Who Trolled Amber? - The Tavistock - Episode 3: Thin ice

Episode Date: September 18, 2023

As the increase in referrals to the Gender Identity Development Service increases, the profile of the young people seeking treatment changes too. There are now two natal girls for every natal boy, a complete reversal of what it had been a decade before. Polly Curtis tries to make sense of this change and goes to Blackpool which has the highest referral rate of anywhere in England. 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 Do you remember a moment when you noticed the proportionate rise in female assigned at birth young people?

Yeah, definitely. I think we were talking about that from early on, maybe certainly 2014. So I'm looking at a graph. It has the years running along the bottom, charting the last decade, and referrals to the Tavistock Clinic on the vertical. And there's a blue line rising steeply from left to right. It shows that back in 2011, 210 young people are referred to the clinic. By 2022, it's more than 3,500. It means the Gender Identity Development Service

is the fastest-growing specialist service in the whole of the NHS. It was turbocharged by the 2016 decision to allow school counsellors or social workers to refer a child, as well as medics. But that's not all. The referrals aren't just increasing, they're changing. Ten years ago, there were two natal boys for every natal girl who arrived at JIDS.

Now, it's the opposite. I would say that it became a preoccupation of the service, obviously because the numbers, the skew was so apparent as time went on. So it was a phenomenon that people were scrambling to try and understand and really struggling to understand. When you start to dig into the numbers, they reveal other things too. A third of children arriving at JIDS are on the autistic spectrum. The vast majority also have some mental health problem. In this episode, I want to find out why more young people are being

referred to the clinic and why the patient profile has changed so radically. I'm really aware that even asking why more young people are coming out as trans could offend some people. That's not why I do it. I need to try to ask because understanding this is key to understanding what treatments should be offered. I'm Polly Curtis and from Tortoise, this is The Tavistock. Episode 3, Thin Ice.

I'm in the middle of trying to make sense of this phenomenal rise in referrals of trans people. A lot of the media reporting on this story tends to be very London-based and perhaps, unsurprisingly, quite middle class. I'm a Londoner. When I first thought of this story, I saw it in the kids of my friends and the friends of my kids, middle-class Southerners. So I stopped in my tracks when I came across some data showing where children who are referred to JIDS live. I'm not surprised to see places like Brighton featuring prominently. But I am surprised by the area that refers the most children. It's Blackpool. We all know what it's been famous for historically

the bright lights and fun by the seaside but recently it's attracted a darker sort of reputation as the most deprived town in England I know Blackpool quite well because my last big reporting project was about children in care and there are more children in care in Blackpool than anywhere else by a stretch.

Now, I learned that Blackpool has the highest referrals to jids of anywhere in the country, three times the national average. This isn't the story I thought it was, and I need to go to Blackpool. My name's Jace Hardinson. I'm transgender, female to male, sorry. And I live in Blackpool. I have the normal life. Yeah, I'm Perry.

I'm 18, a trans male, and I live in Blackpool. In a vast, modern seafront hotel in Blackpool, I meet two trans men with very different experiences. Jace is 17 and doing a health and social care course. He wants to be a mental health social worker. He came out as trans to his mum first. Yeah I was sat down with her I said I think that I'm a boy or that I want to be a boy and she just told me it was it was good and that she accepts me and she supports me. She's always known and she'll get me the best support that she has and she continues to this day to carry on trying to speed my support up

and get it to where I want it to be. She sounds like a hero. Yeah, she is my hero, yeah. Jay cut his hair short and came out on Facebook soon after. He had a support worker at school who helped him change his name by depoll and agreed to be his witness on the document. He describes how before coming out he didn't take care of himself because he couldn't bear to look in the mirror. He says he still struggles with how he looks and dreams of going on T, that's testosterone, but it's a long

wait. He's been on the JIDS waiting list for four years and has just been told he's being transferred to the adult waiting list as he's 17. It just feels like the longest wait of my life. It's nearly been five years. That's how long I was at high school for. The weekend after we meet, it will be his 18th birthday and he's having a big party in a pub in nearby St Anne's. I asked Jay whether he realised there were so many young people in Blackpool being referred to JIDS.

I didn't even know that myself. I didn't think there was a lot of transgender people or people with less community getting referred to that gender clinic or things like that. He doesn't know many other trans people, apart from Perry. I was sitting in class one day. People were, like, picking on me, as they did. So then my friend turned around and said, like, right, guys, this is Perry.

Perry is trans. See him from now on. I remember I just started crying, and I was just like, oh, my God, like, yep, that's it. I've read about Perry in the local paper because he's crowdfunding for top surgery that's a double mastectomy. He's 18 has left school and is looking for work he's got an interview at a drag bar next week. Perry told his mum he was trans in a text message when he was 14. She texted back, Come back to me in a year if you're still feeling this way. Then we can talk.

Growing up, I kind of, like, hated myself. I didn't know why. Like, I just wasn't comfortable being me. Obviously, I never, like, had a pinpoint to it. After coming out of school, he was badly bullied. Just nasty kids. Like, I got bullied for having red hair. And then I got bullied for having no eyebrows. and then I got bullied for having no eyebrows,

and then I got bullied for being, like, overweight, and then I got bullied for being trans, and it's like, if there was a fight going on, the teachers knew it was me. It'd be one of them where you'd hear the radio. Perry's, like, getting it again. I remember one day, literally, I was surrounded by about 100 kids. What were they saying?

Oh, they really, like, battered me. And there was, like, no teachers around for some reason. My friend group just kind of sat there and watched. And then I got in trouble for it, and I got put in isolation for four days. There was some support at school, though. He had a friend who came out before him, and there was one supportive teacher who bought him a chest binder.

So she bought it and she gave it to me and then I just started crying and I put it on and I remember there was like a really big mirror in the bathroom, like a body length one, and I just stood in it and I went like that and I just like started sobbing. I was like, this is, this is everything. Binders are tight straps that bind a person's breasts to make them appear more flat chested. His mum never knew. Bought the teacher chocolates and flowers and was like, thank you so much. But eventually his mum did accept him.

One day she just casually used his new name, Perry. And I was just like, what? Then she was like, Perry? I was like, yeah, that's me. And yeah, it's been like that ever since. Perry has also sat on the waiting list for JIDS, having been referred by his doctor. But here's where it gets weird. He says his GP prescribed testosterone when he was 16.

And then I just went in and he was like, is Perry your legal name? Yes. Does your family know Perry your legal name? Yes. Does your family know you, Jans? Yes. Here's testosterone. And I was just like, great. And how old were you? 16, when I started T.

I've been on it for a year and five months now. I have to ask again to make sure I've heard this right. So when you were 16, you 16, were you asking for a referral to JIDS and they offered you testosterone? Well, I got the referral as well. And then, yeah, because I tried going privately for my testosterone, but something messed up, so I wasn't able to get it. And so then I just walked in and was like, can I have some testosterone? And yeah, I've got it. And I will get it every time I need it. He literally just asked if my name was legally changed

and if I was out to my family and how long I'd been out for. And then he was like, OK, here's the prescription. You need to inject it in your thigh or your bum and you can get it from the chemist over there. To be honest, I'm pretty stunned by this, that a 16-year-old can get testosterone from his GP without counselling or going on puberty blockers first. This is way more free and easy than anything Jits has ever been accused of. Within weeks, he discovered new hair on his body, then his voice broke. He was on his way. I was actually literally over the road at a tram stop

and an old couple came to ask me what time the tram was at and then they said, thank you, sir. And I was just like, you're welcome. That's right, they got it right. And I was so happy. Was that the first time ever? Yeah, just that little old couple and it made such a difference and obviously to them it's just being polite.

And to me, I'm just like, I still smile at that today. Because it just made me feel great. It made me feel like almost valid in a way. Perry has his blood monitored every two weeks and injects himself with testosterone every three. He's now on the adult gender clinic waiting list. I'm confused by this story. I think of the guidelines that require counselling before treatment.

I think of my 16-year-old and, if they were prescribed testosterone for life without having counselling first, I think I'd be pretty shocked. I would want to know. I'm starting to wonder whether what I'm hearing might explain why Blackpool's referrals to JIDS are high. It has schools that support children to socially transition without parental support and testosterone is being prescribed by a GP. Perry and Jay also both mention a very active LGBT plus support group which encourages young people to seek help.

I ask Perry outright, why does he think the referrals are high? I mean, it doesn't surprise me. I remember when I came out in high school and then literally about two weeks after I came out, there was this whole group of trans kids that weren't there before. Group of them in all the different years. And I was just like, OK. How many?

Maybe four in the year below me. There was like, I can't even count the number of like the younger kids, like year seven, year eight. So it was so many. It's also true that in Blackpool, lots of families have social workers, and part of their job is to signpost people to other services. They're more likely to make referrals. I look again at the statistics that show Blackpool has the highest referrals.

They're 317% higher than the national average. They're 317% higher than the national average In 2018, that was 35 children That was the year that Perry came out and he noticed all those other children in his school coming out too Maybe it was just a blip in time There's one other really interesting thing about Perry's story Here's something There's a picture

We're talking about his job interview and he shows me some pictures of him in drag other really interesting thing about Perry's story. There's something. There's a picture. We're talking about his job interview and he shows me some pictures of him in drag. Oh wait, I'll show you another one actually. I'll show you a Halloween one. It's Halloween. I enjoyed that look a lot. So how, like, looking at this picture, I mean, you look absolutely gorgeous, like big red horns, very kind of like black catsuit with a with black boots you look quite feminine in a way tell me about that yeah like I've had it a lot like especially off my mom and friends have been like okay but you're trans so why are you gonna be a drag queen like I'm at that point in my transition with myself where I don't see myself like as a trans male anymore I'm just a male and like it's

actually quite annoying because I'll be picturing like drag outfits in my head and in my head I'll just see myself like with a flat chest and a male's body and then I'll be like yeah this outfit's gonna look great never mind no it's not can't wear that not gonna work why wouldn't it work because like obviously some drag outfits like are very revealing of the chest area they'd be like low down or whatever so then like my binder would just be in the way and it wouldn't look very flattering this is one of those moments where my brain is struggling a bit for someone like me who's never questioned my gender this is hard to understand why after everything does perry want to dress up as a woman painting your face and dressing up

and, like, having this kind of other side to you. So I don't really see it as dressing up as a woman. I see it as, like, an art form. I'm back with my graphs and data, and this time I'm interested in the stats about autism. One in 100 children in the UK have an autism diagnosis, yet at JIDS it's reportedly as high as a third of referrals. Do you want to start just by introducing yourself? My name's Felix. I am autistic and trans. I was diagnosed with autism when I was about 16. I came out as trans when I was 19.

How old are you now, Felix? I'm 28. I was already too old for JIDS by the time that I came out. But I do certainly fit the profile of the kind of autistic trans person that I feel people use as a porn, which is why I feel obligated to speak up about it. So as Felix says, he didn't go through JIDS, but he did come out as a trans man in 2014, right at the start of that huge increase in referrals to JIDS. I'm wondering if Felix's story can tell us something about what's going on. The first thing I hear is about the prejudices that trans and autistic people face. Quite often it's just a throwaway sentence like when someone is expressing

concern about the people being referred to jids or you know the young people who are coming out as trans and they'll often they'll say something like oh increasing numbers of young girls comma many of them autistic comma blah blah blah blah they're banking on people hearing young girls comma many of them autistic comma blah blah blah blah they're banking on people hearing young girls many of them autistic and the takeaway that they're going to get from that is vulnerable naive being manipulated in some way don't know their own mind which i feel is in consulting and reductive and sexist and people also feeling those things about autistic people and sexist and people also feeling those things about autistic people that we are gullible and easy to manipulate and don't know who we are and incapable of real self-reflection I can feel your anger yeah it's something that makes me pretty angry yeah because they know what people think about autistic people and

they don't really don't really need to spell it out a lot of the time. For Felix, being trans has nothing to do with gender stereotypes. He has no interest in sports or cars or any of those things he calls the trappings of masculinity. It's harder to pin down. Do you mind me asking what it is about? You can ask, but I don't know. I don't, I'm not a man because I decided I want to be one.

I think I know I'm a man about the same as any, if you went out into the street and asked the first man who walked by you, what does it mean to be a man? Or like, what does being a man mean to you? I think they would have about the same level of insight. I'm back on thin ice. I'm asking Felix what being trans is like. But I need to ask to hear him tell me that it's an innate part of who he is.

It's not because I want to be or because I thought being a man looked cool and fun. I just am and I can't change that about myself. Most trans teenagers face questioning, often from sceptical adults. But if you're autistic, it's a whole other level. Felix is patient with me. The way Felix sees it, the world puts autistic people into two categories. He describes so-called Sherlock's, those with almost magical superhuman qualities, and then all the other autistic people, those that aren't treated with the same respect,

those who are learning disabled. There's a common thread, though. The world doesn't trust them to know their own minds. In many ways, I am the quintessential kind of autistic trans person that people who say that they're worried about autistic young people, young trans people say that they're worried about. You know, it was a fairly major shift

from who I had previously been. It wasn't sudden. It's something that I wrangled with for a long time you know and I told my friends like a long time before I told my parents. One of the reasons it can be so hard for parents is that they are often the last to know that their child is questioning their gender. I think back to my teenage years, there's so much my parents didn't know. Well, yeah, I came out to my dad and then not out to the rest of my family for a few months. I think it was a very slow process. How was it coming out to your dad?

It was pretty easy. I mean, there have been major struggles that my family has had with it. I'm not going to say that it was all great all the time uh he's come a long long way so much of this debate is about gender stereotypes the did you play with barbies or trucks as a child question comes up again and again but felix makes me think differently about gender. His innate sense of his own identity sits confidently outside the stereotypes. Trans people are frequently accused by what I'm going to charitably call people who are hostile to or critical of trans people of like quote unquote upholding gender stereotypes. And they say, you know, they say things like, oh, well, well like why can't you just be a tomboy you know why can't girls you know who want to climb trees just climb trees without being boys and they can no one is forcing tomboys to become trans I wasn't a tomboy my sister was a tomboy

she's not trans you know so this accusation has never made a lot of sense to me. I don't think I am upholding gender stereotypes in the way I live my life. I, yeah, I was a girly kid. I'm a girly man. I love you. 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 everywhere. ACAS.com. In trying to understand the uptick in numbers and the changing profile, there seem to be theories everywhere. One is that being trans has become somewhat more acceptable for teenage girls than being lesbian. That today, it's easier to be a trans man than a butch gay lesbian. Another is that it's proxy for body hatred, blurring the lines between gender dysphoria, being uncomfortable with your birth sex, and body dysmorphia, which is discomfort with your appearance. I think it's become a new way and a new socially acceptable way for adolescent girls to express unhappiness and alienation. Hadley Freeman is a journalist. She started writing about why more teenage girls are

experiencing gender dysphoria, partly because of her own teenage experience suffering from anorexia. Adolescent girls have found lots of different ways over the past few decades. We've seen it to express unhappiness. First there was anorexia, then there was bulimia, then there was cutting, and now there's this. And what's different with this is this is being validated and enabled by a lot of their schools, certainly by social media, by their friends. It is also, like with eating disorders,

social contagion. I know that the Tavistock and a lot of its supporters are horrified at that. But teenagers pick things up from each other, whether it's being a fan of Harry Styles or a new way to wear your hair or the new length of your skirt, why would they not pick this up? Why would this be the one thing immune to social contagion? That doesn't make any sense. I put this to Steph. They recoil at the word contagion, which makes being trans sound like a disease. I think the rise in numbers of people who are outwardly identifying as trans and are seeking medical intervention or

support, of course there will be a social element to that. I don't think it's right to call it contagion. We know that as more people outwardly present as something and as more people become aware and as there's a much higher focus on people from particular backgrounds and an awareness of what that means, of course there will be more people understanding how they feel. But is that liberation, not contagion? how they feel. But is that liberation, not contagion? Exactly. I think it is liberation, because that's showing that it's okay to be different. It's not saying you have to be trans, like we're turning your kids trans, because it's not. It's saying, actually, I'm trans. This is my experience. It's okay. You might be like this. You might not be like this. Either way, that's okay. It's like the black gold dress again. Hadley's social contagion is Steph's inspiration, their trans liberation. It's another point in this story where I find

an almost agreed fact that there is a social element to the huge change we've seen in recent years, but totally different interpretations of what that means. And of course, the huge rise in social media over the past 10 years is part of that. I think there were a couple of people. There was one trans YouTuber who I was going to show you who had made a video talking about how they went through it and what their process had been like and kind of talking through the options rather than being like, you should do this, you should do that. It's not prescriptive. Do you want to show me? Yeah, sure. Steph is showing me some of the YouTubers that they followed as a teenager.

What's their name? Alex Bertie. This might be the one, I think. What is up, guys? So I'm always asked how to deal with waiting times in transition. Straight away, I just want to say, do not beat yourself up if waiting makes you sad.

Steph talks about the power of the algorithms on social media to suck them down a rabbit hole. Just kind of watching people talk about coming out was kind of cathartic in a way. It was very much, for the most part, supportive and their families and friends were so lovely and they would come out as trans or as gay or as bi and everyone would accept them and then you hear the few where people have been kicked out of the house or not accepted by family it was those videos that

almost plant that seed of doubt and the stories you would read on Tumblr and social media. It was scary sometimes, but also really helpful. The thing I notice is that people on the gender-critical side of the debate aren't immune to this either. People who are gender-critical believe that sex is biological and immutable and cannot be conflated with someone's gender identity. So you can identify as the opposite gender, but you can't change your biological sex. It sounds obvious, but when you put it in the context of the opposing belief that trans women are women, you start to see the fundamental clash. Parents like Sandra have also disappeared down social media rabbit holes,

just different ones to their children. I was doing more reading and becoming more aware of the issues. And where were you getting the information from? Newspapers, Mumsnet, Twitter, all the usual places. What was it like reading that information? It became more and more alarming. So each side in this debate uses media to create its own echo chamber, pitting YouTube against The Times, TikTok against Twitter,

generations divided by the platforms they hang out on. And I have been told by people I know that I've been radicalized on Twitter, whereas I just think, no, what I've found is that I'm not alone in still believing what I've always believed, and that's a huge relief. There's one more theory about the rise in the numbers of referrals to jids worth exploring. In the course of our conversations, I've heard both Polly and Bernadette suggest it. You know, about the extent to which gender identity is partly socially constructed and that there are loop, what is sometimes called in philosophy, looping effects. A looping effect. I've heard this described as social conditioning as well.

In its simplest form, it's the idea that the very existence of the gender identity service at the Tavistock created its own demand. So as the puberty blocker pathway became more widely known, the waiting lists grew longer. And by the time kids were arriving at the clinic, they were no longer just after advice or information. They wanted action and they understood how it all worked. I wonder if we can find the referral one. So I had been, my GP had said, I have to go through CAMS and go through this sort of referral.

And I was like, actually, I've seen a YouTuber. I have done my research. I don't have to go through CAMHS. So we cancelled that and went through my school counsellor instead. But it was just... It was, like, the video that helped me realise how I could get to the surface. And YouTubers like Alex Bertie

were on hand to give advice. If there's child services where you live, go for that. Or just talk to some sort of professional so it's on the system. Number two, try to move forward in your transition in other ways. For example, you can- So we have a fact.

There are many more trans children and young people coming out and looking for help today than 10 years ago. We have theories as to why, but science hasn't given us an answer. We don't have the evidence to be confident about why this is happening. But here's what I think. What if this isn't black and white? What if all these things were true? That some people are innately trans, that some people become socially conditioned to be trans, and for some that is liberated and good, but for others it might be masking some unhappiness or other problem. What if the very existence of the clinic had a looping

effect? That other young people like Steph were watching YouTubers explaining how to get that referral? What if that was liberating for some and a complicating factor for others? What if all those things were true? I asked Polycar Michael why referrals went up so dramatically? I think the cross-cultural aspects of this are really important you know we need to take a long-term perspective thinking about the influence of social media has been mentioned I'm you know sure that's important for some young people, thinking about acceptability of gender behaviours attached to a gender, thinking about the timing of puberty. So I think there are many factors and, you know, unfortunately there isn't going to be one simple answer that applies to all young people.

When she first tells me this in one of our early interviews, I'm dissatisfied. It doesn't feel like an answer. It feels like she's swerving the issues. But I come back to it again and again, and now I think she may have a point. But given all this uncertainty, and if young people could be having very different experiences,

how do you know who to prescribe puberty blockers to and who needs other sorts of therapy? I'm curious to know if Polly ever reconsidered that 2011 decision to start the puberty blockers. Was there ever a point when you stopped and said, what's going on here? Are we doing the right thing? Gosh, we're and said, what's going on here? Are we doing the right thing? Gosh, we're continually saying what's going on here. I think, you know, working in a field where there is still a lot to learn. And I think, you know, in that context, one is always evolving, looking at the data, thinking about what one's doing.

evolving, looking at the data, thinking about what one's doing. I'd almost ask a question back of you, which is, in what respect, what aspects of the model would change? Because I think the model is such that it accommodates, if you like, those changes. I find Polly's confidence in the service she runs, in the face of the increasing opposition, extraordinary. Back in 2017, the referral numbers are ramping up, the waiting list is growing, and NHS England is pumping in cash. JIDS is bringing in new clinicians who are starting to question what is happening. are new clinicians who are starting to question what is happening. The debate about what it means to be trans, why and what should be done for these young people is starting to play out between

clinicians in clinics and meetings. Then my colleague said I think you're transphobic I think this you know what you're saying is transphobic. And I was just really shocked, like, oh, my God. I don't think I'd ever heard that word before, but I knew it was really bad and it felt like being called racist. And, like, I was just, like, in panic. Like, oh, God, what have I done? What have I said? And the Tavistock is left divided. Next time, in episode four, the internal divisions spill out into the open.

You know, there's a sort of myth to think that the service was ever completely harmonious and everybody thought the same. If you have a fundamental problem with the way in which care is offered to this group of young people, whilst one can hear some concerns, one doesn't necessarily accommodate them. You know, it's sort of like working in a centre that offers abortions where you don't believe that abortions are right. I'd leave and I'd cry. I would cry to my mum outside to have a stock and then I'd cry when I got home and it just felt like no progress was being made

because they were very much hung up on, are you sure? So we know that the service takes an affirmative approach, controversial words, raising your eyebrows. Yeah, I wouldn't agree with that. You wouldn't agree with that? No. I think it's much more complex,

much more nuanced than that. This series is written and recorded by me, Holly Curtis. The producer is Katie Gunning. Additional production by Phil Sansom. The executive producer is Jasper Corbett. The Tavistock is a Tortoise production. I'm I'm I'm I'm I'm

I'm I'm I'm I'm I'm I'm I'm I'm

I'm I'm I'm I'm We'll see you next time. No. But Moosehead? Yes. Because that's alcohol, and we deliver that too. Along with your favorite restaurant food, groceries, and other everyday essentials. Order Uber Eats now. For alcohol, you must be legal drinking age. Please enjoy responsibly. Product availability varies by region. See app for details.