A long-awaited report has found “remarkably weak evidence” to support gender treatments for children and made 32 recommendations – but what is the current system?
The major review – led by Dr Hilary Cass – was launched in 2020 after a sharp rise in referrals to the Gender Identity Development Service (Gids), which was the only specialised service in England for young people experiencing difficulties in the development of their gender identity.
The clinic, run by the Tavistock and Portman NHS Foundation Trust, had more than 5,000 referrals in 2021/22 – up from just under 250 a decade earlier.
But it closed almost two weeks ago with new regional hubs launched led by London’s Great Ormond Street Hospital and Alder Hey Children’s Hospital in Liverpool, in a bid to move away from a single-service model.
NHS England hopes they will be the first of up to eight specialist centres over the next two years and said children attending these clinics will be supported by experts in neurodiversity, paediatrics and mental health, “resulting in a holistic approach to care”.
Around 5,000 children and young people are currently on the waiting list for referral into the new clinics, while the care of 250 patients was transferred to them.
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Last month, NHS England confirmed children will no longer be prescribed puberty blockers at gender identity clinics, saying there is not enough evidence to support their “safety or clinical effectiveness”.
The drugs will now only be available to children as part of clinical research trials.
Puberty blockers can be used to delay the development of physical characteristics which can make someone look male or female, allowing transgender young people to explore their gender identity and weigh up medically transitioning.
Taking them early in puberty may mean less treatment or surgery in the future, but critics have raised concerns over issues including consent, mental health risks and bone density development.
At the time of the move, there were fewer than 100 children on puberty blockers, who will continue their treatment at Leeds and University College London Hospital.
The NHS says children referred to one of the new clinics will be seen by a team, who will carry out a detailed assessment over three to six appointments over several months.
“Most treatments offered at this stage are psychological rather than medical,” the NHS website says.
“This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.”
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Those diagnosed with gender incongruence or gender dysphoria who meet the clinical criteria may be given gender-affirming hormones “from around the age of 16”.
But Dr Cass said in her report the current policy on giving children testosterone or oestrogen from age 16 should be urgently reviewed.
Young people aged 17 or older may be seen in an adult gender identity clinic but following the review NHS England said it would now pause first appointments at adult clinics for teens under 18, as well as bringing forward its review of adult gender services.
