A landmark report has found that thousands of vulnerable children who are unsure of their gender identity have been let down by the NHS’s use of unproven treatments and by the “toxicity” of the trans debate.
The UK’s just NHS gender identity development assistance used puberty blockers and cross-sex hormones, which masculinize or feminize people’s images, despite “remarkably weak data” that they improve the well-being of young people and issue they may damage health, Dr. Hilary Cass said.
Cass, a leading expert pediatrician, stressed that her findings were not intended to undermine the validity of trans identities or problem people’s straight to move, but rather to improve the attention of the fast-growing range of children and young people with gender-related distress.
However, she claimed that the polarized open debate and the way in which opposing edges had “pointed to study to defend a position, regardless of the quality of the studies” made this care even more difficult to give.
There aren’t many other areas of medicine where doctors are so adamant about speaking out about their opinions, where users of foul language are criticized on social media, and where bullying behavior is echoed worst. This must stop.”
In light of growing concern about the gender identity development services (Gids) offered by the Tavistock and Portman NHS mental health trust, NHS England commissioned her inquiry in 2020. It treated about 9,000 children and young people, with an average age at referral of 14, during 2009-2020.
Her inquiry has already resulted in NHS England closing Gids, outlawing puberty blockers, and switching to a new, “holistic” model of care where under-18s who are unsure of their gender identity will routinely receive psychological support rather than medical help.
“For most young people, a medical pathway will not be the best way to manage their gender-related distress. It is insufficient to provide this for those young people for whom a medical pathway is clinically indicated, according to Cass, an ex-president of the Royal College of Paediatrics and Child Health.
The report advises screening for all such young people to identify neurodevelopmental conditions, such as autism spectrum disorder, and evaluation of their mental health because many people who seek help with gender identity also have ADHD, anxiety, or depression, for example.
Some transgender adults are living fulfilling lives and feeling empowered because they made the choice to transition, Cass said. However, “I have spoken to people who have detransitioned, some of whom deeply regret their earlier decisions”, she added.
Young adults looking at their younger selves would frequently advise slowing down, the report states. While some young people may feel an urgency to transition, some young people may feel this way.
Some young people told us they wish they knew there were more ways to become trans than just a binary medical transition, according to Cass.
She describes in her report how, despite a lack of supporting evidence, the Tavistock trust started prescribing puberty blockers much more frequently in 2014.
In an interview with the Guardian, Cass said that gender-questioning children have been “let down” by the NHS, health professionals and a “woeful” lack of evidence about what treatment works.
One of the things that has let them down is that the debate’s toxicity has been so great that people have grown resent working in this field.
“A majority of people have been so afraid, because of the lack of guidance, lack of research, and how polarized this is that they’ve passed [patients] straight on to Gids.”
Wes Streeting, the shadow health secretary, 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 children’s welfare, free from culture wars. At this crucial developmental stage, doctors and parents alike want the best for their children. This report provides an evidence-led framework to deliver that.”
Cass’ report, according to Sallie Baxendale, a professor of clinical neuropsychology at University College London, “has exposed the worrying lack of evidence to the treatments that were prescribed by NHS clinicians to children with gender distress for over a decade.
Some of the most vulnerable children in our society were seriously harmed by these treatments.
When services go rogue and begin operating outside the normal parameters of clinical practice, exceptionalism frequently finds itself at the center of medical scandals.”
However, Dr. Aidan Kelly, a gender-focused clinical psychologist who left Tavistock in 2021, claimed the NHS was struggling to find qualified and experienced staff to operate the eight planned eight clinics, which will offer a new, more comprehensive model of care.
“Although Gids wasn’t perfect, we had a service with a history and expertise. There were some things that needed to change, but I felt it would have made sense to at least to hold on to the knowledge that developed over time, he said.
He claimed that a recent German review had demonstrated that puberty blockers were safe and effective, refuting many of Cass’ findings. He continued, “England is out of step with the rest of the world because of NHS England’s switch to a completely different way of treating young people who are confused about their gender identity.”
Cass made it clear in the report that York University had “thwarted” an attempt by six of the NHS’s seven specialist gender services in England for adults to obtain and examine the health outcomes of people who had received treatment from Gids in order to improve future care.
This refusal to cooperate “was coordinated”, she told the Guardian. “It seemed to me to be ideologically-driven.” She acknowledges that the report’s findings indicate that clinicians who care for those who experience gender-related distress are divided on how to go about doing that.
Additionally, it details how Gids reversed the pattern of referrals and a significant increase in the number of birth-registered females since the demand for its services increased from 2010 to 2010.
Cass claimed that “online influencers” had a significant impact on causing young people’s confusion about their gender identity and what they needed to do to change it.
We haven’t conducted a thorough search, but when I learned about a particular influencer, I followed some of them. Some of them give them very unbalanced information.
And some of them [young people] were told that their parents would not understand, forcing them to actively break up with or disdain their parents. According to all available evidence, family support is fundamental to people’s well-being. So, she said, there was actually some risky influencing going on.
We should be very cautious because we do not yet know the long-term effects of social transitions or medical treatment on them, according to Rishi Sunak.
According to Dr. Cass’ interim report, we quickly made changes to our schools and our NHS, ending routine use of puberty blockers, and making necessary adjustments to our system.”
