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Original poster

New children's gender identity clinic, clinical trials and Cass

157 replies

VegasVagabond · 15/10/2024 10:01

I'm a regular here but have named changed.

I have come across an advert for a psychologist at the new GI clinic for children in Nottingham. I am concerned that the advert says that the psychologist would be supporting children on 'gender affirming pathways' for children receiving hormones under endocrinologists.

My understanding had been that children should no longer be 'gender affirmed' or given puberty blockers and that psychological support should be exploratory to understand the child's context and wider needs?

I also thought clinical trials had not been agreed and were unlikely to be agreed?

Does anyone have any clarity on the current situation in terms of medical pathways, the new clinics, psychological support and the clinical trials?

Here is an extract from the job advert:

Job overview

Due to the development of a new young people’s gender service, there is an exciting opportunity for a Clinical Psychologist (Band 8a) to join The Nottingham Young people’s Gender Service (NYGS) at the forefront of delivering care and support to young patients. You will receive in-depth training and clinical supervision whilst working with our experienced nurses and MDT within a forward thinking and supportive NHS Trust.

NYGS are recruiting to a new team comprising Consultant Psychiatrist, Paediatrics, Advanced Clinical Practitioners, Clinical Nurse Specialists, Psychologists and Research assistants. You will have the opportunity to work with a progressive team leading the way nationally and international in children and young people’s Transgender Health.

NYGS is a multi-disciplinary service offering psychological support to young people on the gender affirming medical pathway and looked after by the adolescent endocrinologist service, some of them will be awaiting to or prescribed hormone blockers or hormones by the NHS following an assessment by the Gender Identity Development Service.

Main duties of the job

The new service will provide multi-disciplinary care and support to young people aged from 11 to (and including) 17 years old who are about to receive or currently receiving gender affirming medical treatment from the Specialist Paediatric Endocrinology services (SPES) which is the endocrinology arm of the Gender Identity Development Service (GIDs) which will be closing on the 31st of March 2024.
This new service (NYGS) service will work to NHS England’s published interim service specification for specialist gender incongruence services for children and young people (Interim Service Specification).
NYGS will sit within the established NCTH Network which provides the Nottingham Centre for Transgender Health Adult Service, the East of England Gender Service, the Linked Clinic activity with Indigo Gender Service and the Linked Clinic activity with the Sussex Gender Service.

OP posts:
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Signalbox · 15/10/2024 11:52

I also thought clinical trials had not been agreed and were unlikely to be agreed?

I’d put money on these trials getting ethical approval. Both the Government and Cass talk about the trials as if they are definitely going ahead. They never say “subject to ethics approval”. I think there will be immense pressure for the ethics committee to approve this in some form or another and of course ethics are as likely to be as ideologically captured as any other process / organisation. Also there was approval for previous trials.

Signalbox · 15/10/2024 11:41

VegasVagabond · 15/10/2024 10:01

I'm a regular here but have named changed.

I have come across an advert for a psychologist at the new GI clinic for children in Nottingham. I am concerned that the advert says that the psychologist would be supporting children on 'gender affirming pathways' for children receiving hormones under endocrinologists.

My understanding had been that children should no longer be 'gender affirmed' or given puberty blockers and that psychological support should be exploratory to understand the child's context and wider needs?

I also thought clinical trials had not been agreed and were unlikely to be agreed?

Does anyone have any clarity on the current situation in terms of medical pathways, the new clinics, psychological support and the clinical trials?

Here is an extract from the job advert:

Job overview

Due to the development of a new young people’s gender service, there is an exciting opportunity for a Clinical Psychologist (Band 8a) to join The Nottingham Young people’s Gender Service (NYGS) at the forefront of delivering care and support to young patients. You will receive in-depth training and clinical supervision whilst working with our experienced nurses and MDT within a forward thinking and supportive NHS Trust.

NYGS are recruiting to a new team comprising Consultant Psychiatrist, Paediatrics, Advanced Clinical Practitioners, Clinical Nurse Specialists, Psychologists and Research assistants. You will have the opportunity to work with a progressive team leading the way nationally and international in children and young people’s Transgender Health.

NYGS is a multi-disciplinary service offering psychological support to young people on the gender affirming medical pathway and looked after by the adolescent endocrinologist service, some of them will be awaiting to or prescribed hormone blockers or hormones by the NHS following an assessment by the Gender Identity Development Service.

Main duties of the job

The new service will provide multi-disciplinary care and support to young people aged from 11 to (and including) 17 years old who are about to receive or currently receiving gender affirming medical treatment from the Specialist Paediatric Endocrinology services (SPES) which is the endocrinology arm of the Gender Identity Development Service (GIDs) which will be closing on the 31st of March 2024.
This new service (NYGS) service will work to NHS England’s published interim service specification for specialist gender incongruence services for children and young people (Interim Service Specification).
NYGS will sit within the established NCTH Network which provides the Nottingham Centre for Transgender Health Adult Service, the East of England Gender Service, the Linked Clinic activity with Indigo Gender Service and the Linked Clinic activity with the Sussex Gender Service.

Please could you link the advertisement?

spannasaurus · 15/10/2024 11:36

I note that all the official documents, reports etc refer to this as a study rather than clinical trial and on Womens Hour the other day Hilary Cass also referred to it as a study initially when talking about no limit to the number of children recruited.
I don't know how significant the difference is between a study and trial is in this setting but it made me wonder if there will be a study of which only part will be a clinical trial.

When Hilary Cass says that there is no upper limit to the number of children that can be recruited is she perhaps saying that there is no upper limit for children to be included in the study as a whole rather than specifically for the clinical trial.

RethinkingLife · 15/10/2024 11:19

Protocol hasn't been published, so many of the answers aren't available.

In a recent Woman's Hour interview, Dame Hilary Cass indicated that there is no upper limit to the number of children who can be recruited to the trial. (I'm genuinely surprised by this and need to see the protocol to understand.)

An ethics review committee will be considering this study very shortly. They may ask for an amended protocol. This is all opaque until there is ethics agreement and a published protocol. NB: there must have been some prior ethical agreement back when the HRA et al. agreed to this study.

Original poster
VegasVagabond · 15/10/2024 10:50

Thank you!

So has the study been agreed?
Do we know numbers of children?

How is any study on children in this area ethical? Surely resrach on children which we know may have negative outcomes should only be conducted if there is a demonstarted need to avoid a negative outcome if there was no treatment?
There is no evidence that children not given puberty blockers have negative outcomes so how can trialling them on children be justified?

OP posts:
RethinkingLife · 15/10/2024 10:05

There is scheduled to be a clinical trial with the sign-off this year and recruiting from Feb. 2025.

The study into the potential benefits and harms of puberty suppressing hormones as a treatment option for children and young people with gender incongruence is being developed through the National Research Collaboration Programme (NCRP) in place between NHS England and the National Institute for Health and Care Research (NIHR). The NRCP joint programme provides a collaborative approach to study development; studies being progressed through this route still have to demonstrate that they can materially build the evidence base for potential future NHS treatment options, while meeting a high scientific bar in terms of research methodology, as well as securing other important research approvals, including ethics committee approval.
It is envisaged that children and young people in both England and Wales will be able to participate in the study with access through NHS children and young people’s gender services. A multi-disciplinary team approach will be taken to identify those children who, with the consent of their parents, may be deemed clinically suitable for consideration of puberty suppressing hormones through the study. Children participating in the study will also continue to receive comprehensive psychosocial support.
The study will measure a range of potential treatment benefits and harms (for example whether puberty suppressing hormones impact in a meaningful way on levels of anxiety or depression, on body image, or brain development) using a range of validated tools, questionnaires and user feedback. Key measures included in the study, and the way data are collected, will aim to bridge gaps in existing research and will also be shaped by engagement with a range of stakeholders, including children and young people referred into NHS gender services and their families or carers.

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/cyp-gender-dysphoria-research-oversight-board/

NHS commissioning » Children and Young People’s Gender Dysphoria Research Oversight Board

This national oversight board has been established to ensure research is embedded at the heart of new children and young people’s gender dysphoria services as they are shaped and developed. The board provides leadership and oversight of a supporting re...

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/cyp-gender-dysphoria-research-oversight-board