England’s Health Service Puts Brakes on Transgender Treatments for Children
The change follows the closing of what was the world’s largest child-gender clinic, Tavistock Clinic, due to concerns raised by an independent review and complaints from patient families.
England’s National Health Service (NHS) has issued new guidance for the treatment of children with gender dysphoria, warning that the condition is often a temporary “phase” and restricting the use of puberty blockers and sex-changing hormones.
The NHS’s revised treatment policy was released last week after a review of existing policies found that gender transitioning may have “significant effects on the [child’s] psychological function.”
The NHS’ full guidance represents a shift away from a “gender-affirming care” model that encourages the medical and social transition of a child into the opposite sex, often with the use of puberty blockers and hormone drugs.
Instead, the new model is focused on child psychology and development and includes specialists on pediatric autism, neurodisability and mental health.
The NHS states that its new care model for children is based on evidence that “in most cases gender incongruence does not persist into adolescence” and “may be a transient phase.”
The majority of children — roughly 84% in some studies — are reported to grow out of gender dysphoria.
Additionally, the NHS warns that social transition — when a child adopts a new name, haircut and clothes to match the opposite sex — could have “significant effects” on a child’s “psychological functioning.”
The NHS emphasizes that social transition should only be considered in cases of “clinically significant distress.”
Europe Restricts Gender-Affirming Care
NHS’ new guidelines come in response to criticism from “practitioners who said it rushed people onto medication,” as Reuters reported Oct. 14.
England is one of several European countries scaling back access to gender-affirming treatments and surgeries on minors.
"The new NHS model is in line with medical ethics and the best science we have. Sweden, Finland and France are also putting the brakes on child and adolescent transgender interventions,” Dr. Michelle Cretella, a Catholic pediatrician and past executive director of the American College of Pediatricians, told CNA.
Cretella is also a board member of Advocates Protecting Children, which offers resources for parents and the lay public to learn the truth about transgenderism.
“This is exactly what America should do as well,” Cretella added.
England’s ongoing review into the safety and efficacy of the gender-affirming model — known as the Cass Review — is led by Dr. Hilary Cass, who previously served as president of the Royal College of Paediatrics and Child Health.
In a letter to children in the review’s interim report, Cass addressed the push to prescribe hormone treatments for those struggling with gender dysphoria.
“The [topic] that I know is worrying some of you is whether I will suggest that hormone treatments should be stopped. On this issue, I have to share my thoughts as a doctor,” Cass wrote.
“We know quite a bit about hormone treatments, but there is still a lot we don’t know about the long-term effects,” she added.
Following a period of public comment and months of review, the NHS’ new program will be subject to a final review before going live by 2023-24.
The NHS did not immediately respond to CNA’s request for comment.
"The NHS decision is a critically important step in the right direction, because it recognizes the lack of evidence to support the ‘gender-affirming’ protocol, which endorses psycho-social transition, puberty blockers, hormones and even surgery on minors,” Mary Rice Hasson, director of the Person and Identity Project at the Ethics and Public Policy Center (EPPC) told CNA.
Hasson said she was still concerned about the NHS' "stated willingness to continue to permit some of these medical interventions in a research setting.”
"The truth is that it is never the answer to block puberty or give cross-sex hormones as the answer to psychological distress about one's identity or body,” Hasson said.
“No one can change sex, so any attempt to embark down a medicalized path to alter a child‘s appearance and destroy or impair the body’s natural function is unjustified.”
Warning About Puberty Blockers and Hormones
Most significantly, the guidance says the NHS will stop prescribing controversial hormone drugs to children unless they are monitored by a “formal research program” that includes follow-up into adulthood.
“NHS England will only commission [puberty blockers] in the context of a formal research protocol. The research protocol will set out eligibility criteria for participation,” the document says.
The NHS explains that the stronger safeguards will ensure children and their parents are provided “greater transparency” about “the uncertain clinical benefits and longer-term health impacts” from the use of puberty blockers and hormone treatments.
This will “further strengthen the consent [and] support informed decision making by young people,” the document reads.
As for the long-term effects of hormones, the report notes that the risks to adults are already well known.
“Sex hormones have been prescribed for transgender adults for several decades, and the long-term risks and side effects are well understood. These include increased cardiovascular risk, osteoporosis, and hormone-dependent cancers.”
“In young people, consideration also needs to be given to the impact on fertility, with the need for fertility counseling and preservation,” the study advises.
The guidance also warns about the dangers of puberty blockers and masculinizing or feminizing hormones that young people may seek to purchase on the private market.
If a child obtains “unregulated” puberty blockers or masculinizing and feminizing hormones, the NHS says it “will not accept clinical responsibility.”