Who Trolled Amber? - The Tavistock - Episode 1: A verdict

Episode Date: September 18, 2023

In the summer of 2022 the NHS announced it was winding up the Gender Identity Development Service for children and young people at the Tavistock. Critics of the service celebrated, its supporters were left in despair. Journalist Polly Curtis has spent months trying to understand what happened. Why has it attracted such criticism and what is the best way going forward of treating young people with gender dysphoria? Listen to the full series today. For the premium Tortoise listening experience, curated by our journalists, download the free Tortoise audio app. For early and ad-free access to all our investigative series and daily and weekly shows, subscribe to Tortoise+ on Apple Podcasts.If you’d like to further support slow journalism and help us build a different kind of newsroom, do consider donating to Tortoise at tortoisemedia.com/support-us. Your contributions allow us to investigate, campaign and explore, and to build a newsroom that is responsible and sustainable. Hosted on Acast. See acast.com/privacy for more information.

ACAST powers the world's best podcasts. Here's a show of glamour and scandal and political intrigue and a battle for the soul of a nation. Hollywood Exiles, from CBC Podcasts and the BBC World Service. Find it wherever you get your podcasts. ACAST helps creators launch, grow, and monetize their podcasts everywhere. Acast.com Hello, it's Basha here.

The Tavistock, or the Tavi as it's often called, is the only NHS clinic in England and Wales which treats children suffering from gender dysphoria. Its critics have accused it of fast-tracking young people into changing their gender. But its supporters argue that it's provided help and support, even a lifeline for some. From Tortoise, journalist Polly Curtis tells the story of the Gender Identity Development Service for children and young people, and the story of what's happened to it. I was in the kitchen, looking at my phone, as usual, and talking to other parents, and we were happy. We were very happy.

It's a bright summer's day, late in July, and news starts to spread that an NHS clinic in North London is being shut down. That was a huge, huge thing. I think someone tweeted it and then I contacted the support group and said, is this, you know, my God, is this true? As the news ripples out, it has a powerful effect. And everyone, everyone was piling, you know, saying, yes, it is. So it was good news, very good news.

Notifications are pinging on phones and the headlines are being rewritten. I was at home at my desk. For some, there's relief and even euphoria. Pleased. I was pleased for the doctors that I've interviewed over the years, that they're whistleblowing and everything they've said to me is being vindicated. But for others, something closer to despair. I was at work. I had to go sit in the toilets for a few minutes and just sit with that news. I saw the breaking news notification and I just thought, it felt like a punch in the gut. I thought, I don't know how I'm getting through the

rest of this afternoon. There's confusion. Then that turns into anger. I can't really describe how I feel. I think we feel very betrayed and disenfranchised, silenced. And there's a lot of fury and anxiety, really, as well. What's announced on that day in late July feels bigger than the sum of its parts. It's more than just a decision to close a clinic. It feels like a verdict, a judgment even. Because the clinic that's being closed down is the Gender Identity Development Service based at the Tavistock Centre in North London. To those in the know, it's simply the Tavistock or the Tavi. The NHS service offers support for children and adolescents

suffering from gender dysphoria. It's the only such service in England and Wales. And it's become a lightning rod for a vicious row. We need to talk about the gender identity clinic, the child gender clinic, the Tavistock Centre. How can this be right? We're referring kids of this age for potential surgery to change their sex. One that's escalated from the corridors of the Tavi...

Let's call it what it is. It's a fad. ...to online chat rooms, to the highest courtrooms in the land, and even the House of Commons. The NHS services in this area are too narrow. They are overly affirmative, and in fact they're bordering on ideological. It's a row that is playing out in social media timelines, on newspaper front pages, in schools, within homes and families. With the T! LGP! With the T!

It's a nuclear-level, toxic row, where the battle lines have been drawn and history is still being decided. And I'm going to explain, as fairly as I can, how we got here. I'm going to tell you the story of the most controversial clinic in the NHS. I'm going to take you inside to understand what's really been happening in the Gender Identity Development Service at the TAVI. It treats children with gender dysphoria, what the NHS describes as a sense of unease a person may have because of a mismatch between their biological sex and their gender identity. I want to abbreviate that into

something simpler, but in this story definitions really matter. For years the headlines about the TAVI have been dark and foreboding. If you followed it casually, you might have an image of a sinister place. I studied history, but one thing I never understood was how the really bad things were allowed to happen. And now I understand how very bad things can happen. If JIDS wasn't there, if gender identity clinics weren't a thing and trans ideology wasn't there, she'd just be a girl. But for others, it's promised support, help, resolution, a lifeline even.

I've always, always struggled with body image issues. And going through male puberty when I didn't want to only exacerbated that tenfold. I wish that, say when I was 14, 15, I wish I'd been referred to puberty blockers because it wouldn't make life so difficult for me now in terms of presenting how I want to. Is the Tavistock a lifeline that's helping some of the most marginalised and vulnerable young people at a crucial moment in their lives? Or are we witnessing one of the biggest medical scandals in NHS history unfold? Or is the truth more complicated, hidden in between these two positions, and different for every person

who passes through the Tavi's doors. At the time, I think we were genuinely conscientious people trying to do the right thing in a very conflicted world. I have had people openly mock me. I've had people harass me. I just don't understand how people think it's a choice or that it's not real. I wouldn't choose to be harass me. I just don't understand how people think it's a choice or that it's not real. I wouldn't choose to be harassed. I wouldn't choose to have a rape alarm in my bag whenever

I leave the house. But I kind of feel that I have to because people just can't learn to let people live their damn lives. It's such a toxic debate that people stay away. Journalists swerve it, politicians dodge the question if they can. It's become shrouded in self-censorship and a fear of saying the wrong thing. I need to put that fear to one side and try to respectfully and carefully show how this all happened. I want to open up this story and let in some light rather than add to the noise.

What I've learned is that this isn't the story you probably think it is. Someone described it and I think it's a really good way of putting it. Like, you know, those photos where there's a dress and some people say it's turquoise and some people say it's, I can't remember, is it dark blue or something? And I think it's a bit like that, isn't it? You might remember the photo of that dress. It went viral at the time. Some people saw it as blue and black and others as white and gold, despite it being exactly the same dress. This story is a bit like the black and others as white and gold despite it being exactly the same dress.

This story is a bit like the black and gold dress. Different people see it in totally different ways depending on their beliefs. Some people have worked out what they think already. Others have avoided this subject at all costs, put off by the language and the vicious tone of the debate. I don't plan to tell you what to think. I'm going to tell you what happened. I'm going to take you with me inside the clinic, because from inside this story,

you can start to understand something more about this particular culture war that's dividing families, workplaces, generations and even society. I'm Polly Curtis and from Tortoise, this is The Tavistock. Episode one, A Verdict. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr.

Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. Mae'r ffordd y byddwn yn ei ddod o hyd i'r llawr. there's three, there's one to the right as well and at the end of two of them there's the GIDS logo which has the eye in bubbles bursting in lots of different colours and it's a long grey corridor

with lots of meeting rooms on either side and some really interesting patient artwork We got a letter about two or three weeks before the appointment and it was that relief We got a letter about two, three weeks before the appointment. And it was that relief. It was, I can breathe finally. I've got that first appointment. I'm in the system now.

This is Steph Preston, one of nearly 20,000 children and young people who have attended the clinic at the Tavistock in the past 10 years. Steph's now 20 and identifies as non-binary. Getting the letter with the first appointment feels momentous because it is. There's nowhere else in the NHS you can go for treatment if you're under 18 and feel that your gender doesn't fit with the one on your birth certificate. and feel that your gender doesn't fit with the one on your birth certificate. The treatment offered at the Tavistocks, people like Steph, involves lengthy therapy sessions with clinical psychologists and sometimes involving the parents too.

But it's not the talking therapy which has placed the Tavi at the centre of the culture war. I remember kind of explicitly saying when they asked what I wanted, I want puberty blockers and oestrogen. It's the puberty blockers. Puberty blockers do what they say on the tin. They block and delay the changes brought on by puberty. They're the first stage on the road to a medical transition. If you want their official name, it's gonadotropin-releasing hormone analogues. But everyone calls them puberty blockers.

And this is the central question I start this story with. I want to know whether we're doing the right thing by medicalising kids. Since 2011, some trans children have been given puberty blockers to arrest the onset of puberty or suppress it and pave the way to further hormonal treatment after the age of 16. That's oestrogen for trans girls, testosterone for trans boys. Medical transition means a lifetime of treatment, a cost that many feel is worth it. But we don't actually know the true costs. The evidence on the longer-term side effects is limited.

This is where the row starts. Are the benefits worth those unknown risks? And are the rollercoaster teenage years the right ones in which to make these decisions? There are risks in treating children. What if they come to regret it? Some of the effects of medically transitioning are permanent and the long-term effects unknown. But there are also risks in not treating children,

that it leaves them suffering the debilitating effects of gender dysphoria for too long. We know many people come out as transgender much later in life, after struggling, sometimes for decades. The evidence base is limited and the stakes on both sides are high. The clinic has become inextricably linked with puberty blockers in the media, in the minds of its critics and of those desperate for help.

We finally got to the top of the waiting list and I think she just thought, you know, we would go into the Tavistock and they would give her a prescription for puberty blockers. for puberty blockers. The TAVI offers a vast range of psychological services to adults and children. I'm interested in just one of them, a clinic known as JIDS, or the Gender Identity Development Service. It's a clinic that's been overseen by the same woman for more than 13 years. So I am Polly Carmichael and I'm a consultant clinical psychologist and I've been in the gender service

since 2001 and clinical director since 2009. She's quietly spoken, deliberate in what she says, and very thoughtful. At times during our conversation, she's guarded, clearly nervous about being misunderstood or misquoted. At others, she's disarmingly candid. By her side for many of those years in charge was her de facto deputy, Bernadette Wren. Well, I'm a clinical psychologist by training and a family therapist, systemic family therapist by further training. And I worked at the Tavistock in one way or another for 25 years. Bernadette's cut from the same sort of cloth as Polly, North London, middle class, perhaps a little bit older. But where Polly has this kind of Teflon coating that makes it feel like she can deflect any question about her work, Bernadette is still wrestling with whether they did the right thing.

The whole question of how you provide treatment for broadly mental health but crossing over into identity questions, particularly with young people, without in some sense at a population level making the whole thing worse, is a very, very large question. She's still struggling with the dilemmas and argues them through with me in the course of our long conversations. I mean, I have a lot of thoughts about what we might have done differently. Sometimes she brings me huge clarity. Then we lose focus and the subject becomes confusing again.

These two women, Polly Carmichael and Bernadette Wren, are key to understanding what's been going on inside the Tavistock It's the Gender Identity Development Service so young people are following a developmental trajectory there's something about non-judgmental acceptance of a young person's gender identity problems and I guess our role is about working with young people

and their families to explore that. You're trying to build trust, but you're trying to do it in a way that people can sort of buy into and make it that they will come back and that these things can be spoken about and aren't too terrifying to be spoken about. So there's a lot going into that and it's always completely underplayed when people talk about the work. It's not about a train getting to a destination.

Is CHIDS a mental health service, a physical health service or something else? Well it's not a mental health service but obviously the people working within the Tavistock have very often mental health training backgrounds and young people experiencing gender dysphoria often experience mental health difficulties for a kind of difficult question, but say now if you're not comfortable with it, which is what do you think makes you trans? Okay. It's very loaded.

Like, I don't know where to start with unpacking that one. You might be questioning who I am to wade into this, to ask questions such as this. What expertise or experience do I bring? What baggage do I carry? I've been a journalist all my career. I was born biologically a woman and I have never questioned my gender identity. I am a feminist. never questioned my gender identity. I am a feminist. I have a nine-year-old son and a sixteen-year-old daughter whose approach to her friends' various gender identities is liberated to the point of breeziness. They wear their gender lightly.

This is difficult territory. This story has become toxic and mean at the extremes. story has become toxic and mean at the extremes people feel silenced by its ferocity it is dehumanized i hate that women who still have so far to go to achieve equal rights and to end misogyny are pitted against young trans people who face so much prejudice so the reason i want to ask and i think you know and and the I was strained to kind of asking a question which can feel really loaded, I totally recognize that. I'm really questioning your experience is because when a clinician is making the decision about puberty blocker, what they're trying to do is understand with with that person is that person going to still feel that way in five ten years time and i think it is a question that things come back to and and you can say now if you're like no that question is just offensive i'm fine with it because i think like if a young trans person listened to it and didn't know they're trans or didn't understand it then like just help that one person realize

something about themselves it's like mission accomplished in life die happy like I'd rather educate people than just be like we're not going to discuss anything. Like, it's a difficult one to unpack because it's just... I am me. It's just who I am. Yeah, yeah, I get that. If everyone else gets to live their life like that, why can't we? It might not be obvious to you, but the reason I'm so uncomfortable asking Steph the question of what makes them trans

is that it is, frankly, an offensive question. Imagine asking someone what makes them trans is that it is frankly an offensive question. Imagine asking someone what makes them gay. It's that. It's offensive. But I'm not asking it to be offensive. I'm asking it because it's impossible to try and understand this story if you're not trans without hearing this from trans people. It goes to the heart of the puberty blocker question. As a teenager, how do you know if you'll always be trans and therefore that the drugs are the right course of treatment? I always knew there was something that made me different from other kids my age. Always felt it, never really understood it.

And so I came out as gay initially, and then I came out as gay initially and then I came out as gender fluid, kind of tried to push that aside, came out as a trans woman and now I'm happy being non-binary. Steph is somewhere between male and female. If you imagine a sliding scale with male at zero and female at 100, Steph says that they are a 75 or maybe an 80, so a bit on the feminine side. I always say to people, my pronouns are they, then. If you're going to fall back to a binary, she, her is fine. I'm not going to get upset by that. He, him, I really don't want to be used.

Steph is now 20, but their journey to the Tavistock and beyond begins a decade ago when they came out, first as gay. I was of the generation that always watched YouTube and used YouTube as a way of finding other people like myself. And so that was kind of how I discovered that side and how to label that. But it never, it never felt complete. It never felt like a full accurate description of who I am and how I felt. So when, when did you start to question there was something more than being gay? Again, YouTubers and generally people in the public eye, it kind of became more obvious and I kind of felt like I could see other people who weren't just gay, bi or straight and that there were people who identified as trans and queer and all these

other identities. Steph tells me a story even though they worry it fits a certain stereotype often used by those who are looking to play down the trans experience. I used to play Minecraft a lot and always enjoyed having the girls skins as they call they call them, more than the boys' ones. If you're not an expert on Minecraft, you should know it's a computer game with infinite opportunities to build an imaginary world from blocks. It's really creative.

My son loves it. He can talk about it forever. Skins are costumes for the characters you assume. And so we'd put the girl's skins on my character. And then it was kind of this realisation, oh, actually, something about this is resonating with me. And I had a group of friends who were all over in America and Canada that I would stay up till the early hours of the mornings

with playing games on Skype. And three of us realised we were trans at the same time. So there was my friend Tristan, who's a few years older than me, who realised he's a trans male. And my friend Cameron, Cam, who also realised that he's a trans male. And we kind of realised at the same time, and we're like, should we chat about this in a separate kind of group chat? Steph's using trans not as a description here,

but as an umbrella term for all sorts of gender identities. Steph's two friends came out as trans men, but for Steph it wasn't quite so straightforward. Sometimes they felt more male, sometimes more female, sometimes non-binary, meaning not solely male or female. They described themselves as gender fluid at that point. So when you think about that sliding scale that Steph described, Imagine it's not fixed in one position. That's gender fluid. It can change with time or even day to day.

But for a teenager who needs to go to school and who on each day might be expressing a different gender, that's complicated. Most people were awful, if I'm honest. People would laugh. You could tell people were pointing, if I'm honest. People would laugh. People would, you could tell people were pointing at me or like singling me out. And I remember after a few weeks, I just felt I'm just going to have to keep this to myself now because I can't go on like this. It kind of evolved into me telling friends and family that I was a trans woman or a trans girl.

You felt that it would be easier and more accepted to be trans than gender fluid? Absolutely, because at least people can see a binary and people can understand man and woman and there's a clear distinction rather than people mocking me and say well you're a boy or a girl today and it's like well I actually don't feel like either but everyone questioning it every single day and that was really difficult. This all happened before they'd even told their parents. Steph came out in August 2015 at the age of 13. And I just have this really distinct memory of it being like the evening both my sisters were in their rooms mum and dad were in the living room and I was like I need to talk to you both. I kind of said to them mum dad I've got something I feel like a girl, and mentioning that I wanted to use the name Steph.

And I remember I broke down in tears before I'd even got the words out, and they were like, what's going on? And the three of us just ended up hugging on the sofa, because they said, of course we love you you of course we support you we're your parents Steph began to see a counsellor at school and after a few months the counsellor referred them to the TAVI the timing is significant it was 2016 and the TAVA stock was coming under pressure with a big wave of referrals for Steph Steph, this felt like a new beginning. But for others, a referral to the Tavistock

sets them on a path to a broken family. Acast powers the world's best podcasts. Here's a show that we recommend. world's best podcasts. Here's a show that we recommend. Hi, I'm Una Chaplin, and I'm the host of a new podcast called Hollywood Exiles. It tells the story of how my grandfather, Charlie Chaplin, and many others were caught up in a campaign to root out communism in Hollywood. It's a story of glamour and scandal and political intrigue and a battle for the soul of a nation. Hollywood Exiles, from CBC Podcasts

and the BBC World Service. Find it wherever you get your podcasts. ACAST helps creators launch, grow, and monetize their podcasts everywhere. ACAST.com Gosh, how to start. This is Sandra. Sandra's not her real name and her words are voiced by an actor.

She doesn't want her child, who's now 16, to be identified. I'm going to follow Sandra and Steph through this series to understand what really happens inside the clinic. It started very gradually, almost without us noticing, because, you know, it wasn't on our radars back then. Sandra's child's birth sex was female. He now identifies as a boy. Even the way I've said that is problematic. Let me explain. For some, the more acceptable way to say this is assigned female at birth. They mean that the doctors looked at him and made the assumption that he was a girl because he was born with female sex organs. Critics of this would argue that sex is a scientific fact, not something that is assigned

at birth. It is evidenced by our physical features and our chromosomes. Bear with me, I'm going to pause and make sure I'm explaining these concepts as we go along. It's also worth understanding what misgendering means. Many trans people find it incredibly upsetting and difficult when they are misgendered. Remember how Steph said they didn't want he-him used? She-her is fine. I'm not going to get upset by that. He-him, I really don't want to be used. It is a reminder of who they aren't and they see it as an attack on who they are. Now when she's at home, Sandra calls her child he or him.

In our conversation, she refers throughout to her daughter. She misgenders her child. This leaves me with a dilemma. I don't want to misgender anyone. It feels disrespectful even if they can't hear me. I decide to follow Sandra's lead in our conversations because it's Sandra I'm speaking with. That means I misgender her child.

If I don't, it will be very hard for me to hear her story and understand it. But when I'm talking about Sandra's child, I'm going to refer to them as he. I don't like this inconsistency. It's a fudge, but it's a way to tell the story and to try to understand. She was always a typical tomboy who loved climbing trees, wasn't into girly things at all, didn't like all the pink sparkly clothes and fairy wings and all the rest of it. When Sandra's child was about six or seven, they asked to be called by a boy's name. And so we adopted it as a sort of nickname,

and it sort of stuck. And it sort of stuck. When did you feel it started to become a problem? When she heard the term trans, which I'd never even heard of, and I suppose she must have been about seven or eight, maybe a bit older, and a friend of hers at school said, oh, maybe she's trans, and I didn't know what she was talking about. I'd never heard the term before.

And that's when I think she started to find all these trans YouTubers. And I think that's when she got the idea in her head. Oh, that must be what I am. At this point, Sandra is really not worried about what's happening. She's quite sanguine. They're a liberal family and they don't see the problem with a child being transgender. Then something happens that knocks them off course. When he's eight, Sandra's child starts having problems with eating and body image issues. You know, it became a complete obsession. It was exhausting. At the same time, Sandra's child started to put on weight, Sandra believes the combination of these two factors marked a turning point.

Which I think has resulted in a deep-seated sort of body hatred, you know. I think she thinks she's fat and ugly from having gained that weight when she was young. The move to secondary school a few years later was the next turning point. That really is when the whole trans issue became a crisis, because she was by then presenting as a boy. The primary school, everybody had known her since they were sort of five, but at the new school she wanted everyone to think she was a boy. So she started that school as a boy?

Yes, presenting as a boy. How did you feel about her? Well, I think at that stage we were still affirming it. How did she tell you that she was going to go to school? Well, she would only wear the boys' uniform, you know. There were different uniforms, so she would wear the boys' and we'd explain to the school and they were fine with her wearing the boys' clothes. So at the time you were really working with her? Yes, yes. And trying to help. Sandra is still affirming her child's trans identity at this point.

That word, affirming. You're going to hear that a lot, because not everyone agrees on what it means. Originally, we thought it was a bit like being gay or lesbian. So, you know, it wasn't an issue. It was fine. But the more I started looking into it, the more I realised that it's not the same. It's not at all the same as a sexual orientation. It's completely different.

But a creeping doubt sets in for Sandra. It's a creeping doubt about her decision to allow her child to live as a boy. She goes on social media and reads everything she can. What she's reading is fuelling her fears. She has all these other issues as well. You know, she was seeing a counsellor at school, but at secondary school there's no contact between the counsellor and parents,

so you don't really know what's going on. And it's around this time that a medical specialist he's seeing for a completely separate condition suggests a referral to the Tavistock. Oh, should I refer you to the Tavistock? And I'd sort of held off. Lots of people had said to me, oh, you know, you should get referred to the Tavistock. Anyway, I agreed against my better judgment. As I set out to understand the clinic, I'm not short of things to read. There's report after report by whistleblowers, NHS controllers and even the High Court. I get slightly obsessive and read 10 years worth of Tavistock board papers searching for mentions of

JIDS. And in the first few years, there's no mention. JIDS is such a small part of the Tavistock story that they even get its name wrong, extraordinarily calling it the Gender Identity Disorder Service. Just to be clear, most trans people would find this really offensive. Then in the past five years, the service comes to dominate the board papers. It's mentioned endlessly as it scrambles to scale up to meet a rising flood of referrals. scale up to meet a rising flood of referrals. I'm starting to build up a timeline of a tiny service operating seemingly without much scrutiny, hit by a wave of referrals and a cultural revolution in trans visibility. Then the scrutiny comes and now it's closing. In the middle of it all is the long-serving clinical director, Polly Carmichael. As I trawl through newspaper cuttings, broadcast interviews and social media,

I see how the clinic has been portrayed and the storm of controversy it has weathered along the way. And yet I don't find much of Polly. Her public profile remains low. I did find one interview she did for a Channel 4 documentary in 2016. It's called Kids on the Edge and there's a moment in it which stops me in my tracks. And in some senses culture and society are moving faster in terms of what they think they understand about it and what they think we should do about it than the evidence base. That's from six years ago, but it feels important, that idea that the culture is moving faster than the science. She's not defending the service or pretending she has all the answers. In fact, she's frank about the evidence vacuum that they're operating in.

We don't really know whether this is the right treatment for everyone, whether there are long-term implications of this treatment. But for families and young people, you know, it can be very difficult because they're seeking certainty. She's openly admitting to some of the things they've since been accused of. and young people, you know, it can be very difficult because they're seeking certainty. She's openly admitting to some of the things they've since been accused of, chiefly that they're operating without an evidence base. The reality is at the moment, we go by the back door,

finding whistleblowers inside sources. We convince people to leak us information or force it out using transparency laws. And I'll do some of that. But sometimes it's best just to go through the front door. The Tavistock press office is initially wary and getting access to Polly takes a while. The press officer tells me he's combed through my social media posts to check me out. But finally, it's agreed. So I'm sitting in the podcast studio just waiting for Polly Carmichael

to join us for the first of our interviews for this podcast. I feel excited. I feel like I have spoken to so many people, read so much, absorbed so much information that I almost want to put that aside and just listen to her version of the account. We've barely begun when she says something extraordinary. There's something extraordinary. I look back and, you know, even when I took over directorship of the service in 2009, and I'd been there, you know, a long time by then, many years, and I sort of felt, oh my God, I really don't know what I'm doing.

You know, I really, you know, I don't feel I know enough about this. That year, 77 children were referred to JIDS. It was hardly on the radar. But just over ten years later, that number had risen to more than 3,500. In a decade, everything has changed. Coming up in episode two, how much kind of day-to-day was that waiting list playing on your mind?

Every day. What was your fear? The fear was that whatever we tried, we had no adequate response to it. He was a tough man, the dad, you know, real hands-on job. And he wept in the first meeting because he was just completely beyond anything he'd ever known. So their starting point is the child is trans.

How is the child coping with life? It's not, why do you think you are trans? Why do you want to present as a boy when you're actually a girl? Which is what I naively thought would be the starting point. But it wasn't. It's easier now to look back and think, you know, was that the wise thing to do?

This series is reported and written by me, Polly Curtis. The producer is Katie Gunning. The executive producer is Jasper Corbett. The Tavistock is a Tortoise production. Thank you.