Brief summary of morning session 17th August. (It’s been hard to follow today. It’s all a bit dry and repetative) I have been reading the @mpts_hearing tweets as well as @tribunal tweets to try and get a sense of what’s going on.
Cross-examination (by Ian Stern QC) of Dr Klink continued
Ian Stern is HW representative.
Dr Klink is one of the GDC’s expert witnesses. He is a paediatric endocrinologist from Amsterdam University Medical Centre, Dept of Paediatrics.
Discussion around Endocrine Soc guidelines (2009) in relation to treatment decisions, evidence, lack of evidence and who can use the guidelines and whether or not they are up to date in relation to prescribing hormones. Low quality evidence available at the time.
There is an ongoing debate about when to start treatment and whether or not it’s OK to start before age 16. There is limited evidence in the 13 to 16 year old cohort but there is anecdotal reports of good feedback. Dr K says care needs to be taken because no data available and these are vulnerable children and adolescents.
IS suggests that Puberty can be unbearable and clinicians treat with PBs to relieve these feelings and leads to better outcomes. IS suggests a full puberty can lead to emotional and social difficulties.IS suggests that blockers are a “neutral” act. Dr K says that not being on par with your peers can cause problems.
IS asks about evidence in relation to MDTs and whether there is evidence to show this is a better approach. Dr K says there is no evidence and that its unlikely that we will ever get the evidence as no research is being carried out [gosh I wonder why that might be]
Discussion around WPATH guidelines and standards of care. Guidelines say they are “flexible… in order to meet diverse needs of trans people”
IS asks about mental health and suggests that the mental health difficulties that trans people experience is related to their GD. Dr K says that 30% with gender dysphoria have a co-existing condition which may or may not impede or cause barriers for successful transition. Dr K says that 30% have conditions that should be looked at before transition. Need to remove stigma.
Dr K asked about blockers and what age his hospital treats patients with blockers. Answer is Age 9. Dr K is asked about concerns in relation to blockers and bone density. He says there is less concern than there used to be but still contentious and should be monitored. Pt A was put on blockers at 11 and would have been on them for 5 years under the NHS.
More discussion about who should provide treatment (mental health professionals or other clinicians) Dr K stresses the importance of an MDT.
Discussion around the “informed consent model” in WPATH. Dr K says that the informed consent model wouldn’t work for a 12 year old.
IS says WPATH states that it is acceptable for a trained / experienced primary care provider to prescribe hormones.
There is a discussion around the difference between treating adults and treating children. It seems that WPATH and another document from 2011 are (in Dr K’s opinion) for treating adults. The difference being that a primary care provider can treat an adult with no MDT and with informed consent (no need for psychological intervention). Dr K says it’s OK for adults but not children. IS seems determined that adults and children could be treated the same and that the guidelines cover both adults and children. Dr K disagrees.