The Economist has reported on concerns about NHS England’s new pilot gender clinics for adults. The protocol is blatantly unsafe, especially for vulnerable young people (17 and above), whose mental health needs are overlooked.
The clinics adopt a US-style ‘affirmative’ approach and use generalist clinicians to prescribe powerful hormones without undertaking a detailed psychological evaluation of the patient’s readiness. Talking therapies to overcome gender dysphoria are “not offered routinely“. The treatment protocol “will sideline mental-health expertise & thereby not address co-existing mental health problems that might be worsening the gender dysphoria“.
Four current & past members of the Royal College of Physicians’ Ethics Committee expressed concerns: “We did not get the sense that gender medicine was open to scrutiny or self-criticism on standard medical criteria, such as side-effects & long-term outcomes” said Professor Alasdair Coles.
We know from recent studies how poor NHS services are for young adults with gender identity problems – including the very long waits for help. Many young adults are vulnerable and have suffered years of mental illness. A free-for-all is no kind of solution.
Gender clinicians themselves admit that the “model of care in adult GICs is based on experience with older transwomen, not younger transmen or non-binary service users” for whom it may represent a risk to their long-term health.
The pilot gender clinics offer hormones for patients with non-binary identities, but there’s no evidence they help. Dr Leighton Seal, consultant endocrinologist at the Tavistock and Portman NHS Trust gender clinic, says: “We have to accept that there is no robust literature on this subject…” and: “there are no clearly established guidelines for the hormonal treatment of non-binary people, and a lack of empirical evidence on which to base practice“. [source: Richards et al, Genderqueer and Non-Binary Genders (2017)] Rates of detransition or stopping treatment, as measured in two recent studies, are very significantly higher than historic estimates, and are as common as 20%.
We’re worried the pilot clinics are offering a one-size-fits-all, highly invasive and burdensome medical approach. The NHS should trial psychological interventions, to find the most effective way to help patients manage their dysphoria.