IT'S IDEOLOGY, NOT HEALTH CARE:

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.

This is a medical scandal, the full consequences of which may only be understood in many years' time

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.

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