NHS's entire gender treatment model for children
is demolished in bombshell report: Teens suffered irreversible changes based on
'remarkably weak evidence', 'toxic' debate taints key issues - and schools are
ALSO blasted by eminent doctor
Dr Cass was appointed to lead review into identity
services for youths in 2020
Report concludes NHS treatment based on 'remarkably
weak evidence'
By ALEX
WARD and SHAUN WOOLLER and HARRIET LINE
PUBLISHED:
00:02 BST, 10 April 2024 | UPDATED: 08:59 BST, 10 April 2024
Children
given NHS transgender treatment have been set on a path of irreversible change
despite scant medical data, a report has concluded.
NHS gender
identity services for children and young people have been based on 'remarkably
weak evidence', the independent review by leading paediatrician Dr Hilary Cass
warned.
Her study,
commissioned nearly four years ago, makes 32 recommendations to overhaul NHS
trans services to improve the care that children receive.
Prime
Minister Rishi Sunak welcomed the report and called for 'extreme caution' in
treating youngsters in the future.
The former
president of the Royal College of Paediatrics and Child Health was appointed to
lead the review in 2020
Dr Cass
recommended a 'follow-through service' for 17 to 25-year-olds to protect
teenagers 'falling off a cliff edge' in care when they hit 17
Campaigners
hailed it as 'a return to common-sense decision-making'. In other developments:
■
Dr Cass said the 'toxicity of the debate' over trans care for children was
'exceptional' –
and revealed she was herself singled out for criticism during her work;
■
The report said there was a 'lack of high-quality research' on the effects of
giving children puberty blockers and hormones, and recommended that NHS England
establish its own research programme;
■
Long NHS waiting lists were said to have driven trans children into the arms of
private clinics, with GPs 'pressurised to prescribe';
■
Dr Cass laid the groundwork for schools to introduce clearer guidance when
dealing with trans children, ending the exclusion of parents;
■
The report called for the creation a separate service for those wanting to
'de-transition', where a gender transition is stopped or reversed;
■
Dr Cass recommended a 'follow-through service' for 17 to 25-year-olds to
protect teenagers 'falling off a cliff edge' in care when they hit 17.
■
NHS England launched a similar review of adult gender services led by an
independent expert.
READ MORE: 'We went to see our daughter get a
school prize and it was handed to a boy called Tommi': SUE REID hears a
mother's heartbreaking story of how teachers kept her in the dark over her
14-year-old's transition
Dr Cass
warned that her review had been hampered by how polarised the debate on trans
care for children has become. She said medical professionals had been left
'[too] afraid to openly discuss their views'.
Dr Cass
said: 'Despite the best intentions of everyone with a stake in this complex
issue, the toxicity of the debate is exceptional.
'I have
faced criticism for engaging with groups and individuals who take a social
justice approach and advocate for gender affirmation, and have equally been
criticised for involving groups and individuals who urge more caution.
'This is an
area of remarkably weak evidence, and yet results of studies are exaggerated or
misrepresented by people on all sides of the debate.
'There are
few other areas of healthcare where professionals are so afraid to openly
discuss their views, where people are vilified on social media, and where
name-calling echoes the worst bullying behaviour. This must stop.
'Polarisation
and stifling of debate do nothing to help the young people caught in the middle
of a stormy social discourse, and in the long run will also hamper the research
that is essential to finding the best way of supporting them to thrive.'
Dr Cass said: 'Despite the best intentions of
everyone with a stake in this complex issue, the toxicity of the debate is
exceptional'
She warned
that her review had been hampered by how polarised the debate on trans care for
children has become
Puberty blockers, known medically as
gonadotrophin-releasing hormone analogues, stop the physical changes of puberty
in teens questioning their gender. Pictured is one example of these drugs,
called Triptorelin
Dr Cass
described having come into contact with some 'very aggressive people' during
meetings as part of her work. The report found evidence for the use of puberty
blockers and hormone treatments relied heavily on 'shaky foundations' and
guidelines not backed by science.
Dr Cass
addressed recent debates over 'social transitioning', such as changing names
and pronouns.
The report
found those who socially transition at an earlier age or before seeing a
medical professional were 'more likely to proceed to a medical pathway'.
She said
'the importance of what happens in school' cannot be over-estimated and said
parents must not be excluded from conversations over their children's welfare.
Unregulated
private clinics were singled out for some of Dr Cass's toughest criticism as
she echoed GPs' warnings over prescriptions issued by services based abroad.
The review
said family doctors had 'expressed concern about being pressurised to prescribe
hormones after these have been initiated by private providers'.
It said no
GP should be expected to 'enter into a shared care arrangement with a private
provider', especially one acting outside NHS guidance. Mr Sunak said the report
emphasised the need for caution over treatment.
He said:
'We simply do not know the long-term impacts of medical treatment or social
transitioning on children.
'The
wellbeing and health of children must come first.'
Helen Joyce
of charity Sex Matters, said: 'Hilary Cass's report demolishes the entire basis
for the current model of treating gender-distressed children.
'It is a
shameful day for NHS England, which for too long gave vulnerable children
harmful treatments for which there was no evidence base.
'Cass's
review is a breath of fresh air, marking a return to common-sense
decision-making and evidence-based medical treatment.'
After the publication of the interim Cass review
in 2022, the Tavistock transgender clinic announced it would close down after
it was considered unsafe for children
A spokesman
for Bayswater, a group that supports parents of trans children, said the Cass
Report 'represents a sea change in the treatment of trans-identified children
and young people'.
The report
was also welcomed by Labour. Shadow health secretary Wes Streeting described it
as 'a watershed moment for the NHS's gender identity services'.
The report
comes weeks after NHS England confirmed it would no longer prescribe children
puberty blockers at its gender identity clinics, saying there is not enough
evidence to support their 'safety or clinical effectiveness'.
A spokesman
said: 'NHS England is very grateful to Dr Cass and her team for their
comprehensive work.'
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