Thousands of children unsure of their gender identity ‘let down by the NHS’, report shows
Thousands of vulnerable children questioning their gender identity have been let down by the NHS’s provision of unproven treatments and the ‘toxicity’ of the trans debate, a landmark report has found.
Britain’s only NHS gender identity development service used puberty blockers and cross-sex hormones, which masculinize or feminise people’s appearance, despite “remarkably weak evidence” that they improve young people’s well-being and fears they could harm health, said Dr .Hilary Cass.
Cass, a leading consultant pediatrician, emphasized that her findings were not intended to undermine the validity of trans identities or question people’s right to transition, but rather to care for the rapidly growing number of children and young people with gender-related improve problems. .
But she said this concern was made even harder to realize by the polarized public debate and the way opposing sides had “pointed to research to justify a position, regardless of the quality of the studies”.
“There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where verbal abuse reflects the worst bullying behaviour. This has to stop.”
NHS England commissioned her research in 2020 amid growing concerns about the care provided by the Tavistock and Portman NHS mental health gender identity development services (Guide). In the period 2009-2020, approximately 9,000 children and young people were treated, with an average age at referral of 14 years.
Her research has already led to NHS England closing Guide, banning puberty blockers and moving to a new ‘holistic’ model of care in which under-18s who experience confusion about their gender identity are routinely given psychological support rather than medical intervention.
“For most young people, a medical path will not be the best way to deal with their gender-related problems. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocial challenges,” said Cass, a former president of the Royal College of Paediatrics and Child Health. .
The report recommends that all these young people be screened to detect neurodevelopmental conditions, such as autism spectrum disorder, and have their mental health assessed, as many who seek help with their gender identity also have ADHD, anxiety or depression. For example.
Some transgender adults “live positive and successful lives and feel empowered by the decision to transition,” Cass said. “However, I have spoken to people who have gone through the transition, some of whom deeply regret their previous decisions,” she added.
“While some young people may feel the urgency to transition, young adults looking to their younger selves often advise them to slow down,” the report says.
“Some young adults told us they wished they had known when they were younger that there were more ways to be trans than just a binary medical transition,” Cass told the Guardian.
In her report she outlines how the Tavistock Trust began prescribing puberty blockers on a much wider scale in 2014, despite a lack of evidence that they helped.
In an interview with the Guardian, Cass said gender questioning children have been “failed” by the NHS and health professionals and that there is a “woeful” lack of evidence about which treatment works.
“One of the things that has let them down is that the toxicity of the debate has been so great that people have become afraid to work in this area.
“A majority of people have been so scared, because of the lack of guidance, lack of research and how polarized this is, that they have referred (patients) straight to Gids.”
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Wes Streeting, the shadow health secretary, said: “Today’s report must provide a turning point for the NHS’s gender identity services. Children’s health care should always be guided by evidence and child welfare, free from culture wars. Both doctors and parents want the best for children at this crucial stage of development. This report provides an evidence-based framework to achieve that.”
Sallie Baxendale, professor of clinical neuropsychology at University College London, said the Cass report “has exposed the worrying lack of evidence to support the treatments that have been prescribed by NHS doctors for children with gender issues for more than a decade.
“These treatments have caused significant harm to some of the most vulnerable children in our society.
“Exceptionalism often underlies medical scandals when services go rogue and operate outside the normal parameters of clinical practice.”
Dr. However, Aidan Kelly, a clinical psychologist specializing in gender, who left Tavistock in 2021, said the NHS was struggling to recruit skilled and experienced people to run the planned eight clinics that will provide the new, broader model of care.
“Although Guide was not perfect, we had a service with history and expertise. There were things that needed to change, but at least sticking to the knowledge built up over time would have made sense for me,” he said.
He disputed many of Cass’s findings, saying a recent German study found puberty blockers were safe and effective. NHS England’s move to a completely different way of treating young people confused about their gender identity has left England “out of step with the rest of the world”, he added.
Cass revealed in the report that six of the NHS England’s seven specialist gender services for adults had “thwarted” an attempt by York University, at her request, to obtain and analyze the health outcomes of people treated by Guide to ensure future improve care.
This refusal to cooperate “was coordinated,” she told the Guardian. “It seemed ideologically driven to me.” Doctors who care for people with gender-related problems are deeply divided about the best way to do so, she acknowledges in the report.
It also documents how, from 2010 onwards, Gids experienced both an explosion in demand for its service and a huge increase in the number of women registering births, in a reversal of the referral pattern.
Cass said ‘online influencers’ had played a key role in fueling confusion among young people about their gender identity and what they needed to do to change it.
“We didn’t do extensive research, but especially when we heard about certain influencers, I followed a number of them. Some of them give them very unbalanced information.
“And some of them (young people) were told that parents wouldn’t understand, so they had to actively separate or distance themselves from their parents. All the evidence shows that family support is crucial for people’s well-being. So there was really dangerous influence,” she said.
Rishi Sunak said: “We simply don’t know the long-term effects of medical treatments or social transitions on them, so we must be extremely cautious.
“We acted quickly based on Dr. Cass to make changes in schools and our NHS, by providing comprehensive guidance for schools and stopping the routine use of puberty blockers, and we will continue to ensure we take the right steps to protect young people.”