England’s national health service will close the only the UK’s only dedicated gender identity clinic for children and young people following an independent review. The Gender Identity Development Service (GIDS) run by the Tavistock and Portman NHS Foundation Trust will be replacedby services based in specialist Childrens hospitals.
Sexologist Patricia Weerakoon tells Theothercheek that she is concerned that while the NHS decision “closes the Tavistock clinic, it keeps the medical pathway open. Therefore hopefully the new centres will be monitored carefully.”
The on-going review led by Dr Hilary Cass, past president of the Royal College of Paediatrics and Child Health identified five areas of concern. As listed by the NHS (National Health Service) they are:
1. A significant and sharp rise in referrals
In 2021/22 there were over 5,000 referrals into the Gender Identity Development Service (GIDS) run by the Tavistock and Portman NHS Foundation Trust. This compares to just under 250 referrals in 2011/12.
2. Marked changes in the types of patients being referred which are not well understood
There has been a dramatic change in the case-mix of referrals from predominantly birth-registered males to predominantly birth-registered females presenting with gender incongruence in early teen years. Additionally, a significant number of children are also presenting with neurodiversity and other mental health needs and risky behaviours which requires careful consideration and needs to be better understood.
3. Scarce and inconclusive evidence to support clinical decision making
This has led to a lack of clinical consensus and polarised opinion on what the best model of care for children and young people experiencing gender incongruence and dysphoria should be; and a lack of evidence to support families in making informed decisions about interventions that may have life-long consequences.
4. Long waiting times for initial assessment and significant external scrutiny and challenge surrounding the clinical approach and operational capacity at GIDS
This has contributed to the current service being unable to meet the scale of rising demand.
The Times reports “[Cass] found that the Tavistock clinic was “not a safe or viable long-term option” and that other mental health issues were “overshadowed” when gender was raised by children referred to the clinic.
The Cass report is here.
Weerakoon points out that research shows:
· If allowed to “live in their own skin” or have some form of “gender exploratory therapy” over 85% of children accept their biological sex at puberty
· But if subjected to social transition and puberty blockers almost 100% stay on the medical pathway.
· Adolescents/children presenting for gender dysphoria intervention experience a high rate of mental health problems and autism.
Weerakoon also provides the research basis for being cautious about the puberty blocker treatment that Cass also urges caution about, particularly for under 16s.
“Puberty blockers (Gonadotrophin Releasing Hormone agonist) work at brain level. Side effects known:
1. Bone mineralisation epiphyseal development: https://www.medscape.com/viewarticle/976777
2. Brain development (cited by CASS review) https://pubmed.ncbi.nlm.nih.gov/28743017/
Sisk, C. L. (2017). Development: pubertal hormones meet the adolescent brain. Current Biology, 27(14), R706-R708
Puberty blockers prevent brain maturation.”
3. Risk of pseudotumor cerebri added to labelling for gonadotropin-releasing hormone agonists https://publications.aap.org/aapnews/news/20636/Risk-of-pseudotumor-cerebri-added-to-labeling-for
4. Causes infertility by blocking gonadal maturation (ovaries or testes)
5. Affects long term sexual function. By keeping genitalia in the prepubertal stage.
The BBC reports that Kiera Bell, who took the Tavistock clinic to the High court over her treatment, “said she was pleased it was closing, adding: ‘Many children will be saved from going down the path that I went down.’