The trouble with Tavistock

“In July, Britain’s National Health Service announced a major revamp of its gender identity services for young people. The famed Tavistock clinic — officially named the Gender Identity Development Service, operated by the Tavistock and Portman Trust and a flashpoint for the country’s debate about gender, trans issues and hormone treatments — would be shuttered. As the New York Times reported, it would be replaced by “a more distributed and comprehensive network of medical care for adolescents seeking hormones and other gender treatments.”

This outcome was strongly hinted at in the interim report of the Cass Review, an ongoing investigation into gender identity services for children, headed by the accomplished pediatrics expert Hilary Cass. “It has become increasingly clear that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand,” she wrote in February.

Cass was tasked with evaluating Tavistock in the wake of years of complaints from internal whistleblowers and outside observers, as well as a lawsuit brought by Keira Bell, a woman who says her teenage decision to transition to male was not sufficiently challenged by medical professionals and who subsequently detransitioned. Critics allege that clinicians were pressured to fast-track kids with complex mental-health comorbidities toward physical transition — and that activists had undue influence on the operations of the clinic.

Tavistock’s critics have been vindicated by Cass’s work so far — her interim report notes straightforwardly that this is exactly what was happening: “Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.” In addition, there’s the problem of “diagnostic overshadowing — many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked.”

One of the many disturbing things about this controversy has been how little data Tavistock apparently bothers collecting. During the Bell hearing, the clinic was initially unable to produce very basic court-requested information about its operations. When the data was finally produced, it appeared to show, contrary to many clinicians’ and activists’ claims, that kids who went on blockers there experienced no mental-health benefits (it also showed that nearly all kids who went on blockers at Tavistock proceed to hormone treatment).

Along the same lines, Cass’s work reveals that the clinic has apparently never had any sort of unifying set of standard practices, let alone a shared philosophy about clinical work with gender nonconforming youth. “At primary, secondary and specialist level, there is a lack of agreement, and in many instances a lack of open discussion, about the extent to which gender incongruence in childhood and adolescence can be an inherent and immutable phenomenon for which transition is the best option for the individual, or a more fluid and temporal response to a range of developmental, social, and psychological factors,” wrote Cass. As a result of this lack of professional agreement, “children and young people can experience… a ‘clinician lottery,’ and failure to have an open discussion about this issue is impeding the development of clear guidelines about their care.”

Given that Tavistock has been administering blockers and hormones to young people since 2011, this is completely unacceptable. Some critics of youth gender medicine refer to the administration of blockers and hormones as an ongoing “experiment” — a term trans activists often take issue with — but in a certain sense this is worse: an experiment at least has agreed-upon rules beforehand, plans for collecting and publishing data, and so on. Tavistock barely had any of this: it’s just been an absolute mess from the beginning, and the institution’s fundamental disorganization and dysfunction left a vacuum into which could step pressure groups that didn’t prioritize careful clinical practices.

Even a failed experiment, properly conducted, advances science a few steps and offers stepping-stones for the next generation. That’s not really the case here. While the ruins of Tavistock certainly will offer lessons to future clinicians, they will be almost entirely “how-not-to.”

One of the most frustrating things about this episode has been the abuse heaped on anyone who has questioned the trend toward carelessness in youth gender medicine exemplified by Tavistock. As the gender-critical philosopher Kathleen Stock, who left the University of Sussex after facing a wave of harassment there, put it: “Just here wondering whether any of the academics who have spent four years mocking, ridiculing, defaming and mischaracterizing my views feel any regret, now a scandal about puberty blockers and child transition is emerging in the mainstream.”

Having encountered a version of this in my own world of journalism — albeit not a fraction of what Stock went through — I can answer that confidently: no. There will be few apologies, if any, and even less introspection. Already, online, many are distorting the news of Tavistock’s closing.

Next up, I think, is the United States. Our healthcare system is an order of magnitude bigger, less organized and less carefully regulated than the NHS. What possible reason would any thinking person have to believe that the same issues that plagued Tavistock aren’t going to pop up, again and again, in our own nationwide patchwork of youth gender clinics?

This article was originally published in The Spectator’s September 2022 World edition.