Public Consultation - Interim Service Spec for Specialist Gender Dysphoria Services for Children/Young People

[rogdmum]

This is what was leaked by Reuters last week and is now live:

www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/

There’s a fair chunk on social transition on pages 15/16:

”Not all adolescents will want or benefit from social transition. The provision of approaches to support social transition may be considered in cases where:
• Gender dysphoria has been diagnosed, is consistent and persistent; AND
• Associated needs and risks have been considered and are being addressed
or supported; AND
• The young person expresses a clear wish to affirm their gender transition and fully understands the implications of affirming a social transition (informed consent); AND
• The proposed clinical approach is necessary for the alleviation, or prevention of, clinically significant distress or impairment in social functioning in the individual.

In these cases the clinical approach will involve a focus on exploring or supporting (as appropriate to the individual) social transition through psychological support and interventions, family work/therapy and guidance for the local professional network”

And what Reuters reported on accessing prescriptions from online/unregulated providers is included (page 16)

”Prescribing from unregulated sources and unregulated providers
Children, young people and their families are strongly discouraged from sourcing GnRHa and masculinising / feminising hormone drugs from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies. In such cases The Service will make the child or young person and their family aware of the risks, contraindications and any irreversible or partly reversible effects of the drugs and will advise the GP to initiate local safeguarding protocols.”

It should make it pretty bloody clear what the TRAs mean when they say 'conversion therapy'.

But it really depends what the aim is. Are children only wearing clothes for the opposite sex because they believe that affirms their opposite-gender identity or are they just wearing the clothes because they like them?

Once puberty hits then clothing becomes gendered because it fits around the different body shapes. Are the children wearing those clothes to give them the body shape of the opposite sex?

I don't think that's what he means. I think he's objecting to safeguarding measures being initiated if children or their parents buy unregulated drugs over the Internet. He seems to think this means the children will be taken into care. He's highlighted the word 'safeguarding' in the screenshot in his tweet.

Is anyone a member ACP UK and can try and get them to do an institutional response to Rhos consultation? They recently published a sdnsible response to the cass interim report.

*this consultation (not Rhos!)

A huge improvement - Cass has really changed the direction of travel, and we've yet to even see the full report.

Clothes are not a battle anyone outside of the Daily Mail would argue for, I would hope (outwith general appropriateness, school uniform etc). Do they form a part of a social transition? Yes, obviously, but social transition is about the external validation of a new persona. The risks come into play when others, particularly the trusted adults in the child’s life (parents, teachers etc) reinforce the child’s belief that they are trans through use of changed name, pronouns etc. Clothes on their own are not going to do that, and particularly (re body shape), for adolescent girls, baggy “male” tops can be used to conceal breasts in a risk free manner as opposed to binding.

Guiding gender distressed children to clothes to fit societies expectations of what they should be wearing will only lead to a feeling of shame around their gender dysphoria when what we should be focusing on is the elements of others providing external validation (names, pronouns, celebration of being “trans” etc).

I sometimes wonder if, if labour did get in, once faced with all the actual evidence, and growing numbers of detransitioners, concerned professionals, and Cass, that they'd be forced to continue what has been started. (Hopeful)

This parent should be reported.

Mum takes 14 yr old to Poland for top surgery www.mumsnet.com/Talk/womens_rights/4660494-mum-takes-14-yr-old-to-poland-for-top-surgery

I wondered something similar about Labour. Also because if the new NHS service gets up and running broadly along these lines, then schools have to follow suit (around social transitioning etc), it'll make some of the other things harder to keep up. Things that have masked what's going on and called it "progress".

I'm thinking of pronouns at work and staff networks that push all the things that have strong roots in causing harm to children. It's why I've always refused, and it's cost me to do so. But it'll be harder to push that kind of thing when it's so clearly linked with doing the wrong thing in looking after children with gender distress.

We've known these things for a while here but they need to be much more prominent.

Hopefully GIDS won’t be discouraging children/adolescents from wearing what they want (or hairstyle etc).

Maybe some more clarity is needed about the differences between gender non-conforming behaviour and transition. Trans activists have been busy for years telling the world that all non-conforming behaviour is a sign of a "trans" identity and must always be treated as such.

Maybe it's time for them to row back on that, eh?

As someone on the thread has pointed out, we don't know if it's true.

Though in such a scenario, definitely should be reported.

I think it rather telling that those against evidence based approaches and measures, watchful holistic treatments are those with a vested interest in convincing children they are trans, surely if you had the best interest of children at heart, you would be advocating loudly for the best, safest and strictly controlled treatments.

Yes Resister, it will be hard to you turn on a number of things that have been set up recently or proposals. They can't deny the reviews of Tavistock nor increasing evidence of harm.

This also overlaps with online harms / Instagram etc. there needs to be urgent robust studies on what influenced detransitioned people to transition in the first place; it's overwhelmingly internet use in some form.

Every major safeguarding fail of a child in the last 20 odd years, that required huge inquiries into what went wrong has sadly made its way into safeguarding in terms of systems, laws, requirements and also scenarios and examples used in training in order to support understanding.

I think a definition or explanation of what is being referred to with the term 'social transitioning' is needed. I am pretty confident that clinicians will not be seeking influence choices around hair, clothes make up and hobbies. A lot of the frothing on Twitter seems to think that this is what is being referred to. I think what is being referred to is 'transitioning' from being categorised and socially included according to natal sex to seeking to be categorised/ socially included according to the sex they want to be.

I think very deliberate obfuscation of issues is being manufactured by some in order to try and prevent clarity about the issues. This is the only way support can be gathered in any meaningful way. I think most of those providing the support are well intentioned but are misguided.

The bottom line is that the NHS is seeking to reduce distress and ensure safe management of dysphoria related medication. They want to align treatment of gender dysphoria with treatment of all other conditions/illnesses. They have no agenda against trans people, indeed, they want to ensure that the same levels of scrutiny about efficacy and risk/benefits of treatment are applied as with other conditions/illnesses. In light of this, claims that the proposed practice discriminated against trans people is DARVO.

I believe that issues related to ideas about gender should not/do not need NHS services/ involvement. The NHS only need to become involved if/ when distress is experienced and/or if medical intervention is being sought. In relation to this, the NHS are experts in treating distress and assessing the risk/benefits of treatment pathways. Trans people, unless qualified, aren't the experts on this so it is ridiculous to suggest that they should be determining this.They should work in partnership with qualified professions who are properly regulated and follow evidence based treatment protocols.

Once 'de-obfuscated', I think the only real controversial point is that of whether physical intervention (e.g hormones and surgery) should be considered a 'least preferred' option. My view is that the goal of treatment should be to reconcile splits between 'body and mind' to enable patients to become content with (or can tolerate) their healthy bodies. Only when this fails should changing bodies/ physical intervention be explored. Whilst this seems like a no-brainer to me, I can see the controversy in as much as it aligns with issues such as being able to choose to have a cesarian due to extreme distress at the thought of giving birth; or having a tooth extraction under general anaesthetic due to phobias around dental work. Lots of people consider medics to be 'gatekeeping' when they suggest non-physical alternatives or therapy to address the distress.

Mermaids aren't happy about this. On their twitter page (that they've no made no comment as almost 100% of tweets in response were critical of them) they say the proposals are seriously concerning.
It's seriously concerning to adopt a safeguarding approach when working with children and young people? Ok then

made no comment. You cant comment on their page. Presumably because they're alarmed that the vast majority of people commenting on their posts were
critical of them.

I would argue that in the article you linked to clothes were just part of a long list of items in the social transition list, it's not some Daily Mail crusade to stop "cross-dressing".

For children hair and clothing are the most obvious ways to tell the difference between the sexes (unless they're naked), so it's quite core to the social transition. Obviously this changes when it comes to puberty (but that's a moot point when puberty blockers are part of the equation).

Clearly there's nothing wrong with unisex clothing (although I'd argue that finding your right size is a pain), but in regards to transition it's about intent.

A lot of gay men use female pronouns for each other, but that's not about transition. I could make the same arguments about those as you have with clothing.

Yes, exactly this.

GIDS was apparently much better back in the day before groups like Mermaids got control. There would've been therapy that would be able to classify whether the behaviour was gender non-conformity, purely just an interest in something, paraphilia or transition intent.

Now everything is a tick list for simple categorisation (and that's worrying when you deal with high levels of autistic individuals due to the black and white nature of it).

As soon as GIDS just became a simple gatekeeper to transition that is where the problems have started. I hear a long list of stories of how individuals follow the same playbook, read the same script, use the same mail merge document etc.

I've just seen a post from Transgender Trend about the consultation:

www.transgendertrend.com/new-nhs-service-specification-consultation/

And this in the Telegraph

www.telegraph.co.uk/news/2022/10/23/children-who-think-transgender-just-going-phase-says-nhs/

That response from Transgender Trend is great ResisterRex
Particularly this:
The new specification has huge implications for schools. No child should now be socially transitioned in school without consultation with the clinical professionals who are supporting that child, along with parents or carers. The service specification makes very clear that teachers are not qualified to make this decision. The Equality and Health Inequalities Impact Assessment attached to the service specification clarifies that children referred to GIDS do not share the protected characteristic of ‘gender reassignment’ as a class or cohort of patients....

Schools should not be pre-empting the service by unilaterally making such decisions about individual children.

I am particularly appreciative of the fact TT highlighted the issues with Scotland. 😁

What I actually find most interesting is the fact that NHS England are saying that under 18s who have not been assessed and diagnosed with gender dysphoria are NOT covered by the protected characteristic of gender reassignment under the EA:

”do not share the protected characteristic of ‘gender reassignment’ as a class or cohort of patients.”

This is going to get VERY interesting as it has all sorts of knock on implications, especially around schools if it stands.

Thanks, RegisterRex - I've reworded some of their points for my own response.