England renews medical care for transgender youth

On Thursday, the UK’s National Health Service announced the closure of the country’s only youth clinic in favor of a more distributed and comprehensive network of medical care for adolescents seeking hormones and other gender-based treatments.

The closure followed an external review of London’s Tavistock Clinic, which has served thousands of transgender patients since the 1990s. The ongoing review raised several concerns, including long waiting times, insufficient mental health support, and the growing number of young people seeking gendered treatment.

The review of transgender youth services in England is part of a notable shift in medical practice in some European countries with nationalized health systems. Some doctors are concerned about rising numbers and a paucity of data on long-term safety and the outcomes of medical transitions.

In the United States, doctors who specialize in gender-based care for adolescents have mixed feelings about reforms in Europe. While many agree that more comprehensive health care for transgender youth is badly needed, as are more treatment studies, they fear that the changes will fuel the growing political movement in some states to ban such care outright.

“How can we draw the line in order to maintain individualized care while maintaining safety standards for all? This is what we are trying to solve, “said Dr. Marci Bowers, gynecological and reconstructive surgeon and incoming president of the World Professional Association for Transgender Health, which is transgender.” It’s the people on the ground who have to make these decisions. not the people in Washington or the state legislatures. “

The NHS said current patients at the Tavistock Clinic could continue to receive treatment there before moving to two new centers in children’s hospitals in London and Manchester. The new clinics will expand the country’s gender services by ensuring children are adequately treated for autism, trauma and mental health issues. The specialists will also conduct clinical research on gender drugs.

There are “critical unanswered questions” about the use of puberty blockers, wrote Dr Hilary Cass, the country’s head of external review of the country’s youth gender identity services, in a letter to the head of NHS England last week. .

Puberty blockers, which are largely reversible, are meant to buy younger patients time to make informed decisions about permanent medical changes. But Dr. Cass wondered if most of the teenagers prescribed these drugs had been given the support to reverse course if they chose to do so.

Tavistock received more than 5,000 patient referrals in 2021, up from just 250 in 2011. The types of patients requesting referrals have also changed over the past decade. When the clinic opened, it mainly served children who had been assigned a boy at birth. Last year, two-thirds of her patients were assigned a woman at birth.

It is unclear why the number of patients has increased so dramatically or why transgender boys are leading the increase.

Advocates of transgender people in Britain welcomed the changes but stressed that many questions still remain about how they would affect youth care.

“We are optimistic, cautiously optimistic about the news,” said Susie Green, chief executive of Mermaids, a advocacy group for transgender and gender-diverse youth. “There is a two and a half year waiting list to see for your first date. We have seen the inconvenience caused to young people by this ”.

But Ms. Green, who has a transgender adult daughter, said the group was concerned whether mental health services would take priority over medical care. Gender diversity, she said, shouldn’t be treated as a mental disorder.

“We would not want any further barriers to be placed in terms of access to medical intervention,” said Ms Green.

In 2020, a former Tavistock patient, Keira Bell, joined a highly publicized lawsuit against the clinic. She claimed that she had been subjected to puberty blockers at age 16 “after a series of superficial conversations with social workers” and that she had her breasts removed at age 20, decisions she later relied on. is repentant.

A high court initially ruled that children under 16 are unlikely to be mature enough to consent to such medical interventions. But that decision was overturned in September last year, with judges ruling that “it was up to the doctors rather than the court to decide” whether a young patient could provide informed consent.

In 2020, Tavistock employees raised concerns about medical care at the clinic, prompting the NHS to commission Dr Cass, a London pediatrician who was not affiliated with the clinic, for an external review. Its interim report was released in February of this year.

The Swedish National Health Service ruled this year that gender-based medical care for young people should only be provided in exceptional cases when children have clear distress about their gender, known as dysphoria. All adolescents receiving treatment will need to be enrolled in clinical trials in order to collect more data on side effects and long-term outcomes. Finland took a similar stance last year.

“Our position is that we cannot see this as just a rights issue,” said Dr. Thomas Linden, director of the country’s National Board of Health and Welfare, in a February interview. “We have to see the patient’s safety and accuracy in judgment. We really need to be certain to some extent that we are providing the right treatments to the right person. “

Although these European countries have placed some limits on transgender care, their approaches are far more permissive than those of some conservative states in the United States. A recent Alabama law made it a criminal offense for doctors to prescribe puberty inhibitors and hormones to minors. In Texas, parents who allow their children to receive gendered treatment have been investigated for child abuse. Both states are involved in judicial battles with civil rights groups.

Some American doctors feared that changing standards in Europe would reinforce the idea that gendered treatments are dangerous for young people.

“My fear is that this is being interpreted as another notch against providing gender-affirming care for children,” said Dr. Angela Goepferd, Medical Director of the Gender Health Program at Children’s Hospital. Minnesota. We need more services, they said, not less. “This is our challenge here.”

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