Where is the NHS really headed with gender treatment for children?

15 March 2024

Public Policy Researcher Carys Moseley looks at what is really happening in NHS England after it was reported that puberty blockers will no longer be prescribed.

This week, NHS England banned the prescription of puberty blockers to children in its gender identity clinics.

This was as part of its response to its 2022 consultation on the future of gender identity services for children. At the time, Christian Concern encouraged supporters to respond. Now that NHS England has fully responded, there is great excitement about the ban.

However, a closer look at the broader picture given strongly suggests we should be cautious, not complacent.

Ban on puberty blockers doesn’t apply to private clinics

The ban currently only applies to NHS England gender services for children. Liz Truss wants the policy to be widened to include private gender clinics as well.

This is because some people have been providing puberty blockers and cross-sex hormones to children on the internet for several years.

Puberty blockers still allowed in research trials

Last June, I warned that the two new gender hubs were obliged by the interim policy to take part in research trials involving giving children puberty blockers.

The interim policy also effectively allowed puberty blockers through the back door. Parents are likely to pressure doctors to allow their child to participate in a puberty blocker trial. The BBC reports that individual clinicians can still apply to have the drugs funded for patients on a case-by-case basis.

5,000 children on waiting lists

Tuesday’s consultation response says that there will be two new gender hubs in England; at Great Ormond Street Children’s Hospital and Alder Hey Children’s Hospital in Liverpool. Some 250 children will be moved to these hubs from the GIDS once they open in April.

At the same time, over 5,000 children and teenagers are on the waiting list for these new hubs.

Further regional centres proposed

Beyond this development, the BBC reports that there are yet more regional centres for children and teenagers being proposed. It’s easy to see that some of the 5,000 children will be moved to these centres. But who will staff all these hubs and centres?

The number of remotely sensible therapists interested in this subject is rather small. Only a minority of the GIDS clinicians resigned in the last few years, objecting to the affirmation policy. All the professional mental health bodies are still signed up to the professional ban on ‘conversion therapy’, which makes it hard or impossible for clinicians to be sceptical about a person’s ‘gender identity’. It is from their ranks that the therapists for these hubs and centres will be drawn.

Why the WPATH leaks matter here

All this comes very soon after the leaking of conversations between members of the World Professional Association of Transgender Health (WPATH) in the USA about giving hormones and puberty blockers to children. Indeed, several respondents to the NHS England consultation asked whether it was using WPATH’s standards. NHS England denied this was relevant to its research methodology.

On 4 March this year, American environmental activist Michael Shellenberger published a file of leaked social media chats and videos from WPATH, dating from 2021 to 2024. These show a disturbing culture of arrogance by clinicians, who are mostly trans activists, towards very vulnerable children and teenagers. The full report including the leaks runs to 241 pages, but we can get a sense of how serious things are from some of its section headings.

‘WPATH knows children do not understand the effects of hormones therapy’

Leaked video footage of a workshop from May 2022 showed a WPATH panel admitting that it was impossible for them to get their teenage patients to give informed consent for cross-sex hormones. A Canadian endocrinologist Dr Daniel Metzger recounted how teenagers thought they could pick and choose which sexual characteristics hormones would give them. This showed a profound lack of understanding of human sexual development at puberty. He even admitted that some of these teenagers hadn’t yet learnt biology in secondary school.

Have things been any better at the GIDS, and how exactly will the new gender hubs and centres in England improve on such an anti-science climate? I can’t see anything in NHS England documentation that promises to educate children and adolescents who are referred about human sexual development.

‘WPATH members trivialising detransitioner stories of harm’

The world of transgender healthcare has long claimed the rate of regret and detransition is low, but this is unconvincing. The report cites studies suggesting these numbers are rising. A psychologist based in Washington DC posted about a teenage girl who had come off testosterone after two years and was angry about having been ‘brainwashed’. Numerous WPATH members wrote defensive replies, claiming detransition was merely another step in the ‘gender journey’, and that regret wasn’t necessarily part of it.

Such an approach is cowardly in its evasiveness, psychologically implausible in its denial that regret would necessarily have motivated detransition, and thus enables clinicians to dodge responsibility for having damaged the patient’s physical and mental health.

I can’t see anything in the NHS England documentation that will improve on this. NHS England never says that taking the path to undergo procedures to look like the opposite sex is not true medicine and therefore unfounded and wrong. Without this basic sense of right and wrong, detransition makes little sense.

‘Permanently medicalising transient identities’

The files show that WPATH clinicians frequently minimised the seriousness of ‘changing gender’, likening it to getting a tattoo. WPATH members are privately aware of the fact that some teenagers turn to a transgender identity as a response to prior trauma. However, their publicly stated official stance is to favour affirmation and access to drugs and surgery, if these teenagers want this.

NHS England may have stopped prescribing puberty blockers to teenagers, but they will still be used in ‘research’. It’s not hard to see that teenagers already caught up in the transgender movement will insist on getting included in this dubious research programme. Among them there may well be those affected by trauma. Will NHS England screen these teenagers out?

‘Misinformed parents cannot give informed consent’

Parents sign the consent form on behalf of their children. However, if parents are not given the full truth about the effects of the procedures, they are not giving informed consent.

The report says that parents are often deceived into thinking that using preferred names and pronouns will help the child.

“Changing names and pronouns is often portrayed as a harmless, non-medical step to alleviate a child’s distress. It is sold to parents as completely reversible at any time, but all available evidence suggests the contrary.” [Mia Hughes, The WPATH files, p. 39]

The report criticises WPATH for misinterpreting a scientific paper on the topic in its response to the ban in Missouri on sex-trait modification for minors in 2023. The paper found that five years after social transition, 97% of such teenagers still identified as transgender. WPATH cited the article to argue that it showed such teenagers are ‘truly transgender’. In fact, it showed that social transition has a very powerful and formative effect on children, making it much more likely that they permanently identify as transgender.

Gender identity as a belief linked to “happiness in the moment”

The WPATH leaks are the latest example of a policy that treats trans as a belief. The real question is: why is this belief allowed to persist in healthcare? One of the clinicians involved says “we all want kids to be happy in the moment.”

This is not simply a matter of good medicine. It is fundamentally a moral matter about how we as human beings should live. Should we give in to impossible fantasies about being members of the opposite sex, or learn to live in harmony with our bodies? Should we give into despair about the ability to do the latter? Should the healthcare system allow such despair to be acted upon, or does it not have a duty to uphold a vision of health?

The influence of WPATH on the NHS

As the WPATH leaks were published and widely discussed on both sides of the Atlantic, it emerged that WPATH has influenced the NHS for more than a decade. The successive versions of the WPATH Standards of Care have been used as the basis for gender identity healthcare. Journalist Hannah Barnes exposed the problems in the Observer. Several members of WPATH have worked in adult gender clinics in NHS England. Susie Green, the former CEO of Mermaids, has been a WPATH member. She has no medical qualifications.

The service specification for the GIDS in 2016 said it would work in line with version 7 of the WPATH Standards of Care. Finally, Barnes reveals how as recently as 2022 – within the time of the leaks – clinicians from the GIDS gave presentations at WPATH conferences.

Trans activist influence on the NHS is not new

For the structural reasons I identified earlier in this article, getting away from the nefarious attitude found in bodies such as WPATH won’t be easy for the new gender hubs and centres in the NHS. There have been several times in the past when critics of these procedures have cried ‘victory’, only for it to emerge soon after that these were hollow victories.

The sad truth is that the historical record clearly shows transgender activists have been increasingly influential in the NHS for over fifty years. Two major examples will suffice to illustrate this. The NHS was infiltrated by trans activists once rogue psychiatrist John Randall from Charing Cross Hospital was allowed to refer patients for surgery in the late 1960s. Randall worked alone and was unaccountable to anybody.

Stonewall’s trans activism in the NHS

The Department of Health set up a Sexual Orientation and Gender Identity Advisory Group in 2005 after the Gender Recognition Act came into force. Ruth Hunt (now Baroness Hunt) then head of social policy for Stonewall wrote many of its early documents on sexual orientation (see here, here and here). She was formally appointed to the group, rebranded as the Department of Health LGBT Advisory Group, in 2008.

Fast forward to 2017, when Hunt was criticised by the former Lord Chief Justice in a court case for having no medical qualifications to handle transgender issues.

Some children are more protected than others

Taking a broad overview of the developments in the NHS, there is little room for complacency.

There is an undeniable NIMBYism at the heart of the view that whilst puberty blockers will no longer be proscribed, they will still be used in ‘research’. I’m not holding my breath as to whether proper safeguards will be put into place. The very idea that giving quack treatment such as puberty blockers is acceptable in research shows a ruthless cynicism at the very least. In reality, it means that some children will be more protected than others.

Those with parents who are still persuadable that ‘transition’ is a bad idea may be more likely to be protected. However, children who have developed a transgender identity because, frankly, their parents have groomed them are less likely to be protected. This is because such parents are more likely to seek out private gender clinics or allow or encourage their children to get hormones and puberty blockers online anyway.

There is a way for the government to step in here to protect all children, which is to get the Department of Health to take charge of the policy. This would require rescinding the MOU on Conversion Therapy, which is what has cemented the affirmative model across both public and private mental healthcare. At present this does not seem to be an available policy option.

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