Public NHS consultation on puberty blockers open

[WarriorN]

www.engage.england.nhs.uk/consultation/puberty-suppressing-hormones/

NHS England commissions gender incongruence and dysphoria services and the purpose of this consultation is to seek views on a proposed interim clinical policy on puberty suppressing hormones (sometimes referred to as ‘puberty blockers’ or ‘hormone blockers’) for children and adolescents who have gender incongruence or dysphoria.

The policy proposition is that puberty suppressing hormones are not recommended to be available as a routine commissioning option for the treatment of children and adolescents who have gender incongruence or dysphoria.

This public consultation will run for 90 days from 3 August to 1 November 2023.

Her synopsis:

"First of all, a proposed change to who can refer into the specialist gender service for children and adolescents.

In older service, most referrals came from GPs, some from CAMHS, some from charities supporting trans youth.

In the new proposal, GPs cannot refer to the specialist gender service.

GPs instead have to refer to secondary care (pediatrics or mental health), and only secondary care can make a referral to the specialist gender service.

The GPs have to deem the child sufficiently distressed to be worthy of a referral to secondary mental health services (role of pediatrics is unclear - they have not dealt with trans kids before in the UK system).

So happy trans kids can't get into the system

Everyone knows the severe pressures that child and adolescent mental health services are under in the UK.

Now all trans kids are forced through secondary care - delaying trans kids getting care & increasing delays for kids (cis or trans) in need of mental health support.

So now, to even get to the specialist gender service, a child has to persuade their parent (usually), their GP, AND a secondary health professional to do those referrals.

Sounds impossible doesn't it!

That is BEFORE whatever hurdles will be within the gender service, which is before hurdles in endocrinology.

Good job trans adolescent healthcare isn't time sensitive hey!

In the old system there was the ability of direct referrals from places like trans support charities.

This route was not commonly used, but was particularly important when trans children had a transphobic GP who refused to refer for ideological reasons.

The new system has no such plans in place for supporting trans child's right to access care.

There is no clear recourse if their GP or secondary healthcare professional is transphobic.

We KNOW that transphobic prejudice exists. This new NHS policy does not care.

The second policy out for consultation today, as was predicted from early documents, states that puberty blockers will only be prescribed under a research protocol.

I've written about this before and haven't got the spoons to say much right now

Headline problems with it include:

1. It involves coercing children into research to receive healthcare. Research coercion is bad. It cannot entail informed consent. It is deeply unethical. And it will distort and make meaningless research findings.

1. It means that access to puberty blockers can be outright denied based on who they define as 'eligible' under their 'research protocols'.

This is an untransparent way of denying healthcare that I expect to see in practice (whilst the NHS denies is happening in policy).

I have more to say, but not today.

The NHS (NHS England) continues to be an acute threat to trans children's rights, well-being, autonomy and happiness."

It illustrates the absolute mess of referrals and loopholes of the current/ previous system

A significant issue is that CAHMS is really stretched already.

Anecdotally, a parent who is a Gp I know said no Gp at the practice wants to touch anything relating to transgender medicine with a barge pole. They had to do some training and they've basically done the scheduled version of flipping a coin.

Wow. All of that is certainly very.... special.

To pick out one bit in particular:

So happy trans kids can't get into the system

This highlights the problem that is still present, even in the new policy. It is predicated on the fact that gender dysphoria is not a mental health issue. The combination of this assertion from the NHS and the acceptance that the standard approach medicates a desire to physically become a stereotype is a foundational flaw that still exists.

It shouldn't be stigmatised - no mental health condition should be - but gender dysphoria should be acknowledged and treated as a mental health issue. Even Buck Angel and Blair White, two YouTubing trans people, agree.

"So happy trans kids can't get into the system."

If it's not causing you distress, why exactly did you want life altering drugs and surgery for it?

An excellent point!

Interesting exploring the RT etc of people like Horton...

transsafety.network/posts/gosh-exploratory-therapy/

"Last month, the originator of the controversial “Gender Exploratory Therapy” approach which rejects the gender affirmative therapy model celebrated being hired as a new Education Lead by Great Ormond Street Children’s Hospital.

Anastasis Spiliadis was one of a team of three who led a training session for London NHS CAMHS staff earlier in the year, reported on by Trans Safety Network at the time. The training contained alarming statements, including that “parents and carers should have access to a range of information to weigh up what may or may not fit or be helpful for each family” before listing two conversion therapy organisations and a group which has been criticised for promoting anti-trans bullying, alongside two mainstream trans support charities.

In this training, Spiliadis and his colleagues Tilly Langton and Anna Hutchinson promoted their “Gender Exploratory” approach to gender dysphoria treatment. This encourages inserting delays into transition and trying to resist a patient’s preferences for changes of name or pronouns. At the end of the slide deck, trainees were encouraged to investigate a list of organisations that “offer different perspectives”, directing NHS CAMHS Psychiatry Trainees towards on the one hand, mainstream trans support charities Gendered Intelligence and Mermaids, but on the other hand, two conversion therapy advocacy groups (Genspect and Bayswater Support Group), and the anti-trans lobby group Transgender Trend, who also campaign against banning conversion therapy for trans people. Transgender Trend who have also been described as a hate group and accused of promoting school bullying of trans youth leading to warnings issued in the educational press.
As context for the inclusion of these harmful organisations, the Gender Exploratory Therapy training advised that “parents and carers should have access to a range of information in order to weigh up what may or may not be fit or be helpful”. Although they deny endorsing any of the organisations that they list, it is difficult to see this as anything other than a suggestion to child psychiatry trainees that they should direct parents to consider conversion therapy and anti-trans resources as potential options."

It is predicated on the fact that gender dysphoria is not a mental health issue.

Exactly.

I really can't think of anything else that needs medication and specific adjustments in education and the work place that isn't a mental or health condition that needs medical diagnosis.

Horton begins her "peer reviewed paper"* with the words "trans kids..." from the outset.

*peer reviewed by others who fully believe.

I don't understand why the public are being consulted on clinical / medical decisions that should be based on rigorous data & medically ethically sound evidence?

One point I would make, is that medical professionals, even those with an interest in medical ethics, aren't necessarily "experts" beyond other people when it comes to ethical questions.

This highlights the problem that is still present, even in the new policy. It is predicated on the fact that gender dysphoria is not a mental health issue.

Really? I thought that gender dysphoria is still recognised as a mental health condition, but transgender identity isn't.

Now I'm not sure I agree with that, but it makes a certain amount of sense that hypothetically you can have a "gender identity" without it causing you distress or being a problem. Not every false belief is a mental health issue.

@PorcelinaV

There are actually quite a few "traditional" mental health issues that don't have strict diagnostic criteria, but rather are judged against the distress they cause, how much it prevents everday activity, and some are even judged relative to "normal" behaviour in society.

On this basis, gender dysphoria need not necessarily be a mental illness, even though the underlying belief (that one has a different sex than that of their body) is mistaken.

I agree that having a transgender identity isn't a mental health illness per se. It's part of having a belief in gender identity. I don't have a belief in it but others do, and that's OK.
However, wanting to change your body to match this belief should be treated as a mental health condition IMO.
As for the NHS..... Unfortunately it does indeed make their position very clear that gender dysphoria is not a mental health illness. From their website in the overview section under gender dysphoria:

https://www.nhs.uk/conditions/gender-dysphoria/

I suppose it could be compared to things like ADHD which is also not a mental illness but is medicated?

two conversion therapy advocacy groups (Genspect and Bayswater Support Group), and the anti-trans lobby group Transgender Trend... who have also been described as a hate group and accused of promoting school bullying of trans youth

I really, really hope those organisations threaten legal action for that libel.

Mermaids hate cats, I heard they eat cats. There we go, Mermaids are now an organisation who've been described as a hate group and accused of eating cats.

They have to smear anything other than full obedience, don't they?

For me the line is crossed when the treatment that is proposed is to a) change the balance of natural hormones within the body so that complications arise e.g. osteoporosis, womb atrophy and b) remove healthy sex organs. All with no evidence base that it actually alleviates the distress in a sufficiently high percentage of cases.

ADHD treatment doesn't have that kind of impact.

Instead, it should be managed like other body dysphorias, such as anorexia. The point at which it deviates is that in a very very very small number of cases, hormones and/or surgery would be the only answer, after all avenues of a neutral (not gender affirming) therapeutic approach are exhausted.

I agree. I was just trying to think of a condition that is not considered an illness but still medically treated.

I have a DC with OCD which is treated similarly to BDD. One thing that is very important with OCD is you do not affirm or accommodate their obsessions and compulsions (lot easier said than done) as these make them worse.

OK thank you. I don't really understand why the NHS would take such a position.

Dysphoria would imply distress, and distress over your normal healthy body sure looks like a mental health condition to me.

Oh that's good, thanks for clarifying I'd understood the previous article on here about this that it has been approved and waved through.

I will look up more information, I really do hope for the sake of vulnerable young people more safeguarding is discussed and agreed for future.

Last month, the originator of the controversial “Gender Exploratory Therapy” approach which rejects the gender affirmative therapy model celebrated being hired as a new Education Lead by Great Ormond Street Children’s Hospital.

Anastasis Spiliadis

Well that appointment looks like rather good news!

mainstream trans support charities Gendered Intelligence and Mermaids,
"Mainstream" is whatever you allow in. Do I get the feeling this self-styled "Safety Network" are upset that they can't gatekeep any more?

Transgender Trend who have also been described as a hate group
By people who don't know the difference between disagreement and hate. Bless their paranoid little cotton socks.

As context for the inclusion of these harmful organisations, the Gender Exploratory Therapy training advised that “parents and carers should have access to a range of information in order to weigh up what may or may not be fit or be helpful”.

They seem so afraid even of balance,. How dare anyone recommend any organisation that doesn't sing their tune? They can call themseves a "Safety Network" but one-sided does not mean "safe" as Hannah Barnes found at the Tavistock GIDS.

I suppose it could be compared to things like ADHD which is also not a mental illness but is medicated?

It's more often not medicated amongst the children I teach as the medicine isn't necessarily always helpful. So comparisons there really should be taking in wide perspectives.

Also, adhd medication isn't permanent.

Environmental factors (specific approaches and teaching self regulation and self awareness/management) can help plus a good OT programme and a lot of understanding.

I've seen larger improvements in children who are 'passive' and struggle uk concentrate who are medicated than the "hyper" type. It also doesn't always seem to last; I feel they're often having meds tweaked or coming off them, due to not working or the child grows and seems to change too much for meds to be effective.

Yes, this seems absolutely awful to me - conform or be told you don't fit your whole life (unless you change your body to make it 'right').

Really important that whatever your view on the public being consulted like this you fill it in with supportive answers. They have considered not only the scientific evidence but also very dubious "research" that should never have been published.

This is not discrimination against trans kids, this is protecting them from people who should know better.

My young trans relative has permanently damaged health, as has their trans partner. We need to protect children and young people from those who would harm them while claiming to be supportive.

If anyone is still planning to respond to the consultation, this article is worth a read IMO:

https://grahamlinehan.substack.com/p/all-eyes-on-the-nhs

Graham Linehan seems to have a better understanding of the medical issues than the ideologues in the NHS.

The ideal outcome for any patient suffering distress about their sexed body is that they learn to live happily with the body they have. As it’s not possible for them to change sex, the best that hormones and surgery can achieve is a superficial resemblance to the opposite sex, at the cost of permanent damage to physical health.

Nobody should have treatment to change their body until after proper and prolonged psychotherapy to address the roots of their distress.

(Obviously the fetishists don’t need psychotherapy, but they don’t need the NHS to fund their jollies either).

The ideal outcome for any patient suffering distress about their sexed body is that they learn to live happily with the body they have.

Yes, certainly for kids we should still be looking at whether therapy can help them recover. We should basically be trying to "convert" them, not have them go on a "gender journey".

If it persists and they want surgery as adults then so be it.