On Hormone Blockers and the Daily Mail

In the Mail on Sunday, there was an article which made the front page of the paper version expressing outrage at the expansion of the prescription of hormone blockers to young people from nine years old onwards, following a successful clinical trial conducted by Dr Polly Carmichael at the Tavistock Clinic in north London. I came across this by chance having glanced at the headlines in the shopping centre, and while I'm not the first person to deconstruct their latest rant, I think I can add a useful perspective to the discussion.

 

Firstly, a bit of background. Hormone blockers can be given to young people who experience gender confusion to delay the onset of the changes that take place in puberty. This gives the young person time to work out if the confusion they've experienced is something permanent, perhaps related to other things like coming to terms with sexual orientation, or simply something that passes as they get older. The effect of these drugs is reversible if the person decides they wish to continue to live as the gender assigned to them at birth, and if they wish to transition, the hormones of the preferred gender can be administered instead. If you want to learn more from someone who has worked with trans young people for many years, check out this TED talk by Norman Spack.

 

I cannot state categorically enough what difference hormone blockers would have made to me as a teenager. I hit puberty at age twelve, and before that point I could pass/be read as male quite easily if I wanted to and was in a context where people didn't know me already. After that, it became impossible to do so, as I went from being flat-chested to having DD breasts in all of a year, a fact that caused me enormous distress because it felt every day like my body was moving further away from reflecting the person I really am (I find the 'trapped in the wrong body' language the Mail uses problematic, for theological reasons as much as anything else - I'm not a disembodied soul dwelling in a temporary vessel, but a fully embodied person!). Added to that, monthly periods were not just painful and unpleasant, but a further reminder of what was wrong with my body that made me feel dirty and incredibly miserable. While there were other things going on and my gender dysphoria was far from the only reason, it played a big role in me being suicidal during my last couple of years at school.

 

If I had been able to do something to stop this happening and delay the onset of female puberty, I would not now be faced with having to undergo major surgery to flatten my chest, and I'm certain I would not have spent so many years feeling deeply uncomfortable in my own skin and distressed every time I looked in the mirror. For those who knew me before transition, the reason I hid under hoodies and baggy t-shirts was to try to be as invisible as possible. It was awful when well-meaning friends tried to encourage me to be more feminine, as it was the last thing I wanted! Given that surveys suggest around 75% of trans people while consider suicide at some point, and the actual suicide rate is many multiples of the national average, I can't be the only person who could've benefitted from this treatment to prevent this divergence of body and identity being so acute.

 

The Mail quotes Andrew Percy, a Tory MP, as saying that hormone blockers will prevent 'natural' development. Let's pause here and think about what's being said. Firstly, like many trans people, I became aware something wasn't right at a very young age, in my case I was four years old when I realised that my body (biological) didn't reflect my inner sense of being male (ontological), and thus people didn't treat me as a boy (social). For someone with gender dysphoria, the ontological (the person's sense of their gender) is not reflected by the biological (both the primary sex characteristics - read genitals - used to assign sex at birth or the secondary sex characteristics - voice, build, facial hair, etc. that emerge later), and because people apply a shedload of presumptions and cultural baggage based on the biological and the binary idea of gender most people work with (social), the person's sense of themselves is also not reflected in interactions with others. Thus, there is nothing 'natural' to someone like me about allowing puberty to progress, only a deepening sense of unhappiness at a body that doesn't reflect the reality of things.

 

Secondly, allowing puberty to progress and forcing people to seek treatment in later life makes it a lot harder, particularly for trans women, to undo the damage. A lot of changes happen by sixteen that can cause immense distress. For example, once someone's voice has broken, that's it, so trans women can be stuck with a voice that sounds male no matter how many hormones they take. Moreover, it means corrective surgery can be much more involved and necessitates dealing with a greater level of risk than if puberty hadn't been allowed to progress. There is nothing 'natural' about forcing people into this position if it can be stopped.Yes, there are risks involved in using blockers, the Mail is right (show me a medicine with no risks at all!), but there are far greater risks involved in having more extensive surgery! Dare I also mention it's by far the least cost-effective solution to have people go under the knife more often than would have been necessary if hormone blockers had been prescribed?

 

Thirdly, Percy and others are working on the presumption that children are way too young to be able to make informed decisions, without understanding that hormone blockers are useful precisely because they do give time, breathing space, for the young person to mature and to be sure they wish to continue with gender affirmation treatment. Moreover, as I've already said, many trans people become aware that something's not right at a very young age, and to treat children as incapable of any self-awareness is not only dangerous but undermines their sense of selfhood. It is very telling that the Mail were forced to rely on a pro-life campaigner (it's funny how people like that are often so keen to stop abortion but seemingly don't care about suffering after birth... ) rather than a medical expert to put their counter-case and spearhead their moral panic, exactly because a thoroughly conducted clinical trail does not support their narrow beliefs about what is 'normal'.

 

Last week, I was privileged to take part in a gathering of local schools, churches, LGBT youth and many others under the auspices of Citizens:MK, a community organisation working for a better city. One of the campaigns we were working on was related to protecting funding for an LGBT youth group, and two of their members stood up and shared their experiences; one was a trans person and the other a young lesbian. Both were incredibly moving, as they talked openly of bullying, suicide attempts and feeling worthless. This kind of journalism, seeking I can only assume to stir up outrage and put pressure on the NHS not to treat trans people (the Mail call the gender clinics, which help hundreds of people like me every year to finally be themselves, a "largely taxpayer-funded industry"), makes life harder for trans people and adds to the pressure many of us experience to justify our existence on a regular basis.

 

The hormone treatment I've finally been able to undergo as a thirty year old guy has already made a massive difference to my self-confidence, not least because my voice has now broken and so I get mis-gendered a whole lot less. I am also very grateful that I don't have to find thousands of pounds to pay for the chest surgery that will finally mean I can look at myself in the mirror and feel good about my body. I feel very lucky to be in a country with a health service that makes this possible, and also seeks to help young people avoid some of the misery my generation have experienced by offering hormone blockers. The Mail has, once again, got it very wrong indeed.