The National Health Service in the UK has determined to shut down its gender identify clinic for children after a review of its services found that it had failed their minor patients. The Tavistock & Portman NHS Foundation and Trust will see its doors shuttered by spring 2023. Tavistock is where Keira Bell, who transitioned to present as male and then detransitioned, brought suit against the clinic saying she had not been able to give consent as a minor.
At issue is Tavistock’s use of puberty blockers, which Tavistock has been accused of rushing to prescribe to children. The drug, brand name Lupron, is used to treat prostate cancer, endometriosis, and precocious puberty, and is not meant for long-term use. Once prescribed to children and teens, the drug can cause sterility and other life-changing, far-reaching side effects.
This will not mean that services for gender dysphoria will not be available to those under 18 in the UK, but that there will be new, “regional centres at existing children’s hospitals offering more ‘holistic care’ with ‘strong links to mental health services,'” reports The Times.
Puberty blockers have been banned for the treatment of underage children and teens in Sweden. In the US, the FDA has added warnings to the drugs, “having identified a serious potential side effect for some that may cause a dangerous surge of spinal fluid pressure in the brain, that can cause headaches, nausea, double vision, and even permanent vision loss,” The Post Millennial reports.
“Keira Bell was transitioned in childhood by the Tavistock but came to regret the procedures and to desist in her cross-sex identification. She, and the mother of a girl awaiting puberty blockers, applied for a judicial review of the clinic’s policies. The court found their concerns about administering the experimental drugs to children more than justified,” wrote Erin Perse for The Post Millennial.
“I should have been challenged on the proposals or the claims that I was making for myself…And I think that would have made a big difference as well. If I was just challenged on the things I was saying,” Bell said.
The review of Tavistock’s services was led by Dr. Hilary Cass, a pediatrician and former president of the Royal College of Paediatrics and Child Health.
Additionally, these new centers will be made to collect data and track the impacts of treatment, such as puberty blockers. This is something that Tavistock notably did not do for those under 16. Cass said that the current evidence for the efficacy of puberty blockers to treat gender dysphoria is “insufficient” and she could not make “any firm recommendations” for their use in young people.
Any young person who is prescribed hormone treatment, Cass recommends, should be enrolled into “a formal research protocol with adequate follow up into adulthood, with a more immediate focus on questions regarding puberty blockers.” The NHS will heed this recommendation and launch clinical trials to track what happens to children who are put on puberty blockers as they progress into adulthood.
It is one of Cass’ recommendations that a replacement for Tavistock should be done at a local level. The “regional centres,” she said, should have an “appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population.”
Cass believes that a diagnosis for gender dysphoria should not take center stage and become the focal point of care. Instead, she said that “Staff should maintain a broad clinical perspective in order to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context.”
In 2021, Tavistock was found to have a waiting list of nearly 5,000 children who were seeking access to gender treatment. Wait times were over two eyars for an appointment, and the clinic was reportedly “facing a crisis of capacity.” Girls make up the majority of those referred for gender services.
The BBC reported that: “Young people often appeared to have complex mental health problems alongside their gender dysphoria – unease caused by a perceived mismatch between biological sex and gender identity. Many were self-harming; others were struggling with depression, anxiety, bullying or eating disorders. Some suffered traumatic or abusive childhoods.”
Cass has given a set of recommendations for how the NHS should treat young people who have gender dysphoria, or the feeling that they should inhabit the opposite sex. Her review began in 2020, under the direction of NHS, and NHS is set to implement her full slate of recommendations, beginning with decommissioning the clinic itself.
In Cass’ report, she found that the clinic was “not a safe of viable long-term option” and that the gender identity conversation and push to treatment “overshadowed” other mental health issues that children who end up at Tavistock were suffering from. The new clinics will be required to have “‘established academic and education functions’ to monitor evidence on children who are put on hormone therapy,” The Times reports.
In essence, once a child presented with gender dysphoria, that became the focus of Tavistock’s engagement with the child, and other aspects of the child’s life fell by the wayside.
Great Ormond Street Hospital in London will be the site of one of the new regional centers, and it will have doctors from a variety of specialties. Mental health support will be provided via specialists from the South London and Maudsley NHS Foundation Trust. Another will be a partnership between the Alder Hey Children’s NHS Foundation and the Royal Manchester Children’s Hospital.
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