackling first to let them understand themselves. And I can’t understand why you’re only seeing those patients who do persist, and I can’t understand why you’re only seeing one type of young person.
[00:32:53]
Helen Webberley: I don’t know why I’m not seeing the others.
[00:32:55]
Polly Curtis: How do you know you’re getting it right?
[00:33:00]
Helen Webberley: Because the stories that the history, as you call it in medicine, that we take at that information gathering stage and then the follow ups, they are of people who have successfully gone through this process.
[00:33:17]
Polly Curtis: The best answer I got from the Tavistock, which remember is now very much discredited, was that what they were looking for is that young people are consistent and persistent over a long period of time about their gender identity.
Everything I’m learning about Gender GP is that there is no time to even assess this because the young people move to medical treatment so rapidly.
In July 2022, the then Health Secretary, Sajid Javid, said that the Tavistock’s Gender Identity Development Service would shut by spring this year (2023), but it hasn’t proved easy to do. A new national service is on its way, but it’s been a struggle to find hospitals willing to take on the NHS’s most controversial clinic and the staff to work there. The only people with any real clinical experience are those currently working at the Tavistock Centre. Many see them as tainted. The staff don’t exist at the moment, was what one person involved in the new services told me.
It’s taken months to even settle on a new service specification. Those are the rules the new service will operate under. That specification was finally published this month. It’s likely to lead to a reduction in the number of young people who are prescribed puberty blockers, because to do so, they will have to be part of a new clinical trial, which is expected to have a narrower definition of who should qualify for it.
The first new clinic, the Southern Hub, led by Great Ormond Street Hospital in London, is expected to take its first patients in the autumn. The Northern Hub, led by Alderhay Children’s Hospital in Liverpool, will launch next year. Clinical leads with paediatric rather than gender backgrounds have been appointed.
No new young people are being seen on the NHS at the moment, but 250 are being added to the waiting list every month. The waiting list currently stands at around 8000. People involved in setting up the new service say it could take five years to clear the backlog. Their modelling suggests that they’d need 600 staff to service the patient group properly. That’s the size of a small hospital. The hubs are expected to start with around 50 each. The only way to make it manageable those close to the new services have told me, is to manage the waiting list differently and to make sure that young people with other diagnoses are getting treatment for those first, be it mental health problems or autism, which are common among the patient group.
But all of that means young people are not and will not get the treatment they want, when they want it. Helen Webberley tells me Gender GP is scaling its operation for even more referrals. But you don’t even need an online private GP like Helen Webberley’s service. You can also buy testosterone online without any medical advice at all. For Faith — and again, that’s not her real name, we’re using an actor to voice her words — her child’s transition took the family by surprise.
[00:36:48]
Faith: Really. The whole thing came out of the blue. When she was 13, her behaviour changed very dramatically and at first we didn’t know why. She started to cut her hair and then she asked for school trousers and all of that was okay, that’s fine. We didn’t have and don’t have any issue with her being gender nonconforming at all. What was actually happening was that she was getting her friends to call her Matthew behind our backs.
[00:37:22]
Polly Curtis: Faith only learnt of this when a teacher rang to ask her about the name change. But it was already having a big impact on her child’s life at school.
[00:37:30]
Faith: All the friends that had previously been not very interested in her and even some who had been a bit mean girl, they were all of a sudden all over her. Everybody was like, oh, Matthew, Matthew, Matthew. Everybody wanted a piece of her. And I do remember seeing that and thinking, oh my God, they’re loving it, these girls that I really couldn’t give her the time of day before they’re all over her.
[00:37:58]
Polly Curtis: One day, Faith is in her child’s bedroom and finds a small bottle marked up with a label saying Beard Oil.
[00:38:04]
Faith: And I thought, well, that is strange. What would you want beard oil for? And then I did think, oh my God, I hope it’s not testosterone.
[00:38:16]
Polly Curtis: She sent a photo to her online support group.
[00:38:19]
Faith: They said, don’t believe it. Don’t believe what the label says because apparently there are things called stealth labels.
[00:38:28]
Polly Curtis: Apparently, if you buy testosterone online, there’s a drop down menu that gives you a choice of these fake stealth labels, so if anyone finds it, it won’t arouse suspicion. Then Faith found the needles.
[00:38:41]
Faith: When you find syringes, it just makes your blood run cold, because, you know, the idea that they’re going to be injecting something, it crosses a certain barrier, a threshold, really, of what you would be prepared to do to your body. Her father, she’s very close to her father, and her father, he snapped the needles in front of her with his handshaking. And we begged her to never do anything like this and that she still felt like this when she was older, that if she must do it, if this, then she should do it through the NHS, but never, never on the black market like this. And she said she wouldn’t. But then a few months later, we found more.
[00:39:26]
Polly Curtis: Faith’s child had been nowhere near the NHS or the private sector. They hadn’t even been online themselves. The testosterone was from a drug dealer.
[00:39:36]
Faith: What happens is this is one of the normal kind of drugs that you might expect. So ketamine, weed and all the rest. There’s also a huge range of prescription drugs as well. And of course, you can get other prescription drugs. I don’t know how they get them, but they do. Then testosterone and Oestrogen are just part of that. So it’s so easy. So easy.
[00:39:56]
Polly Curtis: James Barclay recalls similar cases in his clinic. It poses huge ethical dilemmas for the NHS.
[00:40:05]
James Barclay: I think with the online things, I think it’s just not safe for me anyway. It’s not really up to negotiation, actually. This is not safe. You need to stop. What steps do we need to do to do that?
[00:40:16]
Polly Curtis: Do you ever, at that point, say, okay, we’ll do the referral now, so that at least you’re transferred into an NHS trusted service and having all the monitoring and the wraparound healthcare alongside it.
[00:40:31]
James Barclay: The endocrinology team, and absolutely would agree with them, would not accept a referral like that without an assessment. So this is the sort of dilemma you’re working with, where you want to bring them into a much safer context, but their referral wouldn’t be accepted without proper sort of psychosocial assessment by good clinicians. And I suppose there’s a bit of, as an aside, really, is this sort of a queue jumping as well. Because word will get out very quickly.
[00:41:00]
Polly Curtis: As well in the end. Faith thinks her child was on testosterone for three or four months, but now says there are signs that her gender dysphoria might not persist after all, her child stopped wearing a breast binder. And then last summer…
[00:41:17]
Faith: The scene was very calm and it was really funny and beautiful and it was just me and her. And this is after years of her being very prickly, me reaching out to her all the time and being rejected. Sorry.
[00:41:33]
Polly Curtis: That’s okay.
[00:41:35]
Faith: So just the fact she had agreed to come paddleboarding with me was very special. And when we were far out and all of a sudden she said to me, do you mind if I take my top off? And I said, of course not. And then she took her top off, enjoying this sun on her skin. Sorry. And I was so pleased for her. Sorry. I thought, My God, she’s comfortable enough with her breasts that she can enjoy the sun on them. You know, that’s huge. It’s just huge. And it was so lovely to behold. She was young and perfect and the most importantly, at ease with herself, happy with her natural body. And that was beautiful thing.
[00:42:35]
Polly Curtis: With the new NHS service in limbo, the Tavistock’s reputation in tatters and the verdict still very much out on its replacement, the private sector will inevitably step in to fill that void even more. I keep thinking about what it must be like to be a parent faced with a child in distress and questioning their gender and trying to navigate some help and support for them at this moment in time. Who do you trust?
[00:43:05]
Faith: All the institutions. I don’t trust any of them now. None of them. It’s like the Wild West in my head now. I’m on my own, firing guns left, right and centre. And my husband, we are firing guns and we’ve got our child in the middle and we’re just trying to protect her.
[00:43:28]
Polly Curtis: I asked James Barclay what the uninitiated parent facing this right now should do to help their child.
[00:43:35]
James Barclay: I’d probably be talking to my doctor. I’d probably be sort of wanting perhaps to see if I could access any sort of counselling, perhaps through school or college. I would try and keep it proportional. I would very much emphasise the talking about things. You might want to do a bit of detective work about what’s on offer out there in terms of local counselings or LGBT support. The vast majority of people don’t go down a medical pathway. The vast majority of people just want to explore stuff and make sense of who they are and how their gender experience fits with who they are going forward would. So I’d be very much wanting to kind of almost keep people out of a service like mine, if at all possible.
[00:44:19]
Polly Curtis: His answer basically confirms that there is a void left behind in this whole saga. But I know I wouldn’t trust online services operating on the edge.
[00:44:30]
Helen Webberley: I’m not that savvy on the whole business side, but I know, but I’m not. I’m a doctor. At the end of the day, I’m a doctor peddling in business.
[00:44:40]
Polly Curtis: I would want to trust the NHS, but there’s nothing to trust at the moment. And when the services open, they will be operating with the same pressures that the Tavistock faced. Too little evidence in a heightened atmosphere that every step will be scrutinised by parents, by patients, the press and politicians who all hold strong and conflicting views on what it should do. The delicate work of rebuilding trust will face challenges at every turn. The almost impossible question of how to care for young people with gender dysphoria. When there’s no consensus on what it is or how to treat it mustn’t be left to dr webley, the Dark Web or drug dealers willing to offer medication on demand.
Thanks for listening. To access more of our journalism and invites to exclusive events, join Tortoise as a member, just go to tortoisemedia.com Slow Down to listen to the entire series. Search for the Tavistock inside the Gender Clinic wherever you get your podcasts.
This episode was written and reported by me, Polly Curtis, and by Katie Gunning, who was also the producer. The sound designer was Tom Birchell. The editor is Jasper Corbett.
Reminds me of the cope following the Forstater verdict at the EAT. 
