Bell was prescribed puberty blockers at the age of 16
BETHANY CLARKE FOR THE TIMES
After three further equally superficial sessions, Bell was referred to the endocrinology department, which prescribed a year on puberty-blocking drugs. “It was briefly mentioned this might damage my fertility. They said I could freeze my eggs, but that isn’t available on the NHS and I couldn’t afford to go private. It seemed like a box-ticking exercise. Besides, I was a teenager; I couldn’t imagine wanting a baby.” She was told that blockers were fully reversible and would give her time to decide whether she wanted to proceed to male hormones.
That blockers are a harmless “pause button” is highly contentious. The NHS recently changed its advice from stating they are “fully reversible” to saying that “little is known about the long-term side-effects” on a teenager’s body or brain.
These GnRH agonists release a form of the human hormone gonadotropin to stop testicles and ovaries from producing sex hormones. The most commonly used, Triptorelin, is licensed to treat advanced prostate cancer and endometriosis, “chemically castrate” male sex offenders and halt rare precocious puberty in children.
However, they have been increasingly used “off-label” to treat child gender dysphoria, and in 2010, under activist pressure, GIDS reduced the age of prescription from 15 to 10 years old. A very young child who proceeds from blockers to cross sex hormones — as almost 100 per cent do — will be infertile because sperm or eggs have had no chance to develop.
For Bell, puberty blockers threw her into instant menopause. “I couldn’t sleep or think. I had hot flushes, night sweats, brain fog, concentration issues. My bones ached and I felt less strong.” Moreover, while in this supposed thinking period before she committed to her full transition, she received no psychological counselling from GIDS, just brief catch-up sessions. “There was no discussion of my future, whether I was on the right path.” Nor were her underlying problems — anxiety, depression, social isolation and troubled home life — ever examined.
After 12 months, GIDS prescribed testosterone and Bell had her first injection at her GP’s surgery. Her voice deepened, facial hair began to grow and she “passed” as male at sixth-form college where no one knew her history. By now she was living alone in a youth hostel in Cambridgeshire, ever more isolated. “I still felt out of place, but I had something to latch on to. It felt like my life was progressing. Transition gave me a focus, took my mind off a lot of other things.”
At 20, sick of the discomfort of still binding her breasts, which she hated even more on her now masculine body, she underwent a double mastectomy on the NHS. “I wasn’t really briefed on how serious and extreme this was,” she says. “I found all my advice on how to heal more quickly online. You were given treatment, then they just left you to cope.” Taking testosterone caused painful vaginal atrophy, where the vaginal walls thin and dry out. “Doctors didn’t know what to do about it. We are guinea pigs.”
Once her “top surgery” was complete, and she decided not to proceed with a more complex, risky operation, which creates a non-functional penis from a sleeve of skin stripped from the forearm, Bell felt a sense of anticlimax. “I started to nit-pick about my appearance. I looked at my small hands and feet, my jawline, my short stature. I started asking what makes me a man. And I could never come up with an answer. I will always be a woman whatever changes in my body. I was invested in a fantasy.” Moreover, her other problems had not, as she had hoped, gone away.
Finally, “sick of being a medical experiment”, she stopped taking testosterone. While her periods returned and she found herself able to cry again, her deep voice and facial hair are irreversible. Now happily living with a female partner, she is coming to terms with her double mastectomy and “trying to accept my body for what it is”. However, she grew increasingly angry and troubled that online blogs spoke of transition only in glowing terms, promoting it to children, based, she says, “on lies and sex stereotypes”.
In particular, she felt that “butch” young lesbians like her were under intense online pressure to become trans men. “Gender is polarised: you have to look a certain way. You feel you have to fit in with expectations, even if that means using experimental drugs and surgery.”
Indeed, Bell is part of a 3,000 per cent spike in girls being referred to GIDS in the past decade, a phenomenon noted in every other western nation from Australia to Finland. So far, attempts to explain this have been denounced by the LGBT groups as bigotry. When Dr Lisa Littman of Brown University analysed “rapid onset gender dysphoria” among teenage girls, often clusters of friends, often same-sex attracted, with high exposure to online trans forums, her paper was removed from her college website. James Caspian, a psychotherapist, was told by Bath Spa University that he could not research a rise in trans people detransitioning because it was “not politically correct”.
Yesterday, High Court judges criticised GIDS for their own lack of research data, in particular failing to publish a 2011 study into the outcome of children who took blockers. (Early data so far released from that project “noted that there was no overall improvements in mood or psychological wellbeing” among recipients.) Judges also queried why the sharp rise in natal girls and children on the autistic spectrum has not been analysed, saying it was “surprising that such data was not collated . . . given the young age of the patient group, the experimental nature of the treatment and the profound impact that it has”.
Bell believes the LGBT community should stop trying to shut down academic inquiry and “accept that the trans experience is not a monolith”, that the reasons an adult male wishes to transition may not be the same as a legion of troubled 13-year-old girls with other psychological issues.
She launched her legal case because she felt she had made a “brash decision as a teenager, as a lot of teenagers do” and “couldn’t sit by while so many others made the same mistake”. Since it began she has since been contacted by many other young women with similar stories. She does not see restrictions on prescribing puberty-blocking drugs as an end in itself, but the beginning of a move towards proper, in-depth psychological counselling for gender-questioning young people.
“They need proper mental health support. I just wish someone had analysed my situation and the problems I had without changing my body. My body was fine.”
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