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In the last 10 years, there has been an extraordinary increase in teenagers seeking to transition from female to male. What's behind it—and has the NHS been too quick to find a solution? It is commonly Want female for now or later that while biological sex is genetically determined, gender is a social construct. A human being cannot—and should not—be reduced to their biology, or indeed their genitals, because psychologically we are as much a product of the way that other people treat us as we are of our genetic inheritance. Homo sapiens are social creatures: our ability to cooperate is what gave us the evolutionary upper hand over our stronger Neanderthal cousins.

You would notice the physiological differences. But as to interpreting those differences, where would you start? Precisely because gender is a social construct, the evolution of its boundaries and meanings will tell us something fundamental about our society. Transsexuality is a talking point like never before, and a glance at the figures sheds some light on why. In Novemberthe Guardian reported that 70 per cent of referrals were female. This was a surprising statistic because only 10 years ly the overall ratio had been more like 75 per cent males seeking to be female, and indeed it is still the gender traffic in that direction that dominates the increasingly noisy, divisive and panic-inflected debate.

Right now a legal case is being brought by Susan Evans, a former psychiatric nurse at the Tavistock and Portman NHS Foundation Trust, alongside a parent of an autistic female child wishing to transition to be male, arguing that children are not legally capable of consenting to a gender transition.

November last year saw the launch of the Detransition Advocacy Network, a UK group ing several hundred members. And in January, the NHS announced an independent review into puberty suppressants and cross-sex hormone treatments, to be chaired by Hilary Cass, formerly president of the Royal College of Paediatrics and Child Health.

These vitriolic debates keep bubbling up—especially online. But there is a much bigger scandal brewing than any Twitterstorm. While there have been a great many thoughtful doctors at the Tavistock, the picture is sometimes disturbing. Marcus Evans, a psychotherapist and former governor of the Tavistock and Portman NHS Foundation Trust, reed in Februaryciting an institutional rush to prescribe puberty-blocking hormone treatment to children questioning their gender and who may wish to transition.

We move through experimenting with different identities as our bodies change and our role in society changes. An individual has to tolerate a -certain amount of confusion and anxiety and we should be able to help with that through therapy. A vocal rights lobby is quick to push back against transphobia—both real and perceived.

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Sometimes, though, legitimate challenges tip over into intimidation. She had been led there by research involving the parents of some of these children, who had mentioned that their offspring had friends who also identified as transgender. The US is experiencing a similar shift towards female transitioners, as are Finland, Canada and the Netherlands among others. Along with Marcus Evans, Littman has pointed to a high incidence of autism and eating disorders among the same patients who present as trans.

That observation raises some obvious questions about the narrowness of an approach that fixates on hormonal treatment for gender dysphoria. The Tavistock pushes back against accusations that it is too quick to assume its patients are transgender and to provide hormones. But surgery cannot be performed until the age of The next step is cross-sex hormones with their irreversible effects. Nearly per cent make that journey once they start on the blockers.

Critics charge that senior members of WPATH have been behaving as advocates for transsexuality, rather than dispassionate advisers on mental health. They may… prefer clothes, toys and games that are commonly associated with the other sex and may prefer playing with other-sex peers.

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WPATH has the level of influence that it does, it has been suggested to me, because until the sudden increase in s of people questioning their gender no one paid much attention. Each could be dealt with on a case-by-case basis. WPATH did not respond to questions. Traditional ideas about the physician assessing the patient in the round also seem at risk of being forgotten. Read next Those of us who have worked with the community as long as I have are not surprised by the s.

Read Stephen Whittle on why few take transitioning lightly—and how early treatment could be life-saving An instructive parallel case can be found in Eastern Europe. In the former Soviet bloc, and especially in s Poland, more women than men requested sex changes. Why was this? Current figures are hard to come by in capitalist Poland, but a ratio of women becoming men as against men becoming women has been suggested to me. So perhaps it was actually less about Communism, than more ingrained cultural issues. It is linguistically assumed that your anatomical features are the same as your perceived gender.

It is not only the case with verbs as in French but also nouns and adjectives, and when you speak you express your gender in every sentence as well as the gender of the person to whom you are speaking. All of this makes conversation uncomfortable to anyone who is not quite sure where they fit in.

People say that they feel forced to take hormones so that a judge will see a man or a woman even though they are not unhappy with their existing bodies. Then afterwards they would give up taking the hormones. Whether the root cause is language, the legacy of Communism or patriarchal oppression, this is a Want female for now or later that needs to be understood at the level of society, not just the individual psyche.

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In this case it might have constituted a relatively attractive identity. After all, it turned a lesbian living with another woman into a success. A similar trend can be seen in Iran, where gender reasment surgery is encouraged for gay men who would otherwise be viciously persecuted. The panel comprised of five women between 20 and 23 years old, plus the organiser, Charlie Evans, All six are lesbians whose youthful feelings of self-loathing, self-disgust and social dislocation led them to make a decision to transition to male that they later came to regret, after varying degrees of hormone and surgical treatment.

All six participants are now on better terms with their own lesbianism. But it was a harrowing and physically disruptive journey to have taken at such a young age. All began their transition during puberty some time ago, and therefore have not been a part of the current controversy surrounding puberty-blocker drugs. There are broader questions here for UK society inand about its attitude to girls.

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Keeping up with the requirements of womanhood, as they are understood in these times, imposes a time-sapping burden, and all those most of us who are not prepared to devote a large portion of our day to our appearance end up feeling alienated. Detransitioners might well be merely exposing the tip of an iceberg of social-media generated misery.

Phoebe Jones not her real name is a lesbian attracted to masculine women who mourns the shrinking of her dating pool. The trappings of femininity can be oppressive. One lesbian friend was raped by a classmate when she came out. She breast-bound and tentatively used gender neutral pronouns.

We became good friends. Now she sees herself as a woman and a lesbian and still looks like a boy. I get the feeling she is comfortable being desired as such these days, and desiring too. Such happy negotiations of identity remain largely unacknowledged—to the detriment of others who are still stuck with the anguish that preceded the happy resolution. I mean, to help them learn to cope with their internal contradictions for at least long enough that a decision to transition is an adult, reflective and thoughtful decision.

What a tragedy it would be, if in trying to learn from the historic misstep of gay conversion therapy, we are allowing a rushed regime of transitioning young people that will one day be remembered in an equally controversial way.

History does not repeat itself, but it does rhyme. We want to hear what you think about this article. Submit a letter to letters prospect-magazine. Essays Magazine.

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By Emma Hartley March 3, Read next. Those of us who have worked with the community as long as I have are not surprised by the s. Read Stephen Whittle on why few take transitioning lightly—and how early treatment could be life-saving. Emma Hartley More stories by Emma Hartley. More From Prospect. Politics How we lost our vaccine advantage Philip Ball July 8, Andrew Sentance July 7, A four-day week is both James Plunkett July 7, Politics How do we actually build back better? Andrew Adonis July 7, Politics Has Hungary crossed the line?

Carl Dolan July 7,

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