Mick Hartley

It's one step forward – banning puberty blockers – then one step back – making it easier to get cross-sex hormones. From today's Sunday Times:

The Tavistock Centre’s Gender Identity Development Service (Gids) is closing this month after a review by Dr Hilary Cass said it was “not safe”.

Seventeen-year-olds who were on its 6,000-strong waiting list have been offered a referral to an adult NHS gender clinic. These can approve “gender-affirming”, or cross-sex, hormone treatment as well as, from the age of 18, a pathway to reassignment surgery such as mastectomies. A letter to one teenager inviting them to attend an adult clinic warns about possible long-term risks to fertility.

The government regulator, the Care Quality Commission (CQC), has also approved the registration of a new private practice in east London which can refer patients aged 16 to 18 for cross-sex hormone treatment. Gender Plus Healthcare, which runs the Gender Plus hormone clinic, the first private paediatric hormone clinic licensed in England, has been set up by former Gids specialist Dr Aidan Kelly.

In a surprise move, last week NHS England said the new NHS youth gender services that are replacing Gids would also offer cross-sex, feminising and masculinising hormones to children “from around their 16th birthday” provided certain conditions were met. These include approval from an independent NHS group….

At Gids, children could only access it once they had been on puberty blockers for a year beforehand. These drugs pause the physical changes of puberty such as breast development or facial hair. The new regime skips this step — blockers cannot be prescribed unless part of a clinical trial — and goes straight to cross-sex hormones.

Mothers and clinicians involved in legal actions being brought this week say they fear there is not enough evidence about the long-term effects of such treatments. They want cross-sex hormone treatments to be banned before the age of 25, when they say the developing brain finally matures.

Sue Evans, the nurse and psychotherapist who was one of the original staff who blew the whistle on practices at the Tavistock Gids clinic, will this week seek a judicial review of the regulator’s decision to register Gender Plus Healthcare. She is going to court alongside the mother of a 15-year-old who “believes they are the opposite sex”, according to the mother.

Evans said she was concerned that there was not enough evidence about the long-term effects of cross-sex hormone treatments on youngsters. “With cross-sex hormones you are putting hormones into the body that will have a huge impact,” said Evans.

“For women, they grow beards, they sometimes develop baldness, there is lowering of their voice and thickening of their jaw. Then they have things like vaginal atrophy which leads to urinary infections and can lead to difficulties around sex.

“With men there are shorter-term effects: they have breast development, often gain weight in female-typical ways, thickening of the waist where men do not usually have it, and a decrease in their sexual drive because their testosterone is being suppressed.”

She said the longer-term impacts were still unknown. “We now have an explosion of 17-year-olds coming through. All the kids who were 11 when this phenomenon kicked off six years ago are now 17 and heading up to the adult services so it is a real worry,” she added.

“And because the waiting lists are long the middle classes who have the money to pay are getting pressurised by their kids to go the private route. I want to see a ban on cross-sex hormones for under 18s in both private and NHS services in the UK.”…

Hannah Barnes, the former BBC journalist who investigated Gids and has an updated version of her bestselling book, Time To Think, published next week, said the new guidance on cross-sex hormones at 16 “baffles” her.

“For those born female, even a short period of time on testosterone will have completely irreversible effects,” she said. “The question is whether anyone approaching their 16th birthday can possibly understand the full consequences of what they are doing.”

Paul Conrathe from SinclairsLaw, who is acting in the Evans case, said: “The decision of the CQC to license the first paediatric hormone clinic is a leap in the dark. As regulator, the CQC is responsible for ensuring the public and especially the vulnerable and children receive safe and effective medical treatment. Concerns for this treatment are particularly serious given the irreversible lifelong consequences and that it is given to a vulnerable group of teenagers.”