A Letter to Wes

Edited 29th May

My letter writing campaign to Streeting and Starmer continues. Two days late posting here, this is letter number four to the Secretary of State for Health and Social Care.

Because Streeting has never acknowledged receipt of any of my correspondence, I will copy it to the Prime Minister, as letter number five. Forgive my repetition, I start every letter the same way in the hope that at some point I might get a decent response, one that dares to acknowledge me, Alice and what happened to her.

Dear Mr Streeting

I’m the mother of Alice, a transgender woman who died by suicide aged just twenty. Today is the third anniversary of her death. Instead of sending her a card I am sending you this letter.

Today I learnt that in 2023, in Utah, USA, the Republican party commissioned its own research into gender affirming care. This was an attempt to produce evidence to support the ban on such care that they had already enacted. They were, apparently, so convinced their ban was legitimate, they did not stop to consider that the review might find against them.

The ‘Systematic Medical Evidence Review of Hormonal Transgender Treatment Report’ [i] they commissioned has now been published. Inconveniently for the Republicans, instead of supporting their ban, the review has shown gender affirming care reduces suicide risk and improves mental health outcomes in transgender people, with the effect most marked in the under 18 age group. At 1051 pages, I’ve not read the study, but it is undoubtedly far more comprehensive than Cass, at almost three times its length. 157 pages are dedicated to a bibliography of all included studies. Naturally the Republicans are ignoring it. Will you ignore it too?

The authors of the report write:

“The conventional wisdom among non-experts has long been that there are limited data…however, results from our exhaustive literature searches have led us to the opposite conclusion.”

“The consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric [gender dysphoria] patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer.”

“It is our expert opinion that policies to prevent access to and use of [gender-affirming hormone therapy] for treatment of [gender dysphoria] in pediatric patients cannot be justified based on the quantity or quality of medical science findings or concerns about potential regret in the future.”

In those who started treatment for gender dysphoria as minors, the authors write:

“Overall, there were positive mental health and psychosocial functioning outcomes…Patients that were seen at the gender clinic before the age of 18 had a lower risk of suicide compared to those referred as an adult.”

Today my husband and I drove to Brighton and left flowers where Alice died. We went to the crematorium to clean her headstone. We returned to bed at midday. We sent messages to, and received messages from, Alice’s friends. Some of them visited Alice’s grave too. Instead of going to the pub with Alice for a pint or glass of wine, they went to her grave and wept.

The knowledge that my government cherry-picks research and enacts healthcare policies, like in Utah, that harm the mental health of trans people, compounds my grief. Your actions as Secretary of State for Health retraumatise me, my family and Alice’s friends. Your stance over trans health care for both adults and especially young people under eighteen is ill- advised, dangerous and ultimately, cruel. Treating trans youth in a timely manner is the best treatment. If your government continues on its path of removing gender affirming care for trans youth, in the face of clear evidence that this action harms them, then you have a direct hand in any deterioration in their mental health, and any action that any individual takes as a consequence. I tell you this as a mother and a psychiatrist. The Utah review tells you this.

“Reviewed guidelines generally recommend use of puberty suppressing drugs in GD (gender dysphoria) patients during early puberty (but not earlier) and using CSHT (cross-sex hormone treatment) [ii]in older adolescents.

In the UK you have already banned the private prescription of puberty blockers to under 18s and Keira Bell, a high profile de-transitioner has recently sought a judicial review to stop the private prescription of CSHT to under 18s. You will recall it was her High Court action, Bell v Tavistock, back in December 2020 that started the ball rolling and caused NHS England to direct the now disbanded Tavistock and Portman Gender Identity Development Service to cease prescribing puberty blockers to under 18s; a decision which wasn’t reversed even when Keira Bell’s case was overturned in the Court of Appeal in September 2021. I understand that the judicial review was denied on the basis that you are “currently seeking clinical and expert advice from NHS England" and “actively reviewing” restricting or banning the prescribing of CSHT.

I need you to understand it will be a catastrophe for young trans people to have the healthcare they rely on taken from them because of the regret of one or two individuals, when research shows trans people flourish upon receipt of gender affirming healthcare, which includes prescription of CSHT.

Some things are worse than transitioning and regretting it, namely the mental anguish from being denied support to transition in the first place and the chillingly irreversible actions that may follow. It’s too late for Alice, but it’s not too late for all the other trans people who need help. By persisting in your political policing of trans healthcare you choose to traumatise, rather than help, those who need understanding and care.

I lie awake at night wondering if tomorrow I’ll hear that another mother now walks my path. For the current situation for trans youth is so dire, more suicides are inevitable. Being a teenager is hard, being trans is harder, being trans and denied care, being othered and denied access to public spaces for fear of attack or perhaps arrest, is harder still. This effects a person’s mental health. You don’t need to be a psychiatrist or read it in a medical journal to know this must be true.

But now we do have more medical evidence to confirm what I already know. Please do not ignore it. Do not ignore me. Do not ignore trans people.

Please let me know how this new and extremely important research will shape your policy for trans health care going forward. Do not ban the private prescription of CSHT for trans youth.

[i] https://le.utah.gov/AgencyRP/reportingDetail.jsp?rid=636

[ii] CSHT is used throughout the report for cross-sex hormone therapy. Please note the term hormone therapy is preferred as sex hormones exist in various proportions in all of us. I as a cis woman have testosterone in my system.