New guidelines for treating transgender youngsters have been drafted by England’s National Health Service (NHS), calling for tighter, more stringent controls of the treatment of under-18s who are questioning their gender.
The document, which is out for public consultation, comes after the release of the Cass Report’s “independent review of gender identity services for children and young people”, and follows the recent closure of the Tavistock gender identity clinic for children, after a review found that its services were “not a safe or viable long-term option” for children seeking care.
The guidelines warn doctors about encouraging transgender children to change their names and pronouns, because most are just going through a “phase”, reports The Telegraph.
This follows advice from the Cass Report, led by Dr Hilary Cass, that children who change their names, pronouns and the way they dress could experience “significant effects” regarding “psychological functioning”.
The NHS guidelines differ from the “affirmative care” model favoured by the Tavistock clinic where those claiming to be transgender were encouraged to embrace their new gender identity, reports Daily Friend.
In contrast, the NHS proposes that doctors take a “watchful approach”, mindful that evidence reflects that “in most cases gender incongruence does not persist into adolescence”. Social transition should, however, be considered for those diagnosed with gender dysphoria and in cases where transition will prevent “clinically significant distress” and when the person is “able to fully comprehend the implications of affirming a social transition”.
The NHS also proposes a holistic attitude to treatment by including specialists in “paediatric medicine, autism, neurodisability and mental health” in their clinical teams as opposed to only therapists and endocrinologists, as was the case at Tavistock.
The Telegraph reports that the implementation of a holistic approach takes into consideration that a “significant proportion of children” referred to gender clinics for gender dysphoria experience neurodevelopment issues or social anxiety disorders.
The new NHS guidance recognises social transition as a form of psychosocial intervention and not a neutral act, as it “may have significant effects on psychological functioning”. It also strongly discourages social transition in children, and clarifies that social transition in adolescents should only be pursued to alleviate or prevent clinically-significant distress or significant impairment in social functioning, and after an explicit informed consent process.
Puberty blockers, say the guidelines, can only be administered in formal research settings, due to the unknown effects of these interventions and the potential for harm.
The NHS has not made an explicit statement about cross-sex hormones, but signalled that they too will likely only be available in research settings. The guidelines do not mention surgery, as surgery has never been a covered benefit under the NHS for minors.
B1937-ii-Interim-service-specification-for-specialist-gender-dysphoria-services-for-children-and-young-people-22B1937-ii-Specialist-service-for-children-and-young-people-with-gender-dysphoria
Cass Review – Interim Report (Open access)
Daily Friend article – NHS proposes new guidelines for treating transgender youth (Open access)
See more from MedicalBrief archives:
1 000 families to sue UK gender identity service
Landmark UK ruling on puberty blockers for under-16s
‘Informed consent’ by children for gender transition to be tested