Given the growing furore over their use, this week’s news that NHS use of so-called “puberty blockers” for trans-identified children has doubled in a year might seem surprising. It comes despite growing concern about the safety of blockers, and is accompanied by doubts about the drugs’ capacity to do much to alleviate mental health issues – a key reason cited for their introduction in the first place.
NHS England has already announced that blockers should only be administered as part of a clinical trial. This followed advice from Dr Hilary Cass, the senior paediatrician leading an independent review into the Tavistock Gender Identity Development Service (Gids), whose interim report found “gaps in evidence” around the drug.
Why then, you might ask, are young patients not only still getting them, but getting them at higher rates than before? Part of the answer relates to the current chaos in youth gender services, which – despite Cass’s best efforts – are still heavily dependent on a discredited clinical model.
This model is “gender affirmation”, according to which a clinician should automatically accept and validate a young person’s claims about “really” being of the opposite sex, or of no sex at all, rather than adopting a more neutral approach that views the identity disturbance as probably temporary.
Enthusiasts for the affirmative model are scattered throughout the NHS, and include medics, clinical psychologists and administrators. They see themselves as being on a political mission as much as a medical quest: namely, to facilitate the transition of a trans-identified child as soon as possible.
Managing a list of around 1,000 existing patients but closed to new patients, Gids is still operating despite recent damning reports from the Care Quality Commission and Cass, who recommended that a fundamentally different model is needed. The continued service now appears to be almost entirely peopled by supporters of gender affirmation. Endocrinologists and psychologists at Gids and its Leeds satellite proselytise for the approach and complain about the Cass report.
Matters are not helped by the wider NHS context, in which trans activist organisations have been allowed to structure policies for many years without challenge – a fact which seems to be hampering the attempts of Cass and others to replace Gids with rational, evidence-based new youth services integrated into wider mental health provision.
Many hospitals, foundation trusts and governing bodies are signed up to LGBT charter marks such as Stonewall’s Diversity Champion scheme or the Rainbow Badge scheme. These have incentivised staff to favour gender identity, and to eliminate language referring to biological sex. In such an ideologically saturated context, it is very difficult to change course and reject the affirmation model for one particular cohort alone.
But will the new gender services fix these issues? Sadly, it seems that they too are being populated by former Gids clinicians who favour the affirmative model – precipitating battles of words with more sceptical colleagues about what clinical approaches should be taken with such vulnerable patients.
As a result, the services appear paralysed, with the preparation of training materials for clinicians now paused and planned openings delayed. The ideologues, meanwhile, continue to be emboldened.
Kathleen Stock is co-director of The Lesbian Project