Thousands of disadvantaged children questioning their gender identity are being let down by the NHS offering unproven treatments and the “toxicity” of the transgender debate, a landmark report has found.
Dr Hilary Kass said the UK’s only NHS gender identity development service used puberty blockers and cross-sex hormones to make people look more masculine or feminine despite “very weak evidence” suggest they can improve the well-being of young people, and there are concerns they may harm health.
Chief pediatric consultant Kass stressed that her findings were not intended to undermine the validity of transgender identities or challenge people’s rights to transition, but rather to improve care for the rapidly growing number of children and young people suffering from gender-related distress.
But polarized public debates, in which opposing sides “use research to justify their positions regardless of the quality of the research,” make such care more difficult, she said.
“In healthcare, few other fields have professionals so afraid to discuss their views openly, and people are being vilified on social media with name-calling that echoes the worst forms of bullying. This has to stop.”
NHS England commissioned the survey in 2020 amid growing concerns about the care provided by the Gender Identity Development Service (Gids) at Tavistock and Portman NHS Mental Health Trust. It treated around 9,000 children and adolescents between 2009 and 2020, with the average age at referral being 14 years.
Her investigation has led to NHS England shutting down Gids, banning the use of puberty blockers and moving to a new “holistic” care model in which under-18s confused about their gender identity would receive regular psychological support rather than medical treatment intervention.
“For most young people, medical pathways are not the best way to address gender-related distress. For those young people for whom medical pathways are clinically available, if broader mental health and/or psychosocial challenges are not addressed, , simply providing this access is not enough,” said Cass, the former president of the Royal College of Paediatrics and Child Health. .
The report recommends that all such young people should be screened to detect neurodevelopmental conditions, such as autism spectrum disorder, and have their mental health assessed, as many seeking help for gender identity also suffer from ADHD, anxiety depression or depression, for example.
Kass said some transgender adults “live active and successful lives and feel empowered by their decision to transition.” However, “I’ve spoken to people who have become disconnected, some of whom deeply regret their previous decisions,” she added.
“While some young people may feel the urgency to transition, seeing their younger selves, young people often recommend slowing down,” the report said.
Cass told the Guardian: “Some young people have told us that they wish they had known when they were younger that there are many ways to transition, not just binary medical transitions.”
In her report, she outlined how the Tavistock Trust began prescribing puberty blockers more widely in 2014, despite a lack of evidence that they helped.
Cass told the Guardian he was “disappointed” by the NHS, health professionals and the lack of evidence on the effectiveness of treatments for gender-questioning children.
“One of the things that frustrates them is that the debate is so toxic that people are afraid to work in this area.
“Most people are very scared because of the lack of guidance, the lack of research, and the level of polarization that they’ve gone through. [patients] Go directly to Gids. “
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Shadow health secretary Wes Streeting said: “Today’s report must provide a watershed moment for the NHS’s gender identity services. Children’s healthcare should always be led by evidence and child welfare, avoiding culture wars. Clinicians and parents want the best possible support for their children during this critical stage of development. This report provides an evidence-led framework to achieve this.”
Sallie Baxendale, professor of clinical neuropsychology at University College London, said the Cass report “exposes a worrying lack of evidence to support the treatments NHS clinicians have prescribed for children with gender dysphoria for more than a decade.”
“These treatments cause serious harm to some of the most vulnerable children in our society.
“Exceptionalism often lies at the heart of healthcare scandals when services spiral out of control and begin to fall outside the normal confines of clinical practice.”
However, Dr Aidan Kelly, a clinical psychologist specializing in gender issues who left Tavistock in 2021, said the NHS was struggling to recruit skilled and experienced staff to run eight of the planned centres. clinics that will offer new, broader models of care.
“While Gids is not perfect, the services we provide have a long history and expertise. Some things need to change, but at least sticking to the knowledge that has been accumulated over time makes sense to me,” he said.
He disputes many of Kass’s findings, saying a recent review in Germany found puberty blockers to be safe and effective. He added that the NHS’ shift to a completely different way of treating young people confused about their gender identity had put England “out of step with the rest of the world”.
Cass revealed in the report that six of seven NHS gender specialist services for adults in England had been “frustrated” by the University of York’s request to access and analyze people who had been treated for Gids. health outcomes in order to improve future care.
She told the Guardian the refusal to cooperate was “coordinated”. “In my view, this is ideologically driven.” Clinicians who care for those with gender-related distress are deeply divided on how best to do so, she acknowledged in the report.
It also documents how demand for Gids’ services has surged since 2010, with a huge increase in the number of women registering births, reversing referral patterns.
Kass said “online influencers” play a key role in exacerbating young people’s perceptions of their gender identity and what they need to do to change it.
“We haven’t done a comprehensive search yet, but when we’re told about specific influencers, I’m definitely going to follow some of them. Some of them have very uneven messaging to them.
“And some of them [young people] Told that the parents will not understand, so one must actively separate from the parents or alienate the parents. All the evidence shows that family support is indeed crucial to people’s well-being. So there are definitely some dangerous effects,” she said.
Rishi Sunak said: “We simply don’t know the long-term impact of medical or social transformation on them, so we should be extremely cautious.
“We acted quickly on Dr Cass’s interim report to make changes to schools and the NHS to provide comprehensive guidance for schools and to end the routine use of puberty blockers, and we will continue to ensure the right measures are in place to protect young people. “
