Tag Archives: puberty blockers

Trans adolescents and adults in a therapeutic setting

Many therapists are fearful of the idea of working with trans adolescents and adults in a therapeutic setting. I was recently invited to take part in a study designed to investigate how psychologists and psychotherapists who see trans adolescents in their practices assess their clients’ capacity to make decisions about their treatment and how to approach this subject in an ethical manner. Inevitably it got me thinking…

Is gender exploration any different to any other area in therapy?

No client, adolescent or otherwise, voices questioning their gender if they are not. No one can be made trans simply by talking about possibly being trans. I approach this area as simply as I do with any other. I trust the client knows themself better than anyone. Hopefully I attune to what they are expressing. We explore together how they feel, when they first felt this way, what their understanding of themself is. I affirm who they say they are in the same way I would affirm someone who tells me they have experienced a bereavement, an assault or anything else. I educate myself so I have the most current knowledge about different identities and all the different biological possibilities.

Many possibilities

My client will be one of the many possibilities in terms of biology, identity and expression. It’s our work to discover who they are at that time. Knowing that identity and expression can change during the life span along with everything else. Adolescents are rarely given the opportunity to have surgery or take cross-sex hormones before they are emotionally mature enough to make that decision. In the same way they are mature enough to make a decision to join the army, for example. Puberty blockers are designed to buy time and play a valuable role. See High Court Ruling blog.

Looking for certainty

Often, it’s parent’s and/or therapist’s attitudes that generate fear and friction. Often, they’re looking for a level of certainty that cannot be provided. Some clients will explore and decide they want to press forward with further treatments and others will decide not to. In many ways it’s really that simple. In terms of process, the long waiting lists provide copious time for reflection, pausing if needed or even halting the process altogether.

What clients need is to be heard and seen for who they are now and into the future.

Clear ethical guidance is essential in working with trans adolescents and adults in a therapeutic setting. However, there is no need for fear. Just an open mind to the range of possibilities.

Please get in touch for further information via the contact page or here.

Diversity and Puberty and Shout outs, oh my!

Will Davies July 2021
Diversity and Puberty and Shout outs. Last month, I was lucky enough to attend the final ‘Gender, Sexual and Relationship Diversity Workshop’ of 2021 hosted by Meg-John Barker. The purpose of the workshop was for counsellors and other mental health professionals to expand, understand and challenge our awareness and assumptions of GSR characteristics in our clients.

One of the understandings which sits at the core of the workshop (and also Meg-John’s most excellent BACP resource) is the recognition that most of us will fall into ‘normative’, ‘marginalised’ or ‘invisible’ categories with regards to our GSR characteristics. ‘Normative’ is interpreted as being perceived to be ‘the norm’ by modern day Western society’s ‘standards’, ‘marginalised’ applies to characteristics that were perhaps ‘invisible’ but have now become more ‘acceptable’ to modern day Western society and ‘invisible’ relates to characteristics that generally are not recognised or do not have a distinctive presence in modern day Western society. In one of the workshop exercises participants were asked to identify which GSR characteristics aligned with which categories and what assumptions, awareness and understanding we had in relation to the experience of the world and specifically counselling, GSR clients may have. The learning for counsellors that evolves from this exercise is in my opinion invaluable and I urge you to take a look at Meg-John’s resource to develop your own understanding of this area too!   

You’re probably by now getting a clear sense that I am really passionate about the importance of GSRD awareness amongst counsellors and within the counselling profession and it may not surprise you that this was the second time in 2021 that I have attended this workshop, I love it that much. Second time round though, as well as building on my learning from the previous workshop; of how important GSRD awareness is (oh give it a rest Will – they’ve got the picture!), two other thoughts occurred to me.  

The first thought, which arose out of a discussion about how where we grow up, in my case Yorkshire, contributes to defining our relationship with GSRD and our own GSR characteristics, centres on puberty and the potential it has for being a great leveller or at least the memories of it.  

Whatever characteristics we demonstrate as adults and whatever category that puts us into, we are all likely to have experienced puberty and I would suggest that for the vast majority of us adults, the process was a tricky one, full of challenges and confusions. In fact I’d go as far as to say that everyone will have at least once felt like they have been marginalised, treated as invisible or distinctly not the norm (whatever that means when you’re a teenager) during this time. Of course, I don’t deny that some people’s experiences will be vastly more psychologically impacting than others but if we consider it as a spectrum of experience, we all fall somewhere on it and I think, that it’s likely we’re more clustered together than we’re ever aware of at the time. So whilst it’s often the last thing we want to remember, remembering this when someone is struggling with their GSR characteristics, understanding that we too will have had at least a moment of confusion or upset, could lead us all to demonstrate some unity and compassion when that person needs it the most.

The other thought that occurred to me, apart from how fascinating GSRD is (stop being such a Stan Will!), is my response to something Meg-John suggested when discussing how counsellors who primarily identify with the ‘normative’ category can support peer counsellors who primarily identify with the ‘marginalised’ and ‘invisible’ categories. They encouraged showing support through “solidarity and standing alongside”. This got me thinking about the practice run by Luan Baines-Ball, of which I have been an associate counsellor since March 2020.  Luan’s practice is synonymous with diversity, a very important consideration for me when I was looking to connect with peers and establish my private practice. When I reflect on Meg-John’s words, I reflect on how Luan and my peers have exemplified these words in the practice, in our professional development and in our commitment to supporting the needs of GSRD clients in Leicester and Leicestershire. I feel proud to show solidarity and stand alongside such a diverse team and look forward to continuing the learning and client work in this area for years to come.

And with that, I think it’s time to watch the Wizard of Oz…again.

High Court Ruling on Puberty Blockers

I have huge concerns over the recent High Court Ruling on puberty blockers for transgender young people. One person’s experience will set back transgender rights for all.

Keira Bell was assigned female at birth. Following several appointments with the specialist services at the Tavistock clinic she takes puberty blockers. Keira is subsequently prescribed testosterone and undergoes top surgery. At this point Keira identified as male. Later, she made the unusual decision to de-transition and now lives and identifies as female.

Longer waiting lists

As a result of the High Court Ruling on Puberty Blockers case individuals aged 16 or under will no longer have access to puberty blockers without the intervention of a further court case. For anyone on the waiting list their treatments are now paused and those already taking blockers are having their medication reviewed.

The Media

The media have reported that booking an appointment with a gender clinic is as easy as booking a GP appointment. It really isn’t. They also report that clinics actively encourage young people to transition and that puberty blockers are prescribed at will. This is incorrect information. There’s a very rigorous process involved. Individuals essentially have to prove to several practitioners that they are transgender before being offered any medication and/or surgical intervention. Assessments are carried out at every stage of the process. So the individual has ample opportunity to reflect on the changes happening to them, their body and their identity.

Over several years Keira had first puberty blockers, then testosterone and finally top surgery. At no stage did she raise concerns about the process or the ‘speed’ of the process. That she regrets her decision is heart-breaking. As yet, it is unclear why she felt unable to raise concerns along the way. This one court case will now negatively impact many transgender individuals who are absolutely sure of their need for puberty blockers, hormone treatment and surgery.

Puberty blockers are not new

The courts have given the impression that puberty blockers are new and dangerous. These drugs have been used for many years to stall early-onset puberty. The medication is simply stopped once the child reaches the age when they would more naturally go through puberty. There is only one difference with transgender people. Puberty blockers are used to gain time for the individual to explore their identity before going through irreversible procedures. Going through a puberty out of alignment is traumatic beyond belief.

The anti-trans lobby now uses Bell as a poster girl. I understand the entire case has been crowdfunded by anti-trans supporters.

Something that really concerns me is that, following this case, many will come away with the idea that somehow transitioning is a dangerous thing that should be put off into adulthood. There are some concerns here:

  1. Your child may not live to see adulthood if gender dysphoria is not recognised and treated
  2. The myth is that more people de-transition than they do and therefore we should prevent transition in the first place
  3. That therapists will, having read incorrect information in the media, support the idea that transition is wrong and will not provide the best care and support to their clients/patients.
  4. That not enough is being done within the NHS or private gender clinic arena to fully support those whose gender sits somewhere between the binary of male and female. See: https://bainesballcp.co.uk/uncategorized/thinking-outside-gender-binary/

This really useful link provides much needed information for people wanting to access gender clinic services.


JK Rowling’s open letter

I have some thoughts about the recent media row between JK Rowling’s open letter and some trans activists…

Fear seems to be at the heart of the argument. Fear of difference, fear of the unknown, fear of harm and fear of erasure.

Inclusive language

In the initial Tweet, Rowling takes umbrage with the inclusive language “those who menstruate” which includes trans men and non-binary individuals who are not women but who may still menstruate. It’s hard (for me) to see why the inclusion of these groups seems to undermine a sense of ‘woman’ for those who were assigned female at birth and feel that’s the right category for them (cis-gender).

Rowling has clearly had some awful experiences in the past. However, she seems to be confusing all trans women (those assigned male at birth) as predatory and male as though these are linked. They are not. People of all genders can be predatory and abusive. Rowling talks about being ‘triggered’ and it sounds like she might need some additional support for that so she isn’t assuming all men are evil or trans women might want to harm her. One point she seems to miss completely is the vast majority of trans women feel shame around certain parts of their bodies. The last thing on their minds is to expose themselves others.

Binary thinking

It appears she is also operating from a binary male/female perspective in terms of sex which is long outdated and incorrect. Whilst the two most common categories for sex characteristics and chromosomes are male/female, there are also a number of intersex categories. This is aside from any sense of gender identity which is more of a felt experience rather than something that can be ‘tested’ for. What it immediately highlights is that sex and gender is not a binary system, much as it might be safer to think in these terms.

Equality for all genders

Far from eroding the category of woman, supporting equality for all genders adds weight to equality for women. First we need to widen the legal definition of sex so that intersex individuals are included rather than excluded. This will undoubtedly complicate areas of research where so much focus is placed on the binary sex marker. I have no doubt that what we’d see is simply variation within any given category.

JK Rowling’s open letter voices concern re safeguarding children as though by being more inclusive of trans rights we somehow make children less safe; this is simple scaremongering tactics based on her own fears. We are all entitled to our own opinion; we also need to understand the emotion behind the position. It’s no wonder Rowling feels so strongly given her early experiences. Trans individuals feel equally strongly because of the oppression they face day after day.

De-transition rates

Rowling talks about de-transition rates. There will always be people who find it wasn’t the right approach for them. Many of these might be non-binary rather than trans. The more support we can give these individuals the less regret we might see. However, the de-transition rates remains very low. Currently the system still favours those who transition from one side of the binary to ‘the other’ rather than enabling the freedom to simply be whoever they are with all their complexities. Rowling also talks about people transitioning rather than living with the oppression of being gay/lesbian. Surely our efforts need to focus on making it OK to be gay/lesbian rather than to further oppress a particular group?

Is it OK to disagree with Rowling? Sure. Is it OK to be hounded with death-threats? Quite frankly, no! She is entitled to her opinion. Whilst it’s one I do not share, behaving in an abusive way towards her simply feeds the negativity. It also confirms for her that trans women are indeed scary beings who want to harm her. As someone with such a high profile I do think she has a duty of care to better educate herself and to be more aware of the impact of her comments on those who face oppression. Her books have given many people the hope that love and respect will win in the end. Even though not a single character of hers was trans or non-binary.

Transition rates

JK Rowling’s open letter speaks about being concerned about the increase in people seeking transition. It is inevitable that the numbers will increase as people see that it is a possibility for them. Surely this is a positive step; to know that people previously desperately unhappy are now able to receive the support and interventions they require.

Rowling suggests she might have become a man herself “to turn into the son her father always wanted”. Like that’s the reason people are transitioning and would be supported by the health care system. The suggestion is that transitioning is an easy process! Perhaps she is not aware of the incredibly lengthy, and oft times humiliating hurdles that need to be overcome to arrive at a point of transition. Particularly if medical and/or surgical interventions are required.

The way forward

So, I’m left wondering what the way forward might be. We have a situation where some women are deeply frightened of being attacked by someone they have placed into a non-woman category. We also have trans and non-binary people needing safe spaces. Especially to go to the toilet and use changing rooms without being attacked. Instead of attacking each other, how can we work together with an understanding that both groups feel the terror of oppression and abuse?

I’m back to thoughts around fear and erasure. The way forward is surely in ensuring visibility and equality for all? In terms of equality, it might be difficult for women to think of themselves as both oppressed and privileged. Oppressed by men and also with privilege that trans and non-binary individuals don’t yet have. With greater visibility for women (including trans women) and non-binary people, there’s a greater sense of empowerment for all. It’s important to know where we have privilege and where we experience oppression. Together we are stronger.