Autistic girls seeking answers ‘are seizing on sex change’

Experts on gender dysphoria say vulnerable teenagers are being steered towards harmful interventions

Sian Griffiths, Education Editor Saturday January 09 2021, 5.00pm, The Sunday Times

A global expert on autism has warned in newly released legal papers that girls who are autistic or anorexic appear more likely to say they want to become boys.

The evidence by Professor Christopher Gillberg was given in a High Court case that led to a landmark ruling last month saying children under 16 were unlikely to be able to give informed consent to undergo treatment with “experimental” puberty-blocking drugs, which almost always leads to taking cross-sex hormones to change their bodies.

The Tavistock and Portman NHS Foundation Trust, which runs the only NHS gender identity clinic for children in England, suspended new treatments pending an appeal against the ruling.

The Sunday Times won court approval to publish the evidence of several leading experts who appeared in the case.

Gillberg, a psychiatrist at Gothenburg University in Sweden who holds posts at several universities including Glasgow, is reviewing research into what happens to children who receive treatment for gender dysphoria. The study has not yet been published.

He told the High Court in a written statement that research showed that, left alone, the condition usually resolved itself, and that as girls grew up they accepted that they wanted to live as women. Gillberg said that in 45 years of treating autistic children, he saw few cases of gender confusion until 2013. Since then there had been a worldwide explosion in the number of children saying they wanted to change sex. In Sweden, as in the UK, he said, most were girls who wanted to be boys.

Research showed that teenagers with autism or anorexia as well as those who had endured difficult childhoods were more likely to say they wanted to change sex. One paper published last year suggested autism spectrum disorders had “a prevalence of 6%-26% in transgender populations, higher than the general population”.

Gillberg said teenagers were finding online transgender sites that suggested their problems would be solved if they changed sex. Autistic teenagers, he said, were particularly vulnerable to seizing on a single answer “to the lifelong identity problems they have suffered”.

“Thousands of adolescents are being offered ‘treatment’ with puberty blockers, sex-contrary hormones, and then, finally for some, with a variety of surgical procedures. In the UK as in Sweden, this is in spite of the non-existent research evidence that these treatments are of any long-term benefit to the young people in question,” he said.

IQ might be damaged by puberty blockers, he added, and effects such as a deeper voice and facial hair, as well as possible infertility in girls taking the drugs, were irreversible.

Gillberg said there was “growing anecdotal evidence that many would regret their decision to undergo the biological sex change”. Doctors should tell families that they were “dealing with a live experiment on adolescents and children”.

“Adolescence can be a particularly turbulent time when young people often make reckless decisions they later regret. Young people with autism and young people with anorexia nervosa are particularly vulnerable,” he said.

Gillberg, who is also chief physician at Queen Silvia Children’s Hospital in Gothenburg, is on a list published by the media group Thomson Reuters of the most cited and influential researchers.

The expert evidence was presented to the High Court last year in a case brought by Keira Bell, 23, who was prescribed puberty blockers by the Tavistock centre when she was 16 and seeking to transition to a male. The landmark judgment means court approval is needed before the drugs can be prescribed to children who are confused about their gender identity.

Bell took testosterone, and had a double mastectomy at 20, but now lives as a woman again after “detransitioning”.

The number of referrals to the Tavistock’s gender service has risen sharply in recent years. In 2009, 97 children were referred. In 2018 that number was 2,519. Most of the children being prescribed puberty blockers from the clinic are girls. In 2011 the gender split was roughly 50-50 between girls and boys but by 2019 the split had changed so that 76% were girls.

Professor Sophie Scott, director of UCL’s Institute for Cognitive Neuroscience, told the court that “puberty blockers have profound effects on the developing body, and as part of the changes seen in adolescence involve hormonal effects on brain function, the impact of these drugs on the brain maturation are likely to be deleterious”. She said she was “concerned that the current treatment regime is exposing young people to significant risk of harm. The greater susceptibility to peer pressure in those under 18 may make them especially vulnerable to risk-taking, and this may well be enhanced by social media, where actions can be encouraged without any responsibility for outcomes.”

Stephen Levine, professor of psychiatry at Case Western Reserve University in Ohio, who specialises in sex therapy and has treated transgender patients for the past 40 years in America, gave evidence that it was medically impossible to turn a girl into a boy and vice versa. Many transgender people, he said, had sexual difficulties and suicide rates were high.

Levine also said that black and Asian children, adopted children, girls and autistic youngsters were more likely to be diagnosed as trans in America. “Contrary to trans persons’ hopes that medicine and society can fulfil their aspiration to become a complete man or woman, this is not biologically attainable ... It is a rare gender-dysphoric young person who has no associated psychiatric diagnosis or symptoms suggesting one,” he said.

Levine also told the court that because trans activists attacked critics as transphobic, few dared speak out. He said: “Critical and cautious voices are shouted down as transphobic, hateful and engaging in conversion therapy. Such a climate has created an intimidating and hostile environment where silence and acquiescence are the inevitable consequence. It is left to those of us at the end of our careers, who have nothing to lose, to voice our concerns.”

John Whitehall, professor of paediatrics at Western Sydney University in Australia, another expert witness, said that information given to families attending the Tavistock clinic “does not appear to share with confused children and their parents and carers the statistical assurance that almost all confused children will revert to an identity congruent with chromosomes through puberty, that ‘puberty blockers’ and cross-sex hormones have structural effects on the brain, and the warning that the rate of suicide in adults is significantly higher after transgendering.”

The UK is one of the pioneers of treating children for gender dysphoria with drugs. In America, where puberty blockers and surgery are readily available to children, there has been a push by Republicans for more regulation. South Dakota and Florida are among states that have tried and failed to criminalise it.

The Tavistock clinic said: “GIDS [the Gender Identity Development Service] is a safe and thoughtful service which puts the best interests of its patients and their families first. We have sought permission to appeal the judgment, and so won’t comment on ongoing proceedings.”