Calls to end transgender ‘experiment on children’ Lucy Bannerman in The Times 08.04.19

The original article is here.

Staff quit NHS clinic over ethics and safety fears

The only NHS gender clinic for children is risking a “live experiment” by sending hundreds for life-changing medical intervention without sufficient evidence of its long-term effects, experts have warned.

The Times has spoken to five clinicians who resigned from the service because of concerns over the treatment of vulnerable children who come to the clinic presenting as transgender.

They believe that some gay children struggling with their sexuality are being wrongly diagnosed as “transgender” by the Gender Identity Development Service (GIDS) clinic.

All five former staff were responsible for deciding which trans-identifying youngsters should be given hormone blockers to halt their sexual development. The vast majority of those who begin blockers go on to irreversible cross-sex hormones once they reach 16.

The NHS specialists warned that vulnerable children and teenagers had been sent down the path towards transition before experts had time to assess the causes of their gender confusion.

An Oxford professor has also raised concerns about the safety of drug therapies used by the clinic, saying the treatments were “supported by low-quality evidence, or in many cases no evidence at all”.

The number of young people referred to the clinic in north London has soared. In 2010 there were 94 referrals. By last year there were 2,519. The youngest was aged three. The five clinicians are among at least 18 clinical staff who have resigned over the past three years.

In an internal review, seen by The Times, the GIDS admitted it needed to improve its referral system and the way it obtained and recorded informed consent before young people were sent for life-changing medical intervention.

“I felt for the last two years what kept me in the job was the sense there was a huge number of children in danger. I was there to protect children from being damaged,” one clinician said.

“This experimental treatment is being done on not only children, but very vulnerable children,” another said.

All five said they believed that transgender charities such as Mermaids were having a “harmful” effect by allegedly promoting transition as a cure-all solution for confused adolescents. The charities deny the allegation.

The clinicians said they were often under pressure to refer young people for life-altering treatment, even though they did not always believe it was in the individual’s best clinical interests.

The clinic said it used licensed precocious puberty drugs whose long-term effects were known and insisted that its service was safe and that, “in the growing evidence internationally on the outcomes . . . there is little reported evidence of harm”. “We always place a young person’s wellbeing at the centre of our work,” it said.

The specialists expressed concern that many children decided they wanted to change gender after suffering homophobic bullying. Yet these young people were still referred down the route of hormone treatment, they claimed, without clinicians always exploring the possibility they may simply be gay. One clinician said that she feared the use of hormone therapy for such children could result in a scandal.

The GIDS denies the claims, saying it offers a “safe” service that recognises and respects the complexity of its cases.

Under the clinic’s rules, a young person who has already started puberty may be referred for hormone blockers. These are physically reversible, insofar as the body will continue to develop if they are discontinued, but the long-term effect on brain development is unknown. Irreversible cross-sex hormones can be prescribed from 16.

Carl Heneghan, director of the Centre of Evidence-based Medicine at the University of Oxford, said: “Given paucity of evidence, the off-label use of drugs [for outcomes not covered by the medicine’s licence] in gender dysphoria treatment largely means an unregulated live experiment on children.”

The service insisted that its internal review “did not identify any immediate issues in relation to patient safety or failings in the overall approach taken by the service”.

The GIDS said that time and care was taken at every stage to ensure that individuals grasped the potential consequences of their choices. It said that its staff had no preconceptions as to the appropriate treatment and that discussions around sexuality “now form a more explicit part of our approach to assessment and exploration”.

Addressing concerns over the scarcity of evidence, it added: “It is only in recent years that the number of young people attending specialist services worldwide has dramatically increased. Prior to this the numbers have been small and it has therefore been difficult to collect sufficient evidence to fully evaluate treatment pathways. We and other specialist services worldwide are actively engaged in research to better understand the characteristics and needs of young people attending specialist services.”

The Department of Health said that “the Tavistock and Portman NHS Foundation Trust is subject to inspections, monitoring and regulation”.