Review ordered into rules on child gender transition The Times 10.02.20

The original article is here.

NHS rules that enable children to start gender transition treatment before puberty without their parents’ support are being reconsidered before a court case seeking to challenge them.

Children unhappy with their birth gender can begin treatment after as few as three therapeutic assessments. They can discuss treatments separately from their parents and are encouraged to self-define their status and to develop “autonomy” in decision-taking.

Interventions include hormone blockers to suppress puberty and, later, cross-sex hormones. The average age at which children begin such treatments is 14, but some are as young as 12.

An expert told The Times that the rules, agreed between NHS England and the Tavistock and Portman Trust, which runs Britain’s first gender identity clinic for children in north London, is based on advice that lacks robust evidence and comes from clinicians with close links to transgender groups.

NHS England has ordered an independent review into the use of puberty suppressants and cross-sex hormones. The National Institute for Health and Clinical Excellence (Nice), which is responsible for clinical practice guidelines in England and Wales, also has been asked to develop guidance for the first time about referring children to gender identity services.

Existing NHS treatment draws heavily on international guidelines that recommend approaches in care for gender dysphoria. An NHS contract with the Tavistock trust issued in 2016 says that it will “conform” or “broadly conform” to standards of care issued by the World Professional Association for Transgender Health (WPATH) in 2012. These say that they reflect the best available science and “professional consensus”.

However, Gene Feder, professor of primary care at the University of Bristol and an expert in clinical guidelines, said that these fell far below the benchmark for British healthcare guidelines used by Nice and that he would not recommend their use.

WPATH has been accused of conflicts of interest by receiving income linked with its guidelines or of working at universities or clinics that received funds from advocacy groups or drugs companies that favour certain treatments or receive grants and publish research on transgender care.

Walter Bouman, president-elect of WPATH and a doctor at the Nottingham Centre for Transgender Health, confirmed that they were funded by anonymous donations, but denied conflicts of interests in the 2012 guidelines. However, he said that the new version would include a conflict of interest register.

Professor Feder is to give evidence in support of Keira Bell, 23, who is suing the Tavistock trust and NHS England for giving her gender reassignment treatment in her teens. She later changed her mind and detransitioned.

Ms Bell argues that the existing approach is unlawful because the risks are not fully explained, including to fertility and sexual experience, and because children cannot give informed consent for such treatment.