NHS England: ‘Gender-confusion in children may be a phase’

Gender-confusion may be a “transient phase” in children and young people, which in most cases “does not persist into adolescence”, NHS England has stated.

In draft guidelines open for public consultation until December, NHS England also sets out proposals for an interim service to replace the Tavistock Gender Identity Development Service (GIDS). The clinic will close next spring, after the independent Cass Review’s interim report found it was not a “safe or viable long-term option”.

NHS England noted “scarce and inconclusive evidence” for making decisions which may have “life-long consequences”, amid a rise of referrals to GIDS from 250 in 2011-12 to over 3,500 in 2021-22. Of those referred in 2021-22, only half were for children aged 15 and over, while at least 15 were under four years old.

Mental health

The proposed new guidance said clinicians should be aware that gender-confusion “may be a transient phase, particularly for pre-pubertal children, and that there will be a range of pathways to support these children and young people and a range of outcomes”.

It goes on: “A significant proportion of children and young people who are concerned about or distressed by issues of gender incongruence, experience co-existing mental health, neuro-developmental and/or family or social complexities in their lives.”

Following the Cass Review’s statement that social transition in young children is not a “neutral act”, NHS England warned that clinicians must be mindful of the risks and only consider it for adolescents where deemed “necessary for the alleviation of, or prevention of, clinically significant distress or significant impairment in social functioning”.

NHS England also clarified that it will ‘strongly discourage’ young people from sourcing puberty blockers and cross-sex hormones from unregulated companies, and will not consider medical interventions “at least until puberty has been reached”.

‘Concerning’

Stella O’Malley, Director of parent group Genspect, said: “Professionals working with children need to reflect on that and make sure they aren’t inadvertently causing harm by providing short term relief that leads to long term distress”.

She called it “shocking and concerning” that under-fours had been referred to GIDS, saying: “Children up until the age of roughly seven or eight engage in magical thinking, for example they can believe that thinking about something can make it real”.

Following the expected implementation of an interim service by next spring, NHS England intends to institute long-term plans during 2023 to 2024 based on final recommendations from the Cass Review.

Dangerous

Earlier this month, a Sunday Times investigation revealed that dangerous prescription-only drugs are being sold online to people attempting to ‘change sex’ without medical supervision.

United Pharmacies (UK), a Hong Kong-based company, does not require a medical evaluation to have taken place before dispensing the drugs in plain packaging disguised as body care products.

The newspaper was able to order drugs within minutes on the website, without providing any proof of age or a prescription, and the drugs were delivered within five days.