The Times today:
The medical fates of so many vulnerable young people should never have been under the control of one single, controversial clinic. The monopoly of the Gender Identity Development Service, GIDS, over the treatment of children and young people who identify as transgender, has now been broken, thanks to these latest recommendations by Dr Hilary Cass. The full scale of the damage it has done may never be known.
For years, whistleblowers have been trying to raise the alarm that something had gone badly wrong at the north London clinic. Somehow, the word transgender had triggered a satellite service that operated beyond many of the standard NHS safety protocols.
That special treatment, as Dr Cass makes clear, led to those young people receiving worse care.
The Tavistock and Portman NHS Foundation Trust’s service for children and young people grew out of a small clinic that was founded in 1994. It became an NHS-commissioned service in 2009 and in 2011, the new GIDS director, Dr Polly Carmichael, began its first “trial” of puberty blockers, a type of hormone therapy that literally halts the development of children as a way of treating their gender distress. Before any research was concluded on the long-term impact of these drugs on a child’s physical and psychological development, the clinic made the drugs more widely available in response to apparent increasing demand.
No matter that a significant proportion of these new referrals were on the autism spectrum, or already suffering eating disorders, or were in care, or had complex histories of trauma or abuse — the GIDS leadership pursued an “affirmative” approach which critics said effectively treated a child’s declaration that they were born in the wrong body as sacrosanct and treated all their other complex problems through the prism of gender.
Clinicians who questioned this approach were accused of being transphobic. Whistleblowers like Dr David Bell, a former staff governor; Keira Bell, who regretted her transition; Marcus Evans, a consultant, and his wife, Sue Evans, a mental health nurse, and Sonia Appleby, a child safeguarding expert, all tried to raise the alarm in a hostile environment. There began an exodus of experienced staff who left the service amid concerns that the clinic was sending young people down an experimental medical pathway towards irreversible cross-sex hormones — without their informed consent and without adequate exploration of other issues that might have been at the root of their unhappiness. Some of these children, the whistleblowers suspected, were in the process of realising they were gay, but they claimed the subject of sexuality was not adequately explored.
By moving the care of vulnerable, trans-identifying youngsters back into the NHS fold of mainstream children’s hospitals and shifting the focus away from interest groups obsessed with queer theory and back on to boring old things like evidence-based medicine and clinical research, Dr Cass has done these children and their families a great service.
Critically, she has also called for the appropriate services to monitor the long-term outcome of these patients. Arguably the most shocking part of GIDS was that, despite its supposedly pioneering approach in this brave new world of gender identity, it failed to keep accurate records of what happened to all these children it treated once they grew up.
The full impact of the GIDS experiment on their lives is yet to be known.
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