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Transgender Trend has seen a copy of letters sent from NHS England to all 17-yr-olds currently on the GIDS waiting list, offering a transfer to an adult gender clinic.  All these children have yet to be seen by a specialist doctor.

We’ve heard from parents who are very angry and alarmed by this move. The letters are addressed to the child, not the parent, and come in anonymised envelopes which hide their origin. Many parents may be unaware that their child has been approached.

The letter, from James Palmer, the NHS’s National Medical Director for Specialised Commissioning, informs children aged 17 that because they are unlikely to be seen by the children’s service they now have the option of being referred on to the adult gender service. The time they have waited for the children’s services will be transferred to the wait for adult services ensuring they will move up the queue quickly.

These older teens will be eligible for treatment at one of the 8 adult gender clinics. The letter states that the 5 NHS pilot clinics are currently only taking those on the adult clinic waiting list, not directly from the GIDS waiting list. However, once these children are on the adult waiting list, they could be referred on to a pilot clinic if there is one in their local catchment area. These smaller GP led pilot clinics are still being rolled out, the fifth opening in Sussex in September 2023. To date there has been no independent assessment of their performance or outcomes. One feature is the presence of non-clinical support workers, individuals with lived experience, to support patients before their first appointment. The Indigo pilot service puts it like this:

“To support you throughout your journey with us, you will be assigned a care navigator.  They will have lived experience as a trans or non-binary person as well as an understanding of pathways, services and resources available….”

A 17-yr-old’s first contact with a gender clinic could likely be an unqualified activist, not a clinician.

In addition, all adult services work to service specifications that are in direct contrast with the new proposals for children’s services which came out of the Cass Review. While the Cass proposals, based mainly in holistic, neutral talking therapy, have still to be implemented, they mark a welcome change from the gender-affirmative, activist based approach taken by the Tavistock GIDS.

The NHS service specifications for adult gender services provide a fast track to cross-sex hormones and surgeries. Patients can be given a hormone prescription at their second appointment, there is no requirement for any sort of psychological evaluation, a double mastectomy may be carried out after 6 months, full genital surgery after a year.

Both mental and physical co-morbidities are downplayed:

“If significant medical or mental health concerns are present, they must be reasonably well controlled”

The real-life consequences of this affirmative approach are revealing as we’ve written in a previous blog.  Research showed that, of the women under 25 who were treated at the Exeter adult gender clinic, 89.4% had an adverse childhood experience and 23.4% had a neurodevelopment disorder. 72.4% of the clinic’s users were found to have a previously diagnosed mental health condition. By setting aside these co-morbidities the adult gender service specifications are enabling what Cass uncovered at GIDS – diagnostic overshadowing.

The current cohort of teenagers on the GIDS waiting list is likely to have a similar profile, with a preponderance of adolescent girls and autistic children, with other mental health or trauma based issues. They will also, as Dr Cass points out, still be growing and developing, discovering who they are, a process which continues until their mid-twenties.

Illustrating this point, two mothers of teenage girls, both with autism spectrum disorders, are seeking a judicial review of the adult gender service specifications.* They want the NHS to make psychological checks compulsory. Their daughters are due to be referred and treated at an adult clinic once they are 17. Both girls have expressed a wish for their breasts to be removed.

While the Cass Review has brought at least some semblance of evidence-based child-centred thinking to the question of giving children life altering drugs, there is no sense that the adult services are moving in the same direction. On the contrary, new pro-affirmation services are expanding with NHS backing. The letter to those teenagers on the GIDS waiting list is grossly irresponsible. These young people need more holistic therapeutic care and must not be rushed onto a service designed for adults. Post the Cass Interim Report it’s worth asking, have the activists in the health service pivoted their campaigning weight from children to young people? We fear so.

* These two mothers have replaced the original claimants, Ritchie Heron and Parent A, in seeking a judicial review of adult services. We wrote about the original case here: https://www.transgendertrend.com/nhs-service-specifications-adult-clinic-legal-action/

Ritchie Heron has written an account of why the claimants in the case have changed.

Please support Anna Castle and Ms C in bringing a judicial review against the NHS for providing unsafe treatment advice for young people from 17 years old and vulnerable adults. Click on the image below to donate: