A friend writes to me to ask: "but surely we shouldn't rush children into surgery? What's controversial about that? What am I missing?" https://twitter.com/JolyonMaugham/status/1280769393874677760

It's a good question, for lots of reasons. One answer is that you can't access surgery on the NHS until you are 18 ( https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721642/GEO-LGBT-factsheet.pdf).

But the better answer is to look at how problematic provision is for trans children in England. There is only place where trans children can get on the NHS the help they need. That place is swamped with demand and must be an absolutely horrible place to work.

I say it must be a horrible place for a number of reasons. (1) The medical care children get can't properly center their needs. It has become a political battleground with physicians defensive and worried. (2) There is enormous demand (and materially little or no supply)...

which means many physicians who work in that space will do so out of a sense of obligation to children and must feel pressure (internal or external) to rush them through. (3) There are a range of children - some with quite simple needs and others quite complex - which makes...

it really difficult - under political pressure - to develop appropriate treatment protocols for individual children.

The solution to this, of course, is properly to resource GIDS - but no one talks about that.

(The debate in the UK sometimes confuses two things. (1) Is GIDS doing a good job? Answer, for complex reasons often no (which is why I supported this case https://www.crowdjustice.com/case/gids-concerns/). And (2) does this mean trans children aren't 'a real thing' and of course they are.)

The other thing missing from the debate is the opportunity cost of doing nothing.

You can argue - not without justification (although puberty blockers have been around for a LONG time) that there are risks - that until absolutely certain physicians should do nothing.

But there are also significant risks to doing nothing. A child with body dysphoria who does not receive puberty blockers and who goes on to 'affirm' - and most do - their chosen gender faces much more serious surgery down the line than one who gets blockers.

Moreover, they will experience huge jeopardy to their mental health in the meantime. And the figures for what researchers call 'suicidal ideation' - a polite expression for a vast catalogue of tragedy - amongst trans children are dreadful - but diminished if you help them affirm.

Now, I'm not linking to any studies, and I'm doing that for a reason. A lot of this stuff is contested - what I have asserted is what I understand the evidence clearly to show - but I don't want to cherry pick studies to make my points (which are fundamentally about governance).

The answer, unsurprising although hopelessly unfashionable, is that this stuff is complicated. Different children have different needs. The people who understand this stuff are the experts.

They need to be resourced to treat children properly. And political actors - some of whom (there is no doubt) have formed an ugly alliance with the Christian Right - need to allow them to do that.

Britain might have had enough of experts but trans kids need them - desperately.