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After much controversy, and allegations that children who felt they were transgender were rushed into treatment, the British National Health Service will warn doctors that these feelings often disappear for children as they get older, and that children should not be encouraged to change their names and pronouns.
The new draft guidance from NHS England has shifted sharply from what some described as an unquestioning “gender affirmative” stance to now advising doctors that most children may simply be going through a “transient phase” when they say they want to change sex.
Moreover, the guidelines caution medical practitioners to adopt a ‘watchful approach’ towards children and to be mindful of the possibility of autism and other mental health conditions.
And they are reminded that it is not a “neutral act” for healthcare practitioners to facilitate children who want to transition socially by using their preferred new names or pronouns without consideration of other factors.
“The clinical management approach should be open to exploring all developmentally appropriate options for children and young people who are experiencing gender incongruence, being mindful that this may be a transient phase, particularly for prepubertal children, and that there will be a range of pathways to support these children and young people and a range of outcomes,” the new draft guidance says.
“A significant proportion of children and young people who are concerned about or distressed by issues of gender incongruence, experience co-existing mental health, neurodevelopmental and/or family or social complexities in their lives,” it adds.
The “gender-affirming” model of care, which originated in the US, has now come under sharp focus after the the Cass Review’s interim report – which found some of the care being offered to children as being ‘unsafe’.
The Cass Review, and testimonies from whistleblowers and former clients at the Tavistock clinic which catered for children seeking sex change, has led to significant concerns that the NHS was facilitating a rush to put children on puberty-blocker medication, and begin a process that eventually saw those who had gone through the service undergo irreversible sex-change surgery once they were over 18.
The “affirmative approach” was championed by much of the British NGO establishment – including campaign group, Mermaids, whose founder took her child to Thailand for sex-change surgery aged just sixteen, and whose initiatives were supported by celebrities such as Emma Watson and Prince Harry and Meghan Markle.
NHS England’s draft guidance now states that there is “scarce and inconclusive evidence to support clinical decision-making” for children with gender dysphoria.
It points out that “in most cases gender incongruence does not persist into adolescence” and that “the clinical approach has to be mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty if the gender incongruence does not persist into adolescence.”
In fact, the new advice spells out that for older teenagers, social transitioning should not be assumed to be a necessary or helpful step.
“Social transition should only be considered where the approach is necessary for the alleviation of, or prevention of, clinically significant distress or significant impairment in social functioning and the young person is able to fully comprehend the implications of affirming a social transition,” the draft guidelines read.
The guidelines are open to public consultation but have been welcomed by many commentators who feel that contagion and trends on social media are driving the huge increase in children presenting as transgender.
The public consultation documents say the sharp rise in referrals to the gender identity service is evidenced in the numbers: from just under 250 in 2011-12 to over 5,000 in 2021.
After much controversy, the NHS announced it would be closing the Tavistock clinic and that regional centres in specialist children’s hospitals would help children who were presenting as transgender.
A more “holistic” approach will be adopted, with the understanding that a “significant proportion of children” who are referred for treatment have neuro-development issues or family of social problems.
An audit of the HSE’s National Gender Service here in Ireland found that, in recent times, up to 90% of those seeking to avail of gender-changing treatments and services had Autism Spectrum Disorder.
Women’s groups in the UK welcomed the new NHS draft guidelines as a “huge and significant change”.
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