The debateabout treatments for transgender young people has been reignited by the closure of a controversial NHS clinic that prescribedpuberty blockers to children.

TheTavistock clinic, in north London, has beenaccused of rushing teenagers into life-altering treatment on hormone-blocking drugs, The Timesreported. An independent review led by senior paediatrician Dr Hilary Cass was also highly critical of the Tavistocks Gender Identity Development Service, which is to be wound down by next spring.

The closure means the UK will no longer have a dedicated gender identity clinic for under-18s, but new regional centres will be set up to ensure the holistic needsof vulnerable young patients are fully met, according to the NHS England.

The clinic is being shut down after review chief Cass, a former president of the Royal College of Paediatrics and Child Health,concluded in a recently published report that the Gender Identity Development Service (GIDS) wasnot a safe or viable long-term option.

NHS England commissioned the reviewin September 2020 in response to a complex and diverse range of issues including a significant and sharp rise in referrals. In the decade from 2011, referrals to the Tavistock rose from 250 to 5,000.

Other issues included scarce and inconclusive evidence to support clinical decision; concerns about a significant number of childrenpresenting with neurodiversity and other mental health needs and risky behaviours;long waiting times for assessments; and significant external scrutiny of the service, said NHS England.

Cassfoundthat the current model of care was leaving young peopleat considerable risk of poor mental health and distress.According to her review, therewere critically important unanswered questions over the clinics use of puberty blockers, which have been prescribed to children as young as ten, anduncertainties about the long-term outcome of medical intervention.

The damning extent of the Tavistocks failingshad already beenmade clear inthe Interim Cass reportin February, said Nikki Da Costa in The Telegraph.

These failings included lack of open discussion among clinicians; pressure to adopt an unquestioning approach; failure to consider whether medical transition really is the best option; overlooking childrens complex needs; limited mental health assessments; failure to identify children who may be vulnerable and at risk; and failure to follow up after treatment, Da Costa continued. This would matter if it affected only a handful of children let alone thousands. It is horrific.

Legal experts are now warning that the Tavistock and Portman NHSTrust could besued by patients who felt they did not receive the right treatment.

The Tavistock clinic led the way in prescribing puberty-blocking drugs to children and young people, said The Times. In 2011, the clinic began a trial of puberty blockers including Lupron, a drug used off label to reducethe production of sex hormones.

According to the paper, there has been barely any research into the drugs, including long-term side effects such as infertility.

In her review, Cass said there was a lack of clarity over whether the drugssimply pause puberty or act as an initial part of a transition pathway. She also warned that brain development may be temporarily or permanently disrupted by puberty-blockers.

The closure of the clinic representsa victory for those who say self-proclaimed gender identity should not trump biological sex, saidThe Economist.

The tide in Britain appears to be turning against groups who espouse the belief that gender identity trumps all else, and towards maintaining support for sex-based rights and evidence-based medicine, the paper continued. Critics argue that the next step is tounderstand why so many children with mental health problems are identifying as trans.

With the Cass review,the tide turned on an ideology that has ruined lives, saidThe TelegraphsDa Costa, who served as director of legislative affairs for both Boris Johnson and Theresa May. Coupled with warnings about the use of puberty blockers, it should slow the rush to medicalise young people.

However, tthe BBCs social affairs editor Alison Holtwarned that the Tavistock closure would be a source of worry for other young people wanting support with gender dysphoria.

The hope is the services that replace it will be more helpful, useful and efficient, said Holt.

NHS England has acceptedrecommendations by Cassto establish two new clinics for children with gender dysphoria by spring of next year. One of these clinics will be at Great Ormond Street Hospital in London, and the other will be a partnership between Alder Hey Childrens NHS Foundation Trust in Liverpool and the Royal Manchester Childrens Hospital.

Children being considered for hormone treatment will enter into formal clinical trials and followed until adulthood to assess long-term outcomes, The Times reported. And afurther six or seven similar services could be opened in other parts of the country.

But that may come as little comfort to thethousands of young people and their families currentlyawaiting treatment, saidThe Guardian.Many report having to go private in order to access timely treatment, according to the paper.

And with waiting lists remaining painfully long, it is unlikely the impact of the new hubs will be felt for some time.

Continued here:
What the Tavistock clinics closure means for the trans debate - The Week UK

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