Doctors told not to encourage young people to change their names and pronounsMost children who think they’re transgender are just going through a ‘phase’, says NHS
Most children who believe that they are transgender are just going through a “phase”, the NHS has said, as it warns that doctors should not encourage them to change their names and pronouns.
NHS England has announced plans for tightening controls on the treatment of under 18s questioning their gender, including a ban on prescribing puberty blockers outside of strict clinical trials.
The services, which will replace the controversial Tavistock clinic, will be led by medical doctors rather than therapists and will consider the impact of other conditions such as autism and mental health issues.
The plans, which are currently under public consultation, are for an interim service for young people with gender dysphoria whilst Dr Hilary Cass continues her review into the treatment offered by the NHS.
They note that there is a need to change the services because there is currently “scarce and inconclusive evidence to support clinical decision-making”.
NHS England says that the interim Cass Report has advised that even social transition, such as changing a young person’s name and pronouns or the way that they dress, is not a “neutral act” that could have “significant effects” in terms of “psychological functioning”.
Parent groups and professionals have long raised concerns that NHS medics have taken an “affirmative” approach to treating children, including using their preferred names and pronouns.
Be mindful of ‘transient phase’
The proposals say that the new clinical approach will for younger children “reflect evidence that in most cases gender incongruence does not persist into adolescence” and doctors should be mindful this might be a “transient phase”.
Instead of encouraging transition, medics should take “a watchful approach” to see how a young person’s conditions develop, the plans state.
When a prepubescent child has already socially transitioned, “the clinical approach has to be mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty if the gender incongruence does not persist”.
For adolescents, social transition will only be considered when it is necessary for preventing “clinically significant distress” and when a young person “is able to fully comprehend the implications of affirming a social transition”, says NHS England.
It adds that before medics change a young person’s name and pronouns, a teenager should have been diagnosed with gender dysphoria.
The public consultation documents say that change is necessary against a backdrop of a sharp rise in referrals to the gender identity service, from just under 250 in 2011-12 to over 5,000 last year.
In recent years there has also been a spike, with “the number of referrals currently at 8.7 per 100,000 population per year in 2021-22 compared to four per 100,000 in 2020-21 and 4.5 per 100,000 in 2019-20”.
The health service first announced in July that it would be closing the Tavistock and replacing it with two regional centres based in specialist children’s hospitals.
The move is aimed at taking a more “holistic” approach to treating children and looking at the reasons why they are questioning their gender.
It is expected that the regional centres will be operating by the spring, whilst long-term plans for the gender identity services for under 18s, based on the final recommendation of the Cass review, will come into effect in 2023-24.
Rather than being delivered by therapists and hormone specialists, the new clinical teams will include experts “in paediatric medicine, autism, neurodisability and mental health”.
The proposals note that a “significant proportion of children” who are referred for treatment have neuro-development issues or family of social problems.
The new treatment teams will be led by a medical doctor and the service will only take referrals from GPs and other NHS professionals.
NHS England will also “strongly discourage” young people from buying hormones from private clinicians and will not accept clinical responsibility for the treatment of those who have done so.
The consultation on the plans closes in December.