The Inside Story of the Tavistock Gender Identity Clinic

Getting your Trinity Audio player ready...

Swift Press describes itself as an “independent press.” In February, 2023, three-year-old Swift Press published Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. Author Hannah Barnes is, according to her online bio, “an award-winning journalist at the BBC’s flagship current affairs program Newsnight … Hannah has specialized in investigative and analytical journalism.” My review copy of Time to Think is 445 pages long, inclusive of 59 pages of notes and an eight-page index.

Before Swift Press accepted Time to Think, it had been rejected by twenty-two publishers. Some publishers praised Barnes’ proposal as an important story that needed to be told, but not by them, because the transing of children was a “sensitive” and “controversial” topic and if they published the book they would face backlash. Barnes says that “Swift did not require my manuscript to be scrutinized by sensitivity readers, nor did they ask me to change a word.”

Thank the Lord for Swift Press.

I have never read another book that so thoroughly smashes to smithereens a powerful ideology. Those who understand trans extremism as a fad and social contagion await an event called “peak trans.” Peak trans is that tipping point when trans extremism reaches its greatest power, after which it begins to diminish. Time to Think will contribute to peak trans. No rational person can read this book and not think twice about the transing of children.

Barnes is not anti-trans. She uses chosen pronouns and supports transing for some children. In interviews, she places distance between herself and “right-wingers” who want to, as one interviewer put it, “kill all trans people.” Barnes includes brief accounts of some former GIDS patients who are happy with transitioning. Barnes presents without criticism speakers’ reasons for insisting that they are the sex opposite to their own. Males are “really” female because they wear fingernail polish and high-heeled shoes, or because they dance ballet and hate sports. Females are “really” male because they prefer rough and tumble sports to Barbie dolls, or because they were interested in computers.

Barnes is not an ideologue. In interviews, she is a soft-spoken woman in unglamorous attire. She speaks slowly and hesitantly and often stutters as she appears to be searching for the least controversial way to state an astounding fact. Barnes looks a lot like that girl in high school science class who wore no make-up and paid a lot more fascinated attention than anyone else to the anatomy of the dissected frog.

Time to Think could have been written by a robot. That’s not an insult. Time to Think is dispassionate. It has all the literary style of a workplace report in a three-ring binder; there’s no tugging at heartstrings, and no real narrative drive. There is just a series of facts. In spite of Barnes’ clinical approach, a roomful of readers would not be silent; rather, the room would resound with the sound of gasps, hands slapping foreheads, and outraged cries of, “How could they?”

Time to Think makes no attempt to present a global portrait of the trans phenomenon. Time to Think shuts out many big questions. It makes no mention of other attention-grabbing works in the field, from Dr. Miriam Grossman’s Lost in Trans Nation to Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Daughters to Lisa Littman’s work on social contagion. The wider impact of trans extremism goes unmentioned. The reader will not learn Barnes’ thoughts on the firing of teachers who refuse to knuckle under to pronoun fascism to Lia Thomas’ swimming career to schoolchildren being encouraged to despise their own bodies.

Rather, Time to Think is laser-focused on the history of the National Health Service Gender Identity Development Service, or GIDS, at the Tavistock and Portman NHS Foundation Trust in London, England. GIDS was founded in 1989; it is scheduled to close in 2024. The amount of minute detail in the book can be overwhelming. Drop by drop, a tsunami builds. Barnes is a methodical, thorough researcher. She interviews GIDS staff and former patients, reviews reports from the popular press, and summarizes medical studies. Too many peer-reviewed scholarly publications never achieve the thorough documentation and explanatory power of Barnes’ text.

Barnes’ research presents an inescapable conclusion, whether she wants the book to do this work or not. The trans emperor is naked. For decades, highly credentialed medical professionals harmed children. They did so, evidence suggests, not because they were mislead by rigorous scientific research that was somehow flawed, but because they were driven by ideology, paranoid hatred of those who disagreed with them, and also by greed. These medical professionals went about inducing osteoporosis in children, removing the ability ever to have an orgasm from children, cutting off the healthy breasts and testicles of young people, who had never so much as experienced their first kiss, and these same medical professionals couldn’t even define a trans child. Barnes writes, “Clinicians did not agree on what exactly they were treating.” That is, they didn’t know exactly what being “trans” actually meant. When their colleagues raised alarms, they demonized those colleagues as “transphobic.” Further, medical professionals with children’s fate in their hands chose to distribute drugs and wield scalpels not in accord with research results, but to satisfy amateur activists who breathed down their necks and threatened them with reputational assassination if they did not jump through the hoops the activists held up.

On February 25, 2021, Dr. Rachel Levine, a man who identifies as a woman, testified before the Senate after US President Joe Biden nominated Levine to be assistant secretary of health. Senator and Doctor Rand Paul asked Levine if he supported the genital mutilation of children. Levine ducked the question, saying only, “Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed.”

In 2015, Zoey Tur, a man who identifies as a woman, during a televised discussion of trans, physically threatened to send Ben Shapiro home in an ambulance. Shapiro had referred to Tur as “sir.” Tur lectured Shapiro, insisting that science supported trans extremism, science about which Shapiro, Tur insisted, was ignorant.

Levine and Tur promote deadly lies. Time to Think demonstrates that the “science” and “medicine” supporting trans extremism are not there, and were never there, and medical professionals had every reason to know this.

GIDS followed the “Dutch protocol.” The Dutch protocol was “born,” Barnes writes, in 2000. Seventy adolescents were put on puberty blockers and later offered cross-sex hormones and surgery. The Dutch sample size was small, it lost twenty percent of participants, and the Dutch group did not conduct adequate follow-up. That is, follow-up was for a short period, and a significant number of participants were never followed up at all. Also, the Dutch made claims that could not be supported by the procedures they followed.

In this small group, one eighteen-year-old was killed by the medical procedures the Dutch carried out. The boy was given puberty blockers. These arrested the growth of his penis. In surgical construction of a pseudo-vagina, surgeons invert the penis. This boy’s penis was small, so surgeons attempted to create a pseudo-vagina out of his intestines. Surgeons do this in spite of the following potential problems: “There was a risk of mucus or blood discharge and an ‘unwanted smell’, and in some cases corrective surgery may be required.” The teen died of infection.

“The Dutch team’s findings” Barnes writes “have never been replicated by other teams treating young people with gender-related distress.” For thorough and recent analyses of the Dutch protocol, see a December 1, 2023 City Journal article here, and a scholarly article, “The Myth of ‘Reliable Research’ in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed,” here.

Science demands data. GIDS did not compile adequate data to support its policies. Often, instead of scientific research, GIDS published “‘postmodernist, high-level theoretical ideas and stuff … We don’t f—ing care about post-structuralist ideas … we want to know numbers, some actual numbers. How many?'” How many autistic children were put on puberty blockers? How many desisted or detransitioned? How many left, never to return, and why? GIDS did not know. It did not keep records. “‘How can you be an expert on something without data? … How can you be experts when we don’t know the impact of the treatment, the side effects and the long-term effects? And we don’t know any of the outcomes. Without all of that, what are you expert in?’ … ‘It’s like they’re actively not wanting to find out.'” GIDS will not say that “it has the data behind their own published papers.”

On at least one occasion, GIDS did conduct research. It didn’t like the results. Ideology won out over evidence. After a study conducted between 2011 and 2016, quantitative measures of patient health showed no improvement. “There had been ‘no change in psychological functioning’; ‘no change in self-harming thoughts or behaviors’; ‘no change in gender identity or gender dysphoric feelings’; ‘no change in perception on primary or secondary bodily characteristics … Researchers reported a statistically significant increase in those answering the statement ‘I deliberately try to hurt or kill myself ‘ as well as a significant increase in behavioral and emotional problems for natal girls. Parents reported a significant decrease in the physical well-being of their child.” A former head of psychology for the Tavistock Trust, Dr Bernadette Wren, said in 2020 that “‘studies are still few and limited in scope, at times contradictory or inconclusive on key questions’ and therefore GIDS clinicians are ‘concerned about overstepping what the current evidence can tell us about the safety of our interventions.'” GIDS continued to “overstep.”

There were plenty of red flags. Again and again, there were investigations of GIDS that recognized problems and recommended changes. This process began in 2005. Again and again, these investigations, their findings and their recommendations were memory-holed. The recommendations were not followed; staff were not informed of investigation results. In 2018, a review by Dr. David Bell labeled GIDS “not fit for purpose.”

In 2020, Keira Bell, a former patient who was prescribed puberty blockers when she was 16 and who underwent a double mastectomy when she was 20, lodged a legal complaint against GIDS. Bell said that her mother’s mental illness and alcoholism, her father’s abandonment, her own lesbianism, and being bullied by others because she was a tomboy, all contributed to her confusion. Rather than offering her adequate support, GIDS damaged her body for life. “I was an unhappy girl who needed help. Instead, I was treated like an experiment.”

In 2021, the Care Quality Commission rated GIDS “inadequate,” its lowest rating. Also in 2021, a review of the distribution of puberty blockers to minors reported that it could find “‘no changes in psychological function, quality of life or degree of gender dysphoria’ in the young people prescribed puberty blockers.” Also in 2021, The Central London Employment Tribunal ruled in favor of Sonia Appleby. Appleby was the “children’s safeguarding lead.” She raised concerns. For doing so, she was “vilified.” In 2022, another report declared that GIDS’ model “is not a safe or viable long-term option” for children. In spite of all these red flags, GIDS remains open to this day, and people in power, like Rachel Levine, parrot the GIDS-style party line and practice the same GIDS approach of demonizing anyone who questions trans extremism.

Following the Dutch protocol, GIDS often began its medical transing of children by prescribing puberty blockers. These, as their name suggests, prevent the child’s body from undergoing puberty. Puberty blockers were marketed as a “fully reversible” “pause button” providing a gender confused child with “time to think,” that is, with a chance to pause the natural maturation of their bodies. During that alleged “pause,” the child was, in this argument, supposed to devote deep contemplation to whether or not he or she wanted to grow up as a male or a female, and then make a rational decision. One conference on transing children was “sponsored by Ferring Pharmaceuticals, the makers of triptorelin,” a puberty blocker.

The puberty blocker narrative was false in addition to being patently absurd. Puberty blockers are not reversible. They can and do cause permanent harm. Children are not qualified to decide at age ten whether or not they will ever want to experience an orgasm, have healthy bones, or parent their own children.

Since in some cases the Dutch protocol results in sterility, young people should have been told to consider harvesting and storing eggs and sperm. These conversations did not often take place. Boys were not warned that puberty blockers would make it impossible to create via surgery a successful opening that would serve as a pseudo-vagina. These pseudo-vaginas are constructed from the boy’s penis, but puberty blockers rendered their penises too small to be inverted. Health care professionals had this information; they were just not “routinely” conveying it to patients.

Puberty blockers put children on an assembly line to surgery. Almost all of the children who had been assigned puberty blockers went on to further procedures in an attempt to change their sex. There was no “time to think.” There was no “pause button.” GIDS had this information. It did not, as a matter of policy, convey this information to young people.

A common side effect of transing children was loneliness and isolation. It is not easy to find a lover and life partner when your body does not conform to what most people desire. Trans adults often have impaired sexual function. They have sacrificed their healthy vaginas and penises for ersatz, unsightly, malfunctioning, and often infection-prone and often painful or numb substitutes. One patient said she broke up with her one long-term relationship because she was ashamed of her “genital appearance” and inability to have sexual intercourse with a man-made penis substitute.

Previous studies had shown that the vast majority of children who express gender confusion “desist” after undergoing puberty. Many identify as homosexual, but they come to peace with their physical bodies. Puberty blockers robbed children of ever experiencing that psychological growth. Instead, once children were transed, in some cases, it becomes “almost impossible” for them to “think about the reality of their physical body.” So said Dr. Polly Carmichael, director of GIDS.

Barnes writes that studies “suggest there is evidence that puberty-blocker use can lead to changes in sexuality and sexual function, poor bone health, stunted height, low mood, tumor-like masses in the brain and, for those treated early enough who continue on to cross-sex hormones, almost certain infertility. The use of cross-sex hormones can also bring an increased risk of a range of possible longer-term health complications such as blood clots and cardiovascular disease.” “Some data” show that those who transitioned decades ago are “more likely to suffer from mental health problems.”

Puberty blockers are associated with a range of other side effects. One young person, who had a negative experience at GIDS, says that while on puberty blockers, “‘I had really bad insomnia … I had really bad anger problems … I actually broke my knuckle while I was on the blocker,’ from punching something,” she says. “‘Your mood goes like it’s a roller coaster … There are moments when you’re euphorically happy. And the next day, you crash really bad and you are exhausted. And then you are suicidally depressed.'” This young woman gained “‘tons of weight'” and got stretch marks. She had never previously had a broken bone. Suddenly she had a broken wrist, twice, and also a broken knuckle and toe. She had no libido. “‘You have no desire, no drive whatsoever. You don’t even feel attracted to people.'” Though this young woman stopped trans drugs years earlier, “‘I still haven’t had my first kiss and I’m almost 19 … I still don’t feel attracted to people.'” She also stopped growing. I was “‘sold a lie,'” she now says. “‘It is one of the biggest regrets in my life is that I went on blockers,'” [sic] she says. “‘I was a child.'”

Puberty blockers were prescribed to younger and younger children. “Aged nine or ten” would be just fine. Eventually GIDS would see three-year-old patients. “If anyone, of any age, self-identifies as the other gender, then they’re affirmed as ‘trans.'” Eventually “physical interventions” were available to “anybody who wants it.” GIDS director Dr. Polly Carmichael said, “‘Of course, our work is affirmative … we respect and accept completely children’s sense of themselves.'” Puberty blockers were prescribed, as time went on, after fewer and fewer assessment sessions. Health care providers report that young people received referrals for puberty blockers after one session. Sometimes the health care provider made the decision unilaterally, and merely informed the young person that he or she would be drugged. Records were altered to disguise these quick referrals. Trans extremists argued that any attempt to devote more time to talk therapy before prescribing puberty blockers was “transphobic.”

Puberty blockers were prescribed to children who expressly stated that they didn’t want them, that they weren’t trans, and that their parents were pressuring them to identify as trans. After these drugs were prescribed, there was minimal follow-up to assess the well being of the child. Minimal to no data were kept to assess any benefit or harm patients may have experienced.

The population seen at GIDS was vulnerable. “It was very rare for young people referred to GIDS to have no associated problems.” Similarly, in Finland, “75 per cent of the young people” who arrived at gender clinics between 2011 and 2013 “had been or were currently undergoing child and adolescent psychiatric treatment for reasons other than gender dysphoria when they sought referral.” Children might end up at GIDS because someone mentioned the word “gender” during their intake session at an NHS mental health counselor or in a child welfare setting.

The young people reporting to GIDS showed greatly disproportionate rates of autism, ADHD, self-harm, eating disorders, parental mental illness, parental abandonment, psychiatric hospitalizations, obsessive compulsive disorder, bipolar disorder, depression, suicidal ideation or actions, inappropriate sexual behavior, hallucinations, hearing voices, and living in foster care. One patient “had not left their home for a number of years.” Some were non-verbal. When asked what troubled them, they could not speak. Often these young people had been victims of sexual assault or molestation, often just prior to their expressing a desire to change their sex.

Some didn’t just want to change their sex; they also wanted to change their ethnicity, generally preferring to be Asian. Some had no idea what transing entailed. Girls actually asked when, in their treatment, they’d start producing sperm. When some were warned of loss of bone density and the danger of stunted growth, spinal deformation, and osteoporosis, they said they didn’t care; all they cared about was transing. As one concerned health care provider pointed out, if a child is so immature that he doesn’t care about osteoporosis, he is not mature enough to provide informed consent to life-changing drugs and surgery.

One had lacerations to her vagina. When a healthcare provider insisted that these lacerations be examined, he was treated dismissively. One was groomed by a trans adult, a male who identified as a woman, who gave the teen gifts. The teen planned to move in with this adult after transing. Health care professionals expressed concern to superiors. The superiors “viciously” rejected their concern and recommended that the teen be transed.

Some cases gave every sign of being Munchausen’s by proxy, a.k.a. “fabricated or induced illness.” The push for medical intervention and transition wasn’t coming from the young person themselves, but rather from their family. “‘My mum wants the blocker more than I do,'” one young person said. This patient came from a home with “sexual abuse and domestic violence.” In another case, a health care provider met separately with a mother and child. The mother wanted the child transed; “‘the young person has not communicated any distress in relation to gender. The ideas were all coming from mum.'”

A former GIDS patient says that she was pressured to identify as trans. She says that she was a tomboy and she was distressed by being bullied for not being feminine enough. “‘I was only distressed by the accusation that I wasn’t a girl when I was one. I didn’t mind being called a boy. But I didn’t want to be bullied for it. And a lot of that came from adults.'” She was muscular. “‘It was other people’s perceptions of me that was making me feel so much disgust in my own body, or foreignness of my body. And discomfort in that.'”

One provider assessed GIDS as “institutionally homophobic.” Homophobia was “‘everywhere.'” Parents and the young people themselves made astounding homophobic comments. The institution contributed to “‘completely silencing people who are gay.'” It “‘dismissed the reality'” that being gay might cause young people to choose to identify as trans. Teens said that they wanted to “die” because they were gay, or to “vomit.” Parents said things like “‘Thank God my child is trans and not gay or lesbian.'” GIDS did not pay adequate attention to the young people’s experience of being bullied for being gay. Rather than address a young person’s experience as a gay boy or lesbian girl, GIDS had one product to push – transing. “Clinicians would never dream of telling a young person that they weren’t trans, or that they were gay instead.” GIDS, one staff member said, “‘was performing conversion therapy for gay kids.'” Staff joked that thanks to GIDS, there would be no gay kids left.

Young people reported to GIDS kicking and screaming and demanding that they receive drugs and surgery or else they’d be forced to kill themselves. And some, after these dramatic performances, changed their minds, and rejected the very drugs and surgery they had demanded. “They were adamant that this was the right thing for them,” one health care provider said to Barnes. “He recalls one young person in such distress, so determined to start medical interventions, that they had a panic attack during the assessment. They were screaming, ‘I want my hormones.’ But they later changed their mind. ‘I was shocked … I really didn’t get it. I was certain [they] would go on hormones.'” Imagine that. A professional who works with young people who isn’t aware that young people make dramatic announcements of what they want, and then change their minds shortly thereafter.

The solution to all of these problems was transing. “The service was unable and not commissioned to provide more than one treatment pathway – physical transition.” “It was frowned upon to suggest that something other than ‘being trans’ – unresolved trauma, internalized homophobia, an eating disorder, perhaps – might be the difficulty that needed addressing.”

One reason GIDS offered transing and only transing as the solution to a plethora of diverse problems was pressure from activists who penetrated every corner of GIDS. Mermaids is an activist group pushing trans extremism. Susie Green was its CEO for six years, until 2022. Green took her 16-year-old son to Thailand for surgery in an attempt to change his sex to female. Insiders acknowledge that GIDS leadership deferred to Mermaids. GIDS agreed to “‘co-ordinate’ the content of GIDS’s website with Mermaids so that they were ‘consistent.'” Mermaids leaflets were distributed within GIDS. Mermaids interfered with what health care providers children saw.

Mermaids pushed the position “that there was only one outcome for these children and young people – medical transition. The annual Mermaids meetings were not always pleasant, one clinician recalls. ‘I didn’t ever want to go… You’re going to these people who are really slagging you off and saying, “Why don’t you give medication, you’re killing our children.”‘” Another healthcare professional said that Mermaids was “‘omnipresent … GIDS and Mermaids were virtually inseparable.'” “Sessions for young people attending GIDS were invariably led by trans adults from either Gendered Intelligence or Mermaids.” Both are pro-trans activist groups. “These adults had often not been through GIDS … they were only interested in hearing about positive stories.” A young person was discouraged from speaking frankly about his own life because “Those facilitating the discussion only chose people who were like them – fully sold on medical transition.”

The Bayswater Support Group is “wary of medical solutions to gender dysphoria, when exploring gender roles is part of normal child development.” GIDS rejected association with the Bayswater Support Group.

The number of young people, especially adolescent girls, identifying as trans exploded. “The service faced an exponential increase in referrals … from 97 in 2009/10 to 2,748 in 2019/20 – a 2,800 per cent increase. Even more pronounced was the rise in girls – a 4,700 per cent increase from 40 to 1,892 during the same period.” Given the rapid increase in new arrivals, staff wanted to conduct research into why so many new patients were arriving, but GIDS allotted them no time to conduct such research.

At the same time that numbers increased, senior health care providers left the service, often in disgust. GIDS hired newcomers who were not informed about their predecessors’ discoveries and complaints. Institutional memory was erased. New staff did not receive formal training. New staff were assigned impossibly high case loads – as many as one hundred patients. A superior complained to management. What “‘I was asking'” of a new employee “‘was actually impossible. It wasn’t just unethical and clinically risky. It was also impossible.'” It got to the point where staff did not recognize their own patients. A health care provider who had forgotten who a child was and had no notes of the one previous appointment “within 15 minutes” began to instruct the child in how to trans himself. The family felt “‘railroaded.'” Health care providers were encouraged to push patients through the process in order to free up space for the many new arrivals.

Why the rapid increase? Barnes does not attempt to answer that question, but she does quote people who ponder it. One would-be trans child was addicted to Tumblr, a website that has dragged many into trans extremism. “He was being groomed,” his mother reports. Children arrived at GIDS reciting a rote script they learned from trans extremist recruiters and groomers on sites like Tumblr and YouTube. Other possible factors: porn. Girls are overwhelmed at being objectified. The way boys who have grown up on extreme porn treat girls is disturbing. Girls want to escape the role that porn assigns to them so they identify as not being girls at all. Barnes does not mention family breakdown, but that breakdown is evident in cases she mentions. Kids are adrift; their parents are failing them, or have left their lives entirely.

Actor Hal Holbrook once told audiences to “Follow the money.” Barnes quotes statistics showing that GIDS was financially important to the Tavistock Trust. One former staffer said money “‘is the elephant in the room.'” Administrators “‘didn’t want to jeopardize the budget that came from this enormous number of referrals.'” Transing children was “guaranteed income.” Fame was also attractive. GIDS became a media darling. There were documentaries and flattering press profiles. GIDS adopted a logo, a first for those on staff who had never worked for an NHS health care provider who had a logo.

When health care providers discovered drawbacks to transing, some tried to warn patients and their families. One wrote up an informative pamphlet. Management stonewalled distribution of the pamphlet. Fully informing incoming patients was not official policy. Staff concluded that director Polly Carmichael was afraid to commit the truth to writing because doing so would be condemned by Mermaids. Mermaids pushed the narrative that transing children “‘is an increasingly normal practice, mainstream, safe thing to do, which doesn’t have any significant consequences, and we should just be doing it quickly. And saving all these poor kids lots of trauma.'” Mermaids also pushed the falsehood that not transing a child will cause the child to commit suicide. “The wording on Mermaids’ website was ‘as scary as it can be.'” Health care providers recognized that Mermaids was harming children by “‘encouraging them to be believe that what they feel is completely intolerable.'” Mermaids and others robbed young people of the opportunity to mature. Realizing that life will never satisfy all of our whims is part of growing up. GIDS at least resisted this narrative, saying that “‘suicide is extremely rare.'”

As Barnes makes clear throughout her book, some health care providers at GIDS recognized the problems with the institution. Those who spoke up were abused and lied to. They were told that they were “weak, incompetent” and they were encouraged to quit. When a doctor who was personally familiar with post-trans regret even mentioned the topic, he was condemned as a “trouble maker.” Such accusations “made it very difficult for people to have freedom of thought.” Anyone who recognized any failings at GIDS was branded “transphobic.” “The team had a deep fear of appearing transphobic.” Those who spoke up became “scapegoats.” Speaking up “‘felt very dangerous. It felt explosive.'” “There was a ‘level of malignancy.'” “‘There were things they did not want us to know.'” “Clinicians felt afraid.” “Anyone who spoke out was ‘made to feel hysterical.'” “It felt ‘risky’ to have honest conversations with young people about the reality of what transition entails.” Staff felt that they were “under surveillance.” They felt “‘pressure within the institution to not think.'”

Staff were not just threatened as a result of speaking up at work. If they said anything outside of the workplace that violated trans extremism, they were harassed by activists like Mermaids. In spite of statistics showing that most children who experience gender dysphoria desist, even mentioning this fact was “taboo.” The phrases “natal male” or “natal female” were banned. One had to say “assigned female at birth.” Speaking the word “vagina” was met with frowns. Someone who said that it is not possibly to “literally change sex” was told that that view was unacceptable. There was a “‘subliminal message never to question GIDS.'” “‘Team meetings could be intimidating.'” Staff were pressured to push transing. “Whistle-blowers” were “treated poorly.” “‘It was just a climate of we are under attack, and everybody outside is against us. And no one is to speak or talk to anyone.'” Staff were told not to use social media. They were told not to read any commentary critical of transing children. The directive was, “do not speak to anyone.”

Superiors were “‘very defensive'” with a “‘siege mentality.'” “When people did challenge, it was taken very badly … ‘as a personal affront’ … Executive members of staff would become tearful when criticisms were raised. It would then be made known among the team that ‘this has made [GIDS director] Polly cry’ …’I don’t think that’s appropriate as a management style.'”

The pressure not to speak or think put the kibosh on the accumulation of knowledge. GIDS knows “next to nothing” not just about how to define a trans child, but also about desistence and detransition. GIDS frowned upon mere mention of these topics and GIDS did not keep data. “GIDS didn’t even like the words ‘desist’ or ‘detransition’ to be used in the service. ‘I was in a service where no one had ever asked the question: how many of the people that we see actually changed their mind?'” one former staffer says. This staffer wrote a paper on the topic. He was told not to publish his research. If he did publish his research, he was told, “‘People will think that we are transphobic.'” He was also told not to use the word “desistance” as it is “provocative.” One impact of these directives: search engines for medical journal articles only work when accurate keywords are used. Someone looking for research on “desistance” will search using the term “desistance.” If one is forbidden to use that word, the research that doesn’t use the word “desistance” is effectively memory-holed.

When investigation results went public, GIDS spokespersons lied to the public and said, paraphrase, “Everything is fine; there is no reason for concern.” GIDS promised to do research, for example on rates of desistance and regret. GIDS either never did that research or never released the results. Even after it was obvious that the statement wasn’t true, GIDS spokespeople insisted that puberty blockers are “‘fully reversible.'” Even days after a staff member approached a superior to report problem X, that superior went public and denied that he had ever heard any complaints about problem X. GIDS put a happy face on its failures. When asked how a ten year old who has never experienced an orgasm could “consent” to being rendered physically incapable of experiencing an orgasm, GIDS replied, “‘Many adults are happily asexual.'”

GIDS saw red flags; GIDS could have changed; it did not. If GIDS had acknowledged that its previous policies and practices had not been the best for children, “We would need to acknowledge that we had done things in a wrong way in the past.” Some former staff were able to do what GIDS as an institution could not. Some staff later reported, “‘I did some work that I regret.'” “One person wasn’t sleeping … because they kept thinking about the children … and felt that they’d done damage.” One former health care provider said, “‘What I did – or rather what I failed to do – at GIDS was wrong and I’m ashamed of it and wish I could go back in time and do the right thing.'” Another said, “‘I was broken by the service.'” And another former staffer acknowledged that colleagues might find it hard to admit, “‘I was wrong or maybe that was not [the] best thing for all of those kids.”‘ Staffers used to say amongst themselves, “‘Oh my God, will we look back in ten, 20 years and be like, what did we do?'” “‘I felt morally violated,'” one former staffer said. Another said, that “she cannot think of a single instance in which she signed off a recommendation for puberty blockers ‘with a real sense that this is 100 per cent the right thing to do.'” Barnes asks one former staffer who is responsible for any harm done to children at GIDS. This former staffer said, “‘I think the child.'” This former health care provider blames children for trans extremism, a trans extremism that this health care provider helped to promote.

Medical professionals at GIDS knew early on that regret was a potential outcome. In one case of an adult who attempted to change his sex to female, “he wanted to detransition,” the health care provider reported. “The man had explained how he had woken up from gender reassignment surgery having had his genitals removed, and immediately ‘knew he’d made a mistake.'” If even adults who undergo transing experience regret, how much more did children? “‘I regret all of it,'” said one young person who had undergone a double mastectomy and hysterectomy. “‘I wish someone would have been there to tell me not to get castrated at 21.'” Another detransitioner who underwent a double mastectomy and now has a permanently masculinized voice told Barnes, “‘It does feel a bit like waking up from a nightmare or regaining control of my mind after someone else took over. Emotionally I’m pretty exhausted.'” This person faced “‘the immense stigma against desisting, or detransitioning. It’s like, well, you’re just an idiot, you know? You made a mistake, let’s get on with it. Leave. And there is no compassion towards it at all … the thing I’m most angry about is how much this affected other parts of my life, like my education, my relationships, everything, because it touches everything. I’m not sure how to move forward, but I can at least take comfort in the fact I’m no longer fighting an uphill battle against my own biology.'”

Danusha Goska is the author of God Through Binoculars: A Hitchhiker at a Monastery