This article originally appeared on VICE UK
It's fair to say Dr Polly Carmichael is one of a broad brush of people you could describe with the accolade "hated by the Daily Mail".
She is the country's leading clinical psychologist in the area of transgender children. Her clinic at the Tavistock and Portman Centre in North London is the only NHS service dealing with gender identity for under-18s. Which means she is, as tabloid scare stories would have you believe, the doctor leading the charge of "playing God" by giving young children hormone inhibitors to block puberty and treat a "fashionable syndrome" that has become a "social tyranny".
In reality, hormone therapy – an intervention that can temporarily pause puberty while children have a chance to think about what they want to do – is just part of the work done by Polly's clinic. The Gender Identity Development Service works with children who are experiencing gender dysphoria – a feeling that they have been born into the wrong gender, or don't fit into the neat boy-girl definitions society dictates. Her caseload has increased massively over the last few years. In 1989, when the clinic opened, it got two referrals over the whole year. In the year 2015/16, it had over 1400 – double the year before. The waiting list for her clinic has risen from up to 18 weeks to nine months.
The clinic is already under the spotlight, and it will be even more so after a Channel 4 documentary that looks at the work Polly and her team do via two children with gender dysphoria and their parents. The programme is part of a three-part series looking at the growing crisis in young people's mental health, told through the eyes of the Tavistock – one of England's leading mental health trusts.
We spoke to Polly to find out why she agreed to open her clinic up to film cameras, how she deals with the intense scrutiny on her work by the tabloids and whether or not doctors are having to become more political.
VICE: Hi Polly. Your clinic is under a lot of scrutiny at the moment. You've been accused of "messing with God" by offering hormone blockers to young children – is that a new thing, or is it just that people have more awareness of these issues now?
Dr Polly Carmichael: Hormone treatment was around in the 1980s. It's been available in Holland and over here for many, many years. At that stage, it was available at the end of puberty – so not before the age of 16.
So why are blockers being used on kids under the age of 16 now?
We started introducing the blocker in the early stages of puberty here in 2011. There was a lot of pressure coming from certain group to introduce it – families were traveling abroad because they knew it was available in Holland and America. As a service, we didn't have the evidence one way or the other, so the best way to do it was as part of a research study.
The idea is that if you intervene in that early stage, you won't have experiences of secondary sex characteristics, such as breasts or [the] Adam's apple. So If the young person decides that this is the pathway they wish to follow, they won't later on be having to undertake procedures like top surgery.
There are many strong views about what is the best way to treat young people with gender dysphoria. It's incredibly hard – there isn't a blood test for this… we're working in an area where the outcomes are uncertain. In a sense, this is an area that's now in the public domain, and a lot of philosophical, ethical, empirical things are being thrashed out, if you like.
And where do you see your role in this?
We are often involved with families and young people over a number of years. Not all of them will ultimately decide to go through with physical intervention later on – around 40 percent of young people who come to the service will. Our role is to provide opportunities for them to explore their gender identity, think about their options and the potential pros and cons of treatment. And actually, that's quite challenging when you're in a domain where there is a lot of media, a lot on the internet, lots of very strong opinions. As a service, we're trying to hold that middle ground.
At times your clinic hasn't just been challenged but vilified. How that make you feel about the work you do?
I'd say, in general, for every one of those headlines, there's also the other side of that – which is that we should be doing everything sooner, quicker, earlier. Having said that, I believe in freedom of speech, and what's felt quite positive recently is that it does feel like there are different voices being heard – and there is a danger where you get into a place where you're afraid to say anything for fear of being accused of being transphobic. I don't think that's helpful for people with gender dysphoria. The fact that there can be different voices is a positive thing.
In the documentary, it's clear that children and parents have so much more information and access to these debates through social media and the rest of the internet. Do you think this affects their decisions?
It would be accurate to say that younger people than ever before seem to be very aware of physical possibilities in terms of surgery. So what would actually be helpful for young people is allowing debate to happen, and perhaps giving them an understanding that there are different points of view, and it's not that one is right and one is wrong.
It's also about hanging onto the fact that gender is diverse. We are not seeing all people expressing gender dysphoria identifying in a binary way – they may describe themselves as non binary, gender-queer… So, in a sense, things are still emerging, really. But I think what is probably more helpful is to think of gender as a sort of continuum rather than these boxes.
Do you think your role has had to become more political in recent years in response to the attention your clinic is now getting?
I don't think that working with young people coming to this service should be political. But I think it would be naive to say that gender is not political, because it is. Only last year we had the Women and Equalities Committee's transgender equality inquiry in Parliament, and there's loads of legislation [in this area]. Gender and trans has been taken up in the political arena. I think the impact that has on us, though, is that there's more and more discussion of gender and strong views, and that those views are often played out in the political arena.
The documentary really shows how difficult these decisions are for families, and how hard the decisions are to make within this wider political context. Is that why you did the documentary now?
There has always been a big interest in filming around this area, and we've obviously had a number of people approach us over the years. I think we got to a stage where it was so much in the media – and not all of it necessarily in a sensationalist way. Ten years ago you'd come back from holiday and it'd be front page of The Sun, "Youngest child ever goes to school as a girl." They were very misinformed and simplistic headlines. I suppose we got to a point that, if we were going to do it, now was the time.
The final thing that swayed it was we have a stakeholders group of young people who are users of our service. Unanimously, every single person in that group really wanted to do it. They thought it would bring about more understanding and acceptance. Also, quite a few of them said that they pieced together their own feelings through seeing a character on television. So we just thought maybe it was a good idea to stop being so paternalistic.
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