Instead of listening to JK Rowling, here’s what the NHS and medical experts say about healthcare for trans kids

JK Rowling met with furious anger after sending string of anti-trans tweets

JK Rowling is facing a backlash for using her sizeable platform to opine on the lives of trans people once again.

Rowling, a cis woman and author, has been criticised by many trans people and their allies for broadcasting her views on trans people and their healthcare to her 14.4 million Twitter followers, despite the fact that she is not a recipient of trans healthcare, nor a provider of one.

In a Sunday afternoon (July 5) Twitter thread, Rowling expanded on a previous “like” of a tweet that suggested doctors were sometimes prescribing hormonal treatment out of “pure laziness”.

“Yes they are sometimes necessary and lifesaving, but they should be a last resort – not the first option,” read the original liked tweet. “Pure laziness for those who would rather medicate than put in the time and effort to heal people’s minds.”

Rowling’s claims that “many health professionals are concerned that young people struggling with their mental health are being shunted towards hormones and surgery when this may not be in their best interests” and her assertion that “many, myself included, believe we are watching a new kind of conversion therapy for young gay people, who are being set on a lifelong path of medicalisation that may result in the loss of their fertility and/or full sexual function” were derided by many in the trans community.

The idea that puberty blockers are a sort of quick-fix doesn’t tally with the realities of accessing trans healthcare in the UK. Trans kids face lengthy waiting times before they can receive any physical treatment, currently upwards of three years.

The NHS Gender Identity Development Service – the UK’s only clinic providing transition-related healthcare to young people – says that it takes a “phased approach” to any physical intervention.

“Some young people we see go on to access a physical intervention to help them manage gender dysphoria. Others never want this, or their hopes change over time,” its website reads.

Before any person can access this service, they first face a lengthy waiting period. In November 2019, doctors were beginning to see patients who had been referred in approximately September 2017, more than two years prior.

When a trans person is seen by the GIDS, a doctor will assess and explore the nature of their gender identity, including their developmental and medical history, the attitudes of those around them – eg their family or school – their family history and any sources of stress and support. There is also a risk assessment around any mental health issues, such as self-harm and suicidal ideation.

What are puberty blockers?

This assessment is usually carried out over three to six appointments, over a period of several months, the NHS says. Only then may a doctor may make a referral to an endocrinologist, who can prescribe puberty blockers. This postpones puberty, giving the young person in question more time to contemplate their gender and any future treatment before their adult bodies develop.

The wait time for an appointment with a hormone doctor is “likely” several months, and after the first appointment it can take up to three months to get approval for a blocker.

“The blocker is a physically reversible intervention: if the young person stops taking the blocker their body will continue to develop as it was previously,” the NHS says.

Cautiously, it adds: “However, we don’t know the full psychological effects of the blocker or whether it alters the course of adolescent brain development.”

In 2017, the Endocrine Society – made up of 18,000 members – published clinical guidance advocating for the use of puberty blockers in adolescents.

In its position statement it described medical intervention – including both hormone therapy and surgery – as “effective, relatively safe” and “established as the standard of care”.

The society advises that “no studies have reported long-term, adverse effects” of puberty blocker on ovarian function after treatment has been ceased. For people with testicles, it states that sperm production can be initiated if that person comes off blockers, but warns that for some, sperm numbers can be “far below the ‘normal range'”.

How old does a trans person have to be to receive treatment?

After 12 months on blockers, and only after the age of 16, a doctor can prescribe oestrogen or testosterone, which cause irreversible bodily changes. By this point, the person in question will have undergone at least a year of ongoing psychological exploration with GIDS doctors (this is mandatory in order to receive blockers), and will have, in total, been seeking trans-related healthcare for three years, and likely more (by current wait times).

The NHS says that people aged 16 or over are entitled to consent to any treatment – gender-related or otherwise – and that people under 16 can consent “if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment”. This is known as being Gillick competent, and those who are not can receive treatment if somebody with parental responsibility consents.

A 2020 study, published in medical journal Pediatrics, found that access to puberty blockers can be “life-saving”, reducing the chances of suicide among trans youth, who have a much greater risk of this.