The Gender Identity Clinic is one of the oldest and largest trans treatment centres in the world. It was founded in 1966 by Dr John Bulmer Randell (1918 to 1982) at Charing Cross Hospital, which at that time was still in the West End.

Charing Cross Hospital was established in 1818 and was known as ‘the actor’s hospital’ because it was originally situated behind the Haymarket Theatre. During World War 1 it became a prominent war hospital as many wounded would arrive at Charing Cross Station from the trenches. The hospital moved to a new purpose built site in Fulham in 1973, keeping its name in an act of geographical bifurcation that still causes confusion. The GIC went with it and also kept the Charing Cross name.

The GIC’s founder John Randell was born in Glamorgan in Wales and studied medicine at the Welsh National School of Medicine, graduating in 1941 and serving in the Navy on HMS Standard from 1942. In 1950 he was appointed Physician for Psychological Medicine at Charing Cross Hospital where he remained until his sudden death from a heart attack in 1982. His founding of the GIC and his interest in the adrenogenital syndrome gained him international recognition for his work on gender identity, transvestism and transsexuality.

Marne casualties at Charing Cross Hospital (Image: Imperial College Healthcare NHS Trust)

Marne casualties arriving at Charing Cross Hospital during World War 1

Randell is a controversial figure. For a time he practiced aversion therapy and he was not in favour of surgery for trans people until his patients, who had had surgery abroad, returned with positive evaluations. His voice features in the 1979 BBC documentary A Change of Sex, but he only allowed it to be filmed on condition that he himself was not pictured and remained anonymous. Many of his patients found him petulant and despotic, and some of the conditions for treatment that he imposed on his patients (such as ending existing marriages) might now be considered as breaches of human rights. Such practices have long-since stopped.

Under Randell the GIC favoured physical treatments – hormone therapies and surgery – rather than psychotherapeutic approaches. After his death the clinic was taken over initially by Dr Ashley Robin and then in the mid-nineties by Dr Donald Montgommery. Under Montgommery the clinic expanded and a range of new doctors joined the service. Around the turn of the millennium the leadership changed again with James Dalrymple and then Richard Green taking charge. The clinic moved from Charing Cross Hospital to the Claybrook Centre as part of community psychiatry, which reflected the clinic’s shift towards a psychiatric approach.

GIC

Around 2002 a new generation of clinicians started joining the service including Dr Christina Richards, the clinic’s first ‘out’ trans clinician. Although there was a perception that the clinic was small it was already dealing with greater numbers of patients than an average community psychiatry team and as the internet developed referral numbers began to accelerate.

In the new millennium new approaches to gender developed at the GIC and it became increasingly obvious that gender, as a speciality, did not sit particularly well within psychiatric services. Relations with the GIC’s host organisation, West London Mental Health Trust, gradually grew more strained and in April 2017 the GIC joined the Tavistock and Portman. In April 2020 it moves to a new site on Finchley Road and it is still out for consultation with patients as to whether it keeps the Charing Cross part of its name.

The Gender Identity Development Service (GIDS) has always had a close relationship with the Adolescent Department at the Tavistock and Portman. The Adolescent Department itself was a great Tavi innovation, founded by Henry Dugmore Hunter in 1959 and has been the crucible for a number of innovative projects.

Domenico Di Ceglie

Domenico di Ceglie

Domenico di Ceglie, the founder of GIDS, had originally studied medicine and then psychiatry at the University of Perugia. He moved to the UK from Italy in 1976, taking a registrar post at the Middlesex Hospital. In 1979 he joined the Tavistock Clinic, with supervision under Nick Temple, and split his time between the Adolescent Department and the Hill End Adolescent Unit in St Albans.


In the early 1980s, he had his first encounter with a child saying she was a boy in a female body. When he took this case Domenico knew very little about gender. Researching the subject he was left with a sense that a specialised service was needed for children with these rare experiences and began a workshop in Croydon. At an international conference in 1987 he met Robert Stoller, who suggested that he read and make contact with Richard Green from the GIC, who had been doing similar clinical work and original research with children.
The next big step forward was a meeting between Domenico di Ceglie and Peter Hill, Professor of Child and Adolescent Psychiatry at St George’s Hospital Medical School, who agreed to support the establishment of a gender identity service for children and adolescents at St George’s.

Peter Hill

Peter Hill

In 1992 the Gender Identity Development Service organised the first international conference on gender identity problems in children and adolescents at St George’s Hospital. Domenico presented a paper that outlined the approach taken by GIDS arguing that tackling negatively affected developmental processes were the primary objectives of the service, rather than altering the ‘gender identity disorder’.

St Georges Hospital

St George’s Hospital
The Gender Identity Development Clinic opened in September of 1989, operating one afternoon per fortnight and initially staffed by Domenico, a social worker Mary Lightfoot, a psychotherapist Barbara Gaffney and a senior registrar Martin McCall, with David Grant, an eminent paediatric endocrinologist from Great Ormond Street joining a little later.

The working method at GIDS relied on a series of therapeutic interventions including: family work, individual work, group work, support and educational groups. These focussed on the network around the individual and involved teachers, health visitors, social workers, GPs and other mental health practitioners as well as the child and their family, who were supported by a multi-disciplinary team that decided which intervention would be most appropriate and effective at each particular stage of development. This model has remained core to the way that GIDS works.

In 1996 the clinic transferred from St George’s to the Tavistock and Portman Trust and was initially based in a porta-cabin in the car park before being moved into the Portman Clinic.

In the first two decades of the 21st century GIDS has seen big changes, most notably the number of referrals. During the 1990s there were less than 20 referrals per year. In the first decade of the 21st century this gradually crept up, but from 2009/10, when the service was nationally commissioned by NHS England, numbers climbed sharply from 77 to more than two thousand referrals per year.

GIDS

This increase in numbers went hand in hand with young people presenting in increasingly diverse ways and contemplating a greater range of gender identity options. Just as the increase in numbers has been a challenge to basic operational processes (particularly waiting times), so too the increasing complexity of cases, ‘associated difficulties’ (such as self-harm) and a reduction in the support provided by services such as CAMHS have also had an impact.

At the same time gender has increasingly been in the eye of a media storm. This has created intense pressures not just on the service, but the staff running that service during a period when longitudinal empirical evidence has yet to be established. There are complex legal and moral issues around children’s capacity to consent, and at the same time there are increasingly vociferous calls for rigid certainties where none exist.

In this is environment, GIDS tries to maintain a stance of what Bernadette Wren has called ‘reflective uncertainty’, develop a shared understanding of what is ethical and compassionate practice, and what good care looks like.

A transfeminine student and masculine student laughing together
Since the establishment of both the GIC and GIDS gender has moved from being the province of small scale part-time projects to being a significant part of the work of our trust as a whole. Both the GIC and GIDS have built up reputations for expertise and international leadership in this incredibly challenging and contested area of work. Even within the celebrated history of the Tavistock and Portman that is a huge achievement and needs to be recognised.

Author: Glenn Gossling, first published in In Mind magazine 2020