Fri 5 Jul 2024 — 8 min

Royal College of Psychiatry logo over an image of a person looking visibly distressed and clutching their head

Following concerns raised about panels at the Royal College of Psychiatry (RCPsych) International Congress, Trans Safety Network has seen evidence that submitted questions about issues with the evidence base and ethics of claims made by panelists about trans healthcare, conflicts of interests in the panel and exclusion of trans lived experience voices have been suppressed by the organisation.

According to a source who attended the conference, questions for the session “Treatment of gender dysphoria in children and adolescents: a review of the evidence base” were required to be submitted via an online form, with attendees able to vote for the best questions. Over 40 such questions were allegedly deleted from the website without explanation, this meant that not only were the questions not put to panelists, but no record of the questions being asked remained. One online attendee captured screenshots of the deleted comments and contacted Trans Safety Network with concerns about their deletion.

Questions of evidence

A number of the deleted questions related specifically to questions of evidence and methodology, some specifically with respect to the Cass Review.

"The Cass Review dismisses 48% of the research on puberty blockers as being low quality. It then cites as length research on mice, not replicated in humans and which used no puberty blockers to justify okay [sic] withholding them. This has led to international criticism that the research evidence was cherry picked. Is this criticism accurate?"

"What were [sic] the hypothesis for the demographic discrepancy from what was expected to what was seen?""

Other questions related to evidence on broader issues of trans young people’s mental health, for example one question asked the panel how researchers whether research on the affects of hormonal interventions on mental health adequately controlled for experienced of minority stress and transphobic discrimination.

"You state research shows that those who have significant psychosocial issues prior to starting hormonal therapy and prior to gender questioning, mental health did not with hormonal interventions - were these results adjusted for other factors that contribute to the mental health of trans people, including minority stress, discrimination, family issues, etc?"

"Could trauma which is caused by invalidation and having to develop secondary sexual characteristic [sic] also affect development of executive functioning"

Another deleted question asked whether there was high quality evidence to support “exploratory psychotherapy” as an alternative to medical transition.

"For how long is exploratory psychotherapy expected to last for the clinician to be certain of the child's enduring gender identity? What is the evidence basis for this approach compared to WPATH approach? Is it high quality?"

These questions appear to be examples of legitimate academic enquiry about the data used by a panel claiming to present “a review of the evidence base” in an area of medicine. We find it concerning in the extreme if RCPsych were preventing difficult questions of evidence from being asked while presenting themselves as taking an evidence based approach. The question of the evidence base for the Cass Review Final Report in particular is crucial at a time when the report is shaping NHS policy despite substantial issues with the report’s methodology and evidence base being raised, as summarised in a compilation of criticisms of the review by academic Ruth Pearce.

Ethical issues

Some of the deleted questions related to issues of professional practice and research ethics, with attendees seeking answers from panelists on issues of conversion therapy, the purpose of psychiatric practice in relation to trans lives and patient ownership over their own data. This, again, is concerning for a panel on any form of healthcare, where unethical practice can result in serious harm to patients and research participants.

"Memorandum of Understanding on Conversion Therapy in the UK v2, to which RCPysch is a signatory, makes it clear that conversion therapy in relation to gender identity and sexual orientation (including asexuality) is unethical, potentially harmful, and is not supported by evidence. Are gender exploratory therapy, CBT for gender dysphoria, and other experimental therapies for transgender children not also forms of conversion therapy?"

"People make decisions about their health and life in various ways that are potentially dangerous such as eating behaviours, substance misuse, radical sports... why not let people decide for themselves? Why is the power of decision with us when transgender is not a mental health condition?"

"Could Dr Biggs explain how the GDCs could have shared their confidential patient records with the Cass review without a complex process of gaining all their patient's consent, where the would have been a serious breach of GDPR? Would you be happy if your health records were shared for research/review purposes without your consent?"

"How was capcaity [sic] assessed for young person's participated [sic] in the research? What info was given to weigh up the risks ans [sic] benefits of treatment?"

Other questions related specifically to the ethics of the panel itself and it’s composition, with attendees questioning whether panelists had relevant expertise, conflicts of interest and relationships to anti-trans political activity, pertinent issues when dealing with questions of trans health.

"Could our speakers please declare their conflicts of interest which has been standard across all other talks at conference"

"Why has the Royal College chosen to invite Dr Biggs to speak today, who has no professional expertise in trans healthcare, but has made an anti-trans film for notorious anti-Semite and conspiracy theorist David Icke's streaming platform, and has been investigated by Oxford University for posting a large number of vile and transphobic tweets? Why have the other speakers chosen to share a platform with him today?"

"The ICD-11 and DSM-5 both now recognise that, like homosexuality before it, being transgender is not a mental illness. Why then do many organisations that the speakers today are involved with [such as SEGM, GENPECT and CAN-SG], as well as the Cass review, seem to view transition as a less desirable outcome than becoming cisgendered? Do the speakers also believe that being heterosexual is preferable to being homosexual? If not, then why is being transgender different?"

Undisclosed conflicts of interest (situations where researchers have a financial or non-financial stake in the outcomes of research) are a serious ethical issue in academic research. It is entirely reasonable for conference attendees to ask for openness in this regard and such disclosures are the norm in scientific research. According to RCPsych policy speakers at RCPsych events are required to disclose any conflicts of interest (also called “competing interests”) and that this should be declared on RCPsych’s website at least one month before the event. The policy requires disclosure “if a secondary interest exists which could be construed by others as influencing the individual’s judgement” (emphasis added). At time of writing Trans Safety Network could not find any such disclosure on RCPsych’s website for this panel, despite clear evidence of a perception among some attendees at the event that conflicts of interest existed.

Exclusion of trans voices

Two deleted questions asked panelists about “the voice of lived experience.” This refers to the inclusion of patients and potential patients in research and professional debate about their treatment. One of the two questions suggested that this issue had been raised with panelists ahead of the event.

"Where is the voice of lived experience, to hear what they want and need from service providers?"

"Why did Dr Cornwall say no to having lived experience on the panel when invited to do so by the Congress organising committee?"

The inclusion of lived experience voices in healthcare research is a measure to protect the interests of patients. Given the extensive history of anti-trans conversion therapy by psychiatrists and psychiatric violence against trans people, this is a legitimate question to ask of a panel on trans healthcare. The question of trans people’s voice in decisions about us was also a key issue raised by Trans Kids Deserve Better at their recent protest at an NHS England building.

Trans Safety Network has reached out to RCPsych for comment on the issues raised in this article, at time of writing they have not responded.