In October last year, the Countess team raised concerns with the HSE and the Ombudsman for Children about the guidance provided by the HSE on their website in relation to Transgender support. The guidance, in the mental health section of the HSE website, directs the reader to TENI’s website (the Transgender Equality Network Ireland) for information and support for trans people.
Clicking the link provided (LGBTI+ sexual identity and orientation – HSE.ie) brings the reader to the TENI home page, where the Resources tab has a dropdown leading to the “Life Hacks” section, where information on breast binders, puberty blockers and “tucking” can be found. (Lifehacks – TENI).
There are no references to any independent medical body or suitably qualified medical professional who has responsibility for overseeing the information displayed on the TENI website.
Given our concerns about the effects of these interventions on the developing bodies of young teenagers, on 9th October 2022 the Countess wrote to Tina Kolos Orban, then CEO of TENI, in relation to the “Life Hack” section of the website, raising the following 3 main areas of concern:
- BREAST BINDING: The organisation promotes breast binding, with the following advice:
“Binding refers to the act of flattening breast tissue with restrictive materials. This should be done with a chest binder.”
We requested TENI to discourage teenage girls from using binders and to provide advice to discuss this with their parents before embarking on such an activity. We also requested that TENI inform teenage girls and their parents of the potential adverse side effects of breast binders.
The adverse effects of using breast binders are as follows:
Breast binding damages developing breasts, resulting in atrophy and possibly affecting future ability to breastfeed. It also restricts lung expansion and can cause rib damage and long-term spinal damage. Many girls who commence breast binding during puberty go on to have double mastectomy. The medical and psychological impacts of this practice have not been fully investigated.
Noah Halpin of TENI wrote of binders in Image magazine in 2020: (https://www.image.ie/self/for-the-first-time-i-was-able-to-take-my-top-off-in-the-park-and-just-lie-on-the-grass-204136/amp)
“The worst thing about it was just pain, all the time. You always have a pain in your back, you always have a pain in your chest and around and under your arms.”
It is clear from even this anecdotal report by Noah Halpin, who then later became TENI’s Healthcare Officer, that binders are not a neutral intervention and should not be used without medical supervision.
The TENI fact sheet on breast binding – or chest binding as they call it – is still available on their website as of 29 September 2023. It provides details of where to purchase these online, without mentioning parental consent or medical advice. They offer tips for getting help to purchase these items, with the list of people to ask for help specifically excluding parents! The fact sheet also explains how to hide these items by washing them in a friend’s house.
2) PUBERTY BLOCKERS: The letter from the Countess expressed concerns about the information given on Hormones in the “Life Hacks” section of the TENI website. Page 3 of that section covers puberty blockers, and states that the effects of taking puberty blockers are temporary, despite studies being inconclusive about the effects of puberty blockers on the developing body. At the end of this section they claim it’s a “myth” that suppressing puberty is irreversible (yet they provide no medical references to back up that claim):
Suppressing puberty is irreversible. If someone changes their mind about taking hormone blockers and stops taking them, puberty will continue from where it was stopped. You may go through puberty at a quicker rate that you would have.”
We requested that TENI clearly state on their website that there is no evidence to support their assertion that puberty blockers are temporary and not irreversible. We emphasised that the medical effects require further investigation, as per the Cass Review, commissioned by the NHS and carried out by the respected paediatrician Dr. Hillary Cass. We also referred TENI to Section 3.24 of the Cass Review that states that there is a lack of evidence for stating that puberty blockers are reversible. Dr. Cass also noted that the impact of suppressing puberty for developing children is unknown and requires further investigation.
Potential adverse effects of puberty blockers
The adverse effects of Lupron, the drug used to block puberty in children, include loss of bone density, hot flushes, cognitive issues and mood changes. This gonadotropin-releasing hormone agonist, which suppresses the production of sex hormones, is also used in men with advanced prostate cancer and for “chemical castration” of sex offenders, and in women for severe endometriosis. Many adults who take Lupron stop because of the severity of the side effects.
Lupron can be used under medical supervision for 4-6 months to delay puberty where it begins at a very young age (precocious puberty; typically before 8 years of age), and those children do go on to experience normal puberty for their sex; however, when used in children with gender dysphoria, it is given for a much longer period and in 98% of cases it is followed by cross-sex hormones. It is this pathway that results in irreversible harm to fertility and sexual function.
Puberty blockers have no proven benefit for children with gender dysphoria, and the NHS, along with other international health services, have said they are no longer recommending the use of puberty blockers for children with gender dysphoria.
The TENI guidance which claims that the effects of puberty blockers are temporary and reversible is misleading at best and genuinely harmful at worst.
3) CHILD SAFEGUARDING: The Countess raised concerns about TENI’s failure to display a Child Safeguarding Statement on their website in accordance with their obligations under Section 11 of the Children First Act, 2015.
TENI did not respond to our letter of 9th October 2022, and a follow up phone call was made to Tina Kolos Orban, but the CEO was unavailable for discussion.
On 26th October 2022, the Countess referred all three matters listed above to the Ombudsman for Children, Dr. Niall Muldoon, asking him to address these issues directly with TENI. We drew his attention to the UK Charity Regulator’s opening of an investigation into the UK charity, Mermaids, for providing similar advice on breast binding to minors without parental consent. (https://www.bbc.com/news/uk-63837761)
Dr. Muldoon replied to our correspondence on 15 December 2022. He advised that:
“determining medical accuracy of information on a public website is not within our remit and as such we will not be examining this complaint further.”
He also advised that Túsla, the Child and Family Agency, has a role in relation to Child Safeguarding Statements.
However, TENI’s Child Safeguarding Statement was approved on 14th December 2022 (the day before the Ombudsman for Children replied to the Countess) and, while it is now available on the TENI website, it is still not easily accessible (it appears in the small print at the bottom of the home page, under Policies.)
Under Section 11(5)(iii) of the Children First Act, 2015, an organisation’s Child Safeguarding Statement should be provided to any member of the public who requests it. TENI did not abide by this legal requirement by its failure to provide the Countess with a copy, when requested.
The Countess brought this to the attention of the Children’s Services Regulation, Quality and Regulation Directorate (CSSCU). While the CCSU confirmed on 31 January 2023 that the Child Safeguarding Statement should be provided to any member of the public who requests it, they stated they were now satisfied that Child Safeguarding Statement had been published on the TENI website and that no further action was deemed necessary.
Requirements under Children First Act, 2015
“The Act requires providers of relevant organisations to keep children safe from harm while availing of their services, to undertake a risk assessment to identify the potential for harm to a child who is availing of their service, and to prepare a child safeguarding statement which sets out the policies and procedures which are in place to mitigate the risks identified.
The legislation makes provision for a Register of Non-compliance for those providers who fail, on request, to provide a copy of the Child Safeguarding Statement to the Child and Family Agency.”
“The Child Safeguarding Statement must be circulated to all staff members. It must be displayed publicly and made available to parents and guardians, Túsla and members of the public upon request”.
One wonders if TENI would have fulfilled their obligations under the Children First Act, 2015, had our team not called attention to it. It is astonishing that the statutory obligations that apply to all sports clubs and volunteer groups the length and breadth of the country, would be overlooked by TENI, a publicly funded organisation that provides services to some of our most vulnerable children and young people. What responsibility has Túsla and the HSE in this failure to abide by the requirements of the Children First Act, 2015?
Outstanding and unresolved issues
The Countess team decided to further pursue the two remaining areas of concern – breast binding and puberty blockers – with the authorities.
On 30th January 2023 the original correspondence between the Countess and TENI was forwarded to the Minister for Health, Stephen Donnelly, as well as to Túsla, the HSE and HIQA.
In addition to our original 3 areas of concern, we also raised concerns about the promotion of “tucking” on TENI’s website, described as:
“A technique for achieving a flat groin for transwomen and trans feminine people”.
We noted that there is no age warning or age restriction on this page nor are young boys advised to discuss this practice with their parents or a medical professional. Long-term effects of tucking are not known.
The only response to our emails to Minister Donnelly, Túsla, the HSE and HIQA was from the Social Inclusion Office, HSE, which responded on 22nd March 2023 and stated that:
“The HSE holds Service Level Agreements (SLAs) with funded Section 39 agencies such as TENI, and these are negotiated each year. All funding is restricted and provided for specific purposes that are agreed annually. TENI’s website contents and maintenance are not included in the SLA the HSE holds with the organisation.
For your information, in line with HSE Section 39 governance framework, funded services should have a complaints policy and process in place to deal with complaints related to their service in line with HSE Policy “Your Service Your Say.’”
Except for the Child Safeguarding Statement reaching a satisfactory resolution, all other matters remain unresolved.
The Countess remains concerned that, despite the many failings by TENI, the HSE and many other government departments and NGOs continue to signpost TENI as the “go to” organisation for trans-related issues. Given the dangerous nature of the information provided in the “Life Hacks” section of TENI’s website, we remain seriously concerned about this organisation.
Another major concern is that the Ombudsman for Children, an office set up specifically to promote the best interests of children, was not willing to seek to determine whether or not TENI was in compliance with its obligations towards vulnerable children and young people, as well as their families.
In his response of 15th December 2022, the Ombudsman for Children stated:
“Please be advised that determining medical accuracy of information on a public website is not within our remit and as such we will not be examining this complaint further.”
The Ombudsman for Children Website “About Us” section states that:
“The OCO investigates complaints about services provided to children by public organisations. The service is free and independent. The OCO is a human rights institution that promotes the rights and welfare of young people under 18 years of age living in Ireland.”
If not the Children’s Ombudsman, then who exactly is tasked with looking out for our vulnerable young people?
TENI is not some random organisation or an individual acting in a private capacity. TENI receives public funding running into the tens of thousands of euros each year. They have obligations under the Children First Act, 2015, as well as obligations relating to their Service Level Agreements with the HSE.
It would appear that there is no Government agency responsible for ensuring that advice to young people who are questioning their gender, and their parents, is safe and accurate. This is a genuine failure of governance and must be addressed urgently.