What a timely programme Kids on the Edge: The Gender Clinic (Channel 4) has proven itself to be. The first of a three-part series that will look at the mental health of children in the UK, this episode focuses in on the work of the Tavistock and Portman NHS Trust’s gender identity development services in London. These services are now greatly in demand: the clinic has gone from 40 referrals a year a decade ago to 1,400 in 2015. This rapid expansion of parents seeking help and advice has, depressingly, led to a kind of small-scale hysteria in recent times about what it means when children might be trans, bringing with it rabid front pages about them being “damaged” or “confused” by a TV show featuring a transgender character, for example.
I hope the people who rage about such things might also find the time to watch The Gender Clinic, which does a steady job of dismantling many of the panicked, inaccurate fears around what is clearly a complex process. In it, we follow two families discussing the possibility of hormone blockers for their children, which would pause puberty until, in time, a bigger decision can be made. There is Ashley, a headstrong young girl who was born a boy called Ashton, and her mum Terri, who is attempting to keep her daughter safe from bullying at school. And there is Matilda, who has an autistic spectrum disorder and whose gender identity is less defined, though by the end of the programme he is Matt at school. Rachel, Matt’s mother, is supportive but terrified of making the wrong decision for her child in either direction.
As a documentary, this is courageous enough to do what online discussion is often incapable of: explore the subtleties that get lost in the vicious polemics that can dominate the public reporting of such stories. Part of its effectiveness is down to director Peter Beard, who approaches the families with an obvious tenderness. He tells Terri – who is wondering whether to move the whole family again, to better serve Ash’s needs – that “there’s no instruction manual, is there?” His way with the kids is easy and kind. To get to the heart of what Ash is going through, he asks a simple question, made all the more devastating by the response. “What would be the best thing ever?” he asks her, as she plays. “Not being how I am,” she replies, casually, still playing.
It does not shy away from the trickier parts of the picture. Consultant psychiatrist Polly Carmichael explains that often, people are seeking certainty, and the reality is that in the case of hormone blockers, there is no certainty; research in this area is not far-reaching yet. The Tavistock’s staff sit cautiously in the middle of the many areas of debate. She talks about the impact of social media on young people seeking answers or reassurance. Ash, who declares that she will go to Sweden to get a womb transplant and then have a caesarian, Googles everything, says her mother. Carmichael says her patients understand the ideas but not the implications. Part of her role is to explain that “physical intervention is not the panacea to all things”.
There is a grotesque exaggeration perpetuated by some that the doctors and psychiatrists who treat children questioning their identities are trigger-happy gender-abolitionists, ready to strike every tomboy with a shot of testosterone if they so much as hint at cropping their hair. The reality is that the Tavistock’s team are articulate and circumspect. They deal with impossibly tough situations with a gentle level-headedness. This documentary makes clear that when a child is referred to their care, the process is thorough, considered and done in the best interests of both the child and the family.
What contributes to the wider hysteria about gender identity (a hysteria that can be fatal; I am thinking of the death of Lucy Meadows, the teacher who killed herself in 2013 after her gender reassignment became national news) is, in part, a desperate lack of empathy and knowledge. In showing its complicated workings, in showing that professional decisions may take in many different voices over many years, in telling stories that correct misconceptions simply by giving them a human face, perhaps The Gender Clinic might start to redress the balance. Carmichael ends the documentary by admitting that, right now, this is “an evolving picture”. But, she says, she knows one thing: that the young people who have taken this route feel it was right for them.