Do no harm

Stella O’Malley is a public speaker and psychotherapist who is vocal on transgender issues. She made the Channel 4 documentary Trans kids: It’s time to talk and opposes the use of hormone blockers, despite the tremendous good that blockers can do (as I explain below).


It’s worrying that such views are still being aired. Yet Birkbeck, University of London booked Ms. O’Malley to deliver a workshop this week for therapists titled “Working with Gender Identity”. Birkbeck have said ‘it’s important to hear all sides of the debate’ and that ‘the presenter’s perspective is one of many.’


But, as the old saying goes, ‘a little bit of knowledge is dangerous’. The writeup which Birkbeck provides ‘About the trainer’ suggests that she has her facts wrong and doesn’t know how gender dysphoria is treated:


Stella O’Malley, 44, of Offaly, Ireland, believed she was a boy until puberty hit and says had she been a young child living in today’s society she is ‘absolutely certain’ that she ‘would have transitioned’


The idea that this plants in the reader’s mind is that ‘today’s society’ would have been all too eager to induce her to undero irreversible changes at an impressionable age which would have prevented her from developing her into the woman and mother she now is.


But that’s nonsense. With today’s systems, Stella O’Malley would not have transitioned at such a young age. Today’s gender specialists are highly trained and knowledgeable, and she simply wouldn’t have progressed to any form of physical treatment. Nothing irreversible would have happened, no harm would have been done.


By contrast, if people accept the line she is taking against hormone blockers, a great deal of irreversible harm will occur to children who, unlike her, truly are transgender.


Gender dysphoria can’t be medically treated until puberty begins.

Until a child reaches puberty, there is simply nothing to treat medically. Ms. O’Malley’s claim that she would have transitioned is implausible to say the least: she went through what experts would consider a ‘phase’, and grew out of it upon reaching puberty.


Social transition

Before puberty, children who experience gender dysphoria may transition socially. This does not involve any type of medical transition, and simply means wearing clothes the child is comfortable in and changing their name and pronouns. This is completely reversible. It enables a child to find what’s right for them. And for those who truly are transgender, it plays a huge role in alleviating the crippling symptoms of gender dysphoria.

In Stella O’Malley’s case, she would have only reached this stage, and been able to reverse it has her true nature emerged.


Cross gender play

Today’s gender experts are entirely aware of the kind of the childhood experience described by Ms. O’Malley. Endocrinologist and gender expert Dr Norman Spack says in his TED talk:

“It is quite normative for children to act in a cross-gender play and way, and that in fact there are studies that show that even 80% of children who act in that fashion will not persist in wanting to be the opposite gender at the time when puberty begins. But at the time that puberty begins….by that particular point the child who says they are in the absolute wrong body is almost certain to be transgender, and is extremely unlikely to change those feelings, no matter how anybody tries reparative therapy or any other noxious things.”


The young Stella O’Malley simply would not have progressed past the point where any physical treatment could have taken place. The experts would have done the right thing.


Dr Normal Spack explains the role of hormone blockers


Harm is done by not treating

Doing nothing for transgender children actually does a great deal of harm. Irreversible physical changes start at puberty and without medical help a transgender child will be trapped inside an adult body at variance with their psychological reality. These changes almost inevitably have negative repercussions for the rest of their lives.

However, there is a very successful way of tackling this problem at the onset of puberty, which is reversible, but buys a little more time for evaluation and doing the right thing.


Blockers: a safety net which prevents harm but does no harm

Puberty blockers have an important role in successfully treating transgender children, by delaying the development of what are potentially the wrong secondary sex characteristics. They are delayers: their effects are reversible.

A child’s puberty can be placed on hold while further psychological assessments take place. Then, if and when appropriate, the patient can commence cross-sex hormones and develop in a way that is in keeping with their internal gender identity. Blockers mean that transition, if and when it is chosen, can be physically far more successful for the patient.

If it’s decided that gender transition is not the right thing for the patient, then blockers will be halted and the child will progress through the puberty of their birth gender. In a case like that of Ms. O’Malley, who says she only felt like a boy ‘until puberty hit’, it’s most unlikely that she would even have got as far as taking blockers, as professionals would have recognised that she had only been experiencing a ‘phase’. Had such a child taken blockers, it would simply have bought a little more time to establish that medical transition was inappropriate for her.


Harm done by misinformation

It’s disturbing to think that the xyz’s who take Stella O’Malley’s workshop at Birkbeck College will be seriously misled. Anti-trans people can so easily prey on people’s fears, for example the fear of parents that an over-enthusiastic politically-correct system will encourage and authorise a profound and irreversible change to their children.


The fact is that the system has knowledgeable practitioners who are trained to do no harm. On the other hand, alarmist claims spread by the likes of Stella O’Malley can cause a great deal of harm – to those children who, unlike her, are truly transgender. Such children desperately need safe treatment to be given at an appropriate point in their lives to prevent potentially devastating harm.