Update on NHSE and cross-sex hormones for children

[Signalbox]

Update from Hannah Barnes. Not good news.

https://threadreaderapp.com/thread/1770913390896070658.html?utm_campaign=topunroll

NEW: NHS England has announced that new youth gender services will provide masculinising and feminising hormones to children from ‘around their 16th birthday.’ This goes further than GIDS ever did: YPs cld only access hormones at 16 if they’d been on puberty blockers for 1 year.

Just last week, it seemed that the new services would have no medical pathway, with NHSE ending the routine prescription of puberty blockers. Today’s announcement, which was not put out to consultation, appears to signal a move in the opposite direction.

NHSE says it’s considered whether ‘scientific research has shown the treatment to be of benefit to patients’ & if it represents best use of NHS resources. Three documents have informed the policy, dating from 2013, 2016 & 2018 – two apply to adults only.

But there’s no mention at all of NICE’s 2020 systematic evidence review which concluded that for use in '18 years or under' hormones were not cost effective and there was uncertainty over their safety...

“Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria." Seven studies informing the review appear not to have been taken into account by NHSE

Children who are experiencing ‘psychotic episode[s], drug addiction or self-harming’ will be eligible for hormones, as long as the ‘associated difficulties… are not escalating’...

‘Ideally there will be support … from one or both parents (the family)/carers, or social support if the individual is a ‘Looked After Child’, and the Local Authority has been consulted.’ Non-binary individuals will be deemed eligible for hormones.

The decision over when hormones can be given will be up to different clinicians in a multi-disciplinary team – just as at GIDS - over an undefined "period of time". The duration of assessment is ‘determined by the clinical team as relative to the needs of the individual.’

While the policy does not appear to have taken into account the NICE evidence review, NHSE says it will ‘consider the recommendations of the independent Cass Review in so far as those recommendations relate to this policy document.’

One safeguarding measure does appear to be in place: "The CYP Gender Service National MDT, that includes clinicians not directly involved in the formation of the individual’s care plan" has to agree that the child is suitable for treatment.

This is madness.
The only hope is that the outcry will be so loud that it'll be stopped. Have the activists over-reached once again out of hubris?
It's also really bloody sinister, who is making these decisions against all the evidence currently available.
Isn't the final Cass review due next month?

Don’t know if that’s been verified but if so it’s all in line with international (conservative) best practice.

https://m.youtube.com/watch?v=vCRLcFHivmo&pp=ygUIS2FsdGlhbGE%3D

https://m.youtube.com/watch?v=13bOdkil7Io&pp=ygUIS2FsdGlhbGE%3D

This makes no sense at all. If they accept that puberty blockers cause harm to the developing skeleton and brain, surely they must know that, at least for girls, there is a very strong probability that testosterone will do the same.

As I understand it, girls don’t need to take anything to block their naturally produced oestrogen, as testosterone is such a powerful anabolic steroid it suppresses the oestrogen production. Therefore the harmful effects of blockers will still be happening, as female bodily and cerebral maturation doesn't ‘run’ on testosterone.

This is the NHS document linked from Hannah's thread.

https://www.england.nhs.uk/wp-content/uploads/2024/03/clinical-commissioning-policy-prescribing-of-gender-affirming-hormones.pdf

What strikes me is that they don't define what it is that they are trying to treat, or why it requires this particular treatment.

This, from the "Plain language summary" at the beginning of the document is supposed to explain what gender incongruence is.

Gender incongruence / gender dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their natal sex and the gender with which they identify.

Of course it fails to explain anything, because it doesn't explain what constitutes "a mismatch between their natal sex and the gender with which they identify." What is a match supposed to look like, and what exactly is a mismatch between these two different things?

Later on there's a table of definitions, starting with one for gender incongruence.

Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the natal sex in pre-pubertal children. It includes a strong desire to be a different gender than the
assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about two years. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

I think this is copied directly from the NHS webpage on gender dysphoria. They state that behaviour and preferences normally associated with the opposite sex are a part of the diagnosis. So they're still using gender stereotypes as part of the diagnosis, although they have made sure to add that "Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis".

They have added to this a "desire" for opposite sex physical characteristics and "dislike" of their own, so they seem to be saying that a revulsion with their own body is something that suggests that physical treatment to change their body is required. In most other circumstances, a child who hated parts of their body would be referred for counselling or psychiatric treatment to discover why they felt like this and to help them to accept their healthy body as it is.

What are they trying to treat? What are they trying to achieve with this treatment, since it is impossible to change sex? Why are they treating mental difficulties with irreversible and damaging physical interventions?

What are they trying to treat? What are they trying to achieve with this treatment, since it is impossible to change sex? Why are they treating mental difficulties with irreversible and damaging physical interventions?

Only a few of the studies included looked at mental health outcomes at time of follow up, and they found no effect of hormones when controlling for engagement with counselling services.

This is utterly batshit. I am so angry.

This makes the court case to challenge the fast-tracking of 16 and 17 year olds in to the WPATH-aligned adult pathway even more significant. The appeal hearing (to have the case heard) is on Tuesday.

https://www.mumsnet.com/talk/womens_rights/5030198-imminent-court-case-16-year-olds-being-fast-tracked?reply=133825203

From X, this is one of the mums bringing the case:

https://twitter.com/Wayward_sestra/status/1770954803528560953?t=5WgytN0LTksQ4NO0RRd-nA&s=19

Barking at the moon mad. They just don't care and no one is stopping them.

What can we DO?! I feel the need to do something! This is so wrong.

I am a psychiatrist. I cannot believe what I am reading. Giving puberty blockers and hormones with serious longterm sequelae to psychotic children? To what end? I cannot imagine the GMC would just sit back on this, surely? And what about the civil litigation? Are these doctors really going to claim that a responsible body of professional opinion would prescribe these medications under those circumstances? I can't see how.

Many have been working very hard to ensure there's an "evidence base" with dodgy biased studies.

follow the money, and worse.

Any child who isn't conforming to prescribed stereotypes by the age of around 16 will be offered a choice of whatever hormones they fancy.

This seems like the most extreme end of WPATH SoC. Did they mention eunuchs?

What's going on?

When NHSE made the announcement about puberty blockers, I thought that it was probably because it knew what was coming in the Cass Review, and decided to get ahead of it. Now this announcement. Does it mean:

a) Cass is going to recommend cross-sex hormones for 16-17 year olds
b) NHSE doesn't know what Cass is recommending and so has made this decision unilaterally
c) NHSE knows that Cass will recommend 16-17 year olds don't receive cross-sex hormones and therefore is deliberately flouting it?

Hopefully this will shift some people in key positions who have been wanting to speak out in to action.
🤞🤞

We can all do our bit, even anonymously, raising awareness. It's the people in positions of influence that can do more - politicians, senior healthcare workers, newspaper editors, Tim Davie and his equivalents at ITV and Channel 4 etc.

The information needs to be in their hands, with a clear articulation of what's at stake. It needs to cut through the ambivalence or Be Kind layer so that it's being heard. Some will respond to direct facts, some will baulk at that and see it as hateful (so won't listen). Some will respond to a "softer" way in, some will see that as irrelevant fluff because it's more important to be kind. The message needs to be out there in lots of different ways so that it lands.

Also, there must by now be more Roisin Murphy types lurking in the world of celebrity. Hopefully some of them feel suitably concerned to step out of the shadows, use their voices and amplify the message.

My money is on c.

There are too many influencial people in the NHS who have some kind reason to keep this going. When GOSH was called out on its proposed approach to being a regional centre for the devolution of GIDS, it was clear that they were circumventing Cass. It was also at about this time that they were having training delivered by one of the trans lobby groups. Global Butterflies I think, from memory. There are threads on all of that to confirm but I think I've got the basics right.

There's money to be made in long term prescription of medication to individuals - and just think of all the additional medication and surgery they will need as they age.

Our children exist as a means of making money/profit for others now - there is little interest in them having a healthy drug free future.

I agree. Can’t wait for a flood of detransitioners’ court cases. I just wish the genderists would give up before destroying any more young lives and bankrupting the NHS.

This is also linked to the whole mess. Apologies if its already mentioned up-thread and I've missed it. There's a lot unfolding in this particular part of the gender identity stuff ATM:

https://twitter.com/hannahsbee/status/1771054209645019290?t=KG278LzHqNGUcXAy2xsA0w&s=19

Direct link to the article for those not on X:
https://www.newstatesman.com/politics/health/2024/03/inside-the-collapse-of-the-tavistock-centre

These children are being so badly let down 😪

Talk about throwing petrol on a bonfire. Who on earth thought this was acceptable?

This Nottingham? Who are still hosting a link to WPATH SoC v8, the one with the links to the Eunuch Archive?

https://ncth.nhs.uk/other-gp-guidance

'staff assaulting patients' - hold on, wtf?!

(edited for 'assaulting' not 'attacking')

https://www.bbc.co.uk/news/uk-england-nottinghamshire-68436610

Crikey! The bit about the Nottinghamshire Trust’s service reports of staff assaulting patients and falsifying records. What’s going on there I wonder? Sounds like they are throwing this cohort of young people to the wolves!

Thanks. Cross posted.

This news story completely passed me by!

Sounds like they are throwing this cohort of young people to the wolves!

It does, absolutely.

In that link, there’s an information sheet on taking ‘feminising’ hormones listing side effects of not being able to achieve a full erection (so no more sexual pleasure) as well as permanent infertility. The latter remains even if the boy/teen/man stops taking oestrogen. It then goes on to include this statement at the bottom: I confirm I understand feminising hormones are not licenced for the treatment of gender dysphoria, however I am happy to receive this treatment.

How is it ethically possible for health care professionals to prescribe non licensed medication that results in permanent infertility and loss of sexual function to 17 year olds?! For a ‘condition’ that is highly contested and evidence of being a temporary phase. What happened to do no harm?!