How helpful is the NHS’s latest guidance surrounding transgender children?

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Recent draft guidance for NHS doctors recommends a more cautious approach to treating gender dysphoria in minors. It tells doctors to be slower to affirm social transitioning in children and adolescents, which occurs through changing one’s pronouns, name or fashion style. While on the face of it, this news will inevitably push our deep libertarian spirits to rally against the NHS, let’s take a look at the circumstances that led to this decision. 

The NHS recently decided to close Tavistock and Portman NHS Trust in North London, which was the home of the Gender Identity Development Service (GIDS), the only clinic dedicated to treating gender dysphoria in the UK. GIDS was closed after increasing backlash that their operators were “too quick” to affirm a child’s gender incongruence, and that they rushed children onto puberty blocking drugs without adequately informed and explicit consent. The service also was not able to handle the skyrocketing demand- over 5,000 children were referred to GIDS with gender dysphoria last year. 

The new system will have doctors and clinicians operating at the forefront, as opposed to therapists. Doctors will consider other mental health issues such as autism as being the reason for a child’s mental struggle, before considering prescribing drugs to treat gender dysphoria. The clinical approach is “trying to be mindful of the risks of a gender transition”, especially if the incongruence does not persist into adulthood. 

Priority for young children should always be support

Surely, there is merit to taking it slow when it comes to the prescription of drugs that are meant to significantly alter your body’s biology. The UK has set itself apart from the USA’s all-affirming approach, with President Biden recently calling bans on transgender services for minors “immoral” and “outrageous”. It is true, that for us to truly be able to challenge society’s heteronormativity, children should be given any and all support they require to freely express their gender identity from a young age. But equally dangerous is the idea that we can push confused children to make serious medical decisions, just because we wish to be affirmative of queer identities. Keira Bell is a woman who underwent several procedures including loss of her hair, breasts, fertility and more at the age of 16, after a short series of superficial conversations with social workers. She later realized that her gender dysphoria was only a symptom of her misery, but it was not the cause, raising serious concerns about whether the operators at Tavistock merely provided empty affirmations as opposed to genuine support for a confused child. 

While scaling back is a good thing, the extent to which the NHS is currently scaling back is slightly concerning. Not only have puberty blockers been banned for children under the age of 18 but for strict clinical trials, even social transitioning should only be considered when necessary for the alleviation of clinically significant distress. This implies that unless a child is suffering from a significant impairment in their social functioning, they will not even be encouraged to try changing their clothes or pronouns to help them feel better. It may be true that social transitioning can have significant effects on a child’s psychology, and must be carefully considered. But these restrictions feel quite draconian for an act that should be simple- changing the way you want the world to perceive you on a surface level. By making doctors the first point of call for young children, the new system also loses out on the wealth of knowledge brought by social workers about the broader heteronormative contexts within which a child’s gender dysphoria operates, whether that dysphoria is a symptom of a different mental health issue or not. Referrals to NHS identity care can now only be done by NHS healthcare professionals, as opposed to earlier when even family and friends of the patient could refer them. All these measures point to the dangers of an overly clinical approach to a social and emotional problem. 

It remains to be seen what the feedback on the draft guidelines will be. Scottish schools have already been urged not to follow these provisions, with one MP calling them, “straight out of a homophobic playbook”. There is clearly merit to some of these provisions, but others, such as the use of the words “going through a phase” feel very reactive to the controversies of Tavistock and take too many steps back. Ultimately, the priority for young children should always be support and safety, neither mindless affirmations nor gaslighting.

Image credits: Pavel Danilyuk via Pexels

One thought on “How helpful is the NHS’s latest guidance surrounding transgender children?

  • Listening to what a child tells you is not pushing them to do anything. Nobody in the U.K. is giving a child drugs that alter their body. The whole purpose of the puberty blocker (a drug used in trans children for 29 years after 12 years of testing and 8 years of use to treat other conditions – hardly experimental) is to pause not stop puberty.
    There were 11,444 children referred to GIDS between 2015-2020
    0.3% of the population are believed to be transgender. This equates to 22,830 teenagers. That’s people who don’t outgrow gender dysphoria. If the myth that people outgrow it was true then we would expect referrals to be around 152,000 in the same period, and yet, we barely have half the expected numbers being referred. The mathematics just does not support the claims that trans people outgrow gender dysphoria with puberty. One study allowed a child to commit suicide by denying them access to healthcare and then claimed it was the right decision. The results show that those denied treatment find coping mechanisms (not outgrow) for their gender dysphoria but perform much more poorly with greater mental health problems than those who receive treatment.
    The NHS has ideological problems with providing healthcare to trans people and routinely ignores evidence and best practices.

    Reply

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