Disputed trans guide gets NHS nod The Times 15.02.20

The original article is here.

Three NHS trusts have endorsed a guide for transgender patients that approves puberty blockers and declares that anatomy “is not always a good guide” to determining a child’s sex.

The “Supporting Trans People” toolkit, written by campaigners, was formally endorsed to be sent out to medical staff with NHS logos attached by Bristol, North Somerset, South Gloucestershire Clinical Commissioning Group (BNSSG CCG), North Bristol NHS Trust and Devon Partnership NHS Trust.

The toolkit approved the use of puberty blockers on adolescents without explaining to medics that the Royal College of Paediatrics and Child Health and NHS England have both ordered national reviews into the ethics surrounding the rapid increase in the use of hormone blockers to treat under-16s who identify as transgender.

Many health professionals have said there is no robust evidence on the long-term safety of the drugs, which are licensed in the UK only to treat children who start puberty abnormally early, not to treat adolescents who wish to switch gender. Their off-label use has been likened by one expert to “an unregulated live experiment on children”. The toolkit also relied on a non-peer reviewed and non-representative survey of trans people to make claims about self-harm and suicide risk.

The toolkit was co-ordinated by a Bristol charity, Stand Against Racism and Inequality (Sari) and the lead author was Cheryl Morgan, a trans woman and director of the Diversity Trust.

The guidance for medics contains statements such as “anatomy is not always a good guide to what gender a child will be or even what sex they are”. It states that sex is “assigned” rather than observed at birth “based on physical characteristics”, and defines gender as a “social system for coding the behaviour of people as either masculine, feminine or something else”.

Minutes from a BNSSG CCG meeting on November 5 last year, where they endorsed the toolkit, show that North Bristol NHS Trust had already approved the guidance and that it was the culmination of two years of work.

The minutes show that the BNSSG CCG governing body “Endorsed the toolkit and its dissemination to relevant practitioners within BNSSG” and “Agreed that the BNSSG CCG logo can be added to the publication.”

Kathleen Stock, a professor of philosophy at the University of Sussex, said the statement in the toolkit that “doing nothing or delaying treatment CAUSES HARM” [toolkit’s emphasis] was “scare-mongering” and “not responsible or well-evidenced advice”.

“It gives the impression explicitly that the only way of treating gender dysphoria is some kind of transition, social or medical. Yet there is ample evidence that a ‘watchful waiting’ strategy can be right for many young people experiencing gender dysphoria,” she said.

The toolkit has also been criticised for saying that trans patients “need to be given priority” when it comes to provision on single-sex wards and that “forcing a trans person to use a single-sex ward that does not conform to their gender identity is likely to have a catastrophic effect on their emotional wellbeing.”

Professor Stock described this as “shockingly hyperbolic and unevidenced”.

“What should be about well-evidenced medical and psychological treatment for people with gender dysphoria has been instead narrowly over-politicised, with potentially adverse effects for patient welfare,” she said.

The toolkit was not put to public or patient consultation. After complaints made by several women who learnt about the toolkit, the governing body has now asked for an equality impact assessment to see if it is compatible with its own safeguarding policies.

When approached by The Times for comment, the BNSSG CCG said the use of its logo had been “welcomed in principle” but with edits to be made before any formal endorsement or use of its branding.

They later added that they will now “look again at the toolkit” following the outcome of the national review into hormone blockers. Devon Partnership NHS Trust and North Bristol NHS Trust declined to comment.

Sari said that despite the endorsements by the trusts the toolkit was “still in the development phase and not yet published”.