(CP) The NHS will instruct “gender clinics to implement a pause” on first appointments for those under 18 after the discharge of a long-awaited review of how the federal government service treats youth with gender dysphoria.
The Cass Report, commissioned by the NHS in 2020 as a part of an Independent Review of Gender Identity Services for Children and Young People, was released Wednesday.
Chaired by Dr. Hilary Cass, the retired former president of the Royal College of Paediatrics and Child Health, the report lays out the recommendations from the NHS England Policy Working Group as to practices medical professionals should follow when ministering to youth with gender dysphoria in the long run.
Participants within the NHS England Policy Working Group include endocrinologists, psychologists, individuals who’ve experienced gender dysphoria, a toddler psychiatrist, an educational ethicist in addition to several NHS employees.
The review was commissioned following the exponential increase within the variety of youth looking for treatment for gender dysphoria over the past decade-plus, in addition to concerns concerning the long-term impacts of prescribing puberty blockers and cross-sex hormones on trans-identified children.
“The reality is that we’ve got no good evidence on the long-term outcomes of interventions to administer gender-related distress,” Cass wrote in an introduction to the report.
The report acknowledged that while many studies show that the usage of puberty blockers for kids with gender dysphoria is “helpful in reducing mental distress and improving the wellbeing of youngsters and young individuals with gender dysphoria,” the “quality of those studies is poor.”
The report urges the NHS to “review the policy on masculinising/feminising hormones.”
Noting that “the choice to offer masculinising/feminising hormones from age 16 is accessible,” the review really useful “extreme caution” for prescribing cross-sex hormones to minors.
“There ought to be a transparent clinical rationale for providing hormones at this stage slightly than waiting until a person reaches 18,” the report adds.
In a Wednesday letter to Cass responding to the report, NHS England National Director of Specialised Commissioning John Stewart said NHS “will set out a full implementation plan, following full consideration of your final report, in the end, and this can include the detail and structure of our approach.”
“In view of your advice concerning the need for caution within the initiation of medical interventions for young people under 18 years of age, our letter instructs the adult gender clinics to implement a pause on offering first appointments to young people below their 18th birthday,” the letter reads. “This letter also makes clear that NHS England expects full cooperation from the [Gender Dysphoria Clinics] within the delivery of the info linkage study, on which we’ve got corresponded individually.”
NHS said it can “review the usage of gender affirming hormones through a means of updated evidence review and public consultation, much like the rigorous process that was followed to review the usage of puberty suppressing hormones.”
“In the meantime, you could have made clear that the brand new providers ought to be ‘extremely cautious’ when considering whether to refer young people under 18 years for consideration of hormone intervention,” the letter continues. “In order to support the providers in following your advice we’ve got established a national multi-disciplinary team (MDT) that can review and want to agree all recommendations for hormone intervention.”
The Cass report instructed the NHS to determine a research program to “take a look at the characteristics, interventions and outcomes of each young person presenting to the NHS gender services.”
The research program should examine the “outcomes of psychosocial interventions and masculinising/ feminising hormones” along with providing a “follow-up into maturity” for young people prescribed puberty blockers.
The report suggests that puberty blockers should only be obtained as a part of a “research protocol.”
Additionally, the report encourages the NHS to adopt a completely different service model with regards to treating children with gender dysphoria.
Under the present service model, gender clinics are “psychologically focused” with “separate but linked endocrine service.” The report suggests implementing a multi-layered approach to treating children who experience discomfort with their biological sex.
The model proposed within the report involves the creation of multiple designated local specialist services designed to fulfill the “wider needs” of gender dysphoric youth as the primary point of contact. The report envisions these centers as providing “a big selection of services, helping young people to beat the psychological and social needs and challenges they may face,” akin to autism spectrum disorder and a spotlight deficit hyperactivity disorder.
“The expansion of such models could support not only this population of young people, but in addition the broader population of youngsters and young people presenting to the NHS,” the report stated. The document repeatedly asserted that lots of the young people presenting themselves with gender dysphoria have confounding psychological conditions that should be addressed.
The latest model would also include a smaller variety of regional health centers that may “be answerable for managing the caseload of people requiring support around their gender identity and hold responsibility for the assessment and treatment of those with more complex presentations and requiring more specialist care.”
Services provided by these facilities would come with “mental health services, services for kids and young individuals with autism and other neurodiverse presentations, and access to endocrinology services and fertility services, where appropriate for those looking for medical intervention.”
“[A]ll children ought to be offered fertility counselling and preservation before occurring a medical pathway,” the report recommends.
The regional health centers could be linked to designated local specialist services via operational delivery networks created to be sure that youth with gender dysphoria have “access to supportive care and appropriate treatment as near home as possible.”
The model outlined within the report is headed by a “national provider collaborative” that establishes “the event of shared standards, operating procedures and clinical protocols, for instance, for assessment and treatment.”
Additional responsibilities of the national provider collaborative would come with “updating the assessment framework in keeping with emerging evidence, audit and quality improvement, the event of clear referral criteria and intake procedures to make sure equitable access to services,” and “a forum for discussion of complex cases and all decisions about medical care (a national multi-disciplinary team).”
The national provider collaborative would also oversee “an ethics forum for cases where there’s uncertainty or disagreement about best interests or appropriate care” and work on research and the creation of a national dataset about youth with gender dysphoria.
Even before the ultimate Cass report was published, the independent review authorized by the NHS has had implications on treatment for trans-identified youth in Britain.
Two years ago, following the publication of an interim report from Cass, the gender clinic at Tavistock and Portman NHS Foundation Trust in London that provided gender transition services for trans-identified minors within the U.K. was shut down in favor of a network of local clinics.
In October 2022, the NHS issued proposed guidelines stating that doctors should not be so quick to advertise social transitions for kids with gender dysphoria because they could be going through a “transient phase.”
In March, the NHS said it will stop providing puberty-blocking drugs for kids with gender dysphoria aside from once they are a part of a clinical trial.
