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.

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

Yes. There is no way I'm standing by and letting this happen to my daughter. She's one year old being 16 (she's 15 very shortly). I've kept her from this hideous medical experiment so far and I intend to continue doing everything I possibly can to keep her from it. I can't speak to her directly about it as she shuts me down and I don't want to drive her away but I now have several things in motion. I'm doing it for other girls like her too. I'm just one small cog in a big wheel. There will be others.

I wouldn't rule out b.

I work in an area that overlaps with NHSE to an extent, and they often seem to have a terrifyingly poor grasp of their own role, never mind what's going on in adjacent departments. In their comments on some of our recent work they asked a question that wasn't far short of 'what's the difference between a GP and a hospital?'

Thinking of you and your family, and all this madness affects, BonfireLady.

If the people involved are those listed on the CYP Research Oversight Delivery Board then one of them is Cass.

I'm a little confused because the Chair, Simon Wesseley, is well known for the sustained defence of his/Stone's model of ME/CFS that has always been emphasised the psychological (some of you may be familiar with the GET treatment controversy).

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/

This is perhaps helpful
https://twitter.com/segm_ebm/status/1770980220595511503?s=43&t=X2j42I64FXBoZI9k7qDelA

Thanks. The tweet:

'Earlier today,@NHSEngland
posted an updated cross-sex hormones (CSH) policy for minors. It is SEGM's supposition that the CSH policy serves as an interim update to "sync" it with the PB policy. Previously, the CSH policy required PB as a prerequisite step. Now that PBs for gender dysphoria (GD) have been decommissioned, this requirement no longer makes sense, and it has been appropriately deleted in the updated CSH policy. The updated CSH policy also made some other changes. The policy no longer contains the language of "assigned at birth." Further, the previous footnote which had stated, "It is currently most appropriate to refer to people’s assigned sex at birth rather than saying natal or biological sex" appears to have been removed. Notably, the updated CSH policy no longer references WPATH Standards of Care (either version 7 or 8). However, it does reference the Endocrine Society's 2017 guidelines, which are currently undergoing review. The updated NHS England's CSH policy acknowledged that it "did not substantially change the access arrangements of the original policy." It also noted that it will be revised once new evidence becomes available, explicitly referencing the final Cass review due April 2024.@segm_ebm
will be analyzing both the PB and the CSH announcements from@NHSEngland
and will post our analysis shortly. In the meantime, it is our conjecture that the CSH policy may undergo further revisions once the final Cass review is published. The absence of any reference to the CSH systematic review (which was conducted by NICE in 2020) is perhaps the single strongest indication that this is not the final policy.'

it is our conjecture that the CSH policy may undergo further revisions once the final Cass review is published. The absence of any reference to the CSH systematic review (which was conducted by NICE in 2020) is perhaps the single strongest indication that this is not the final policy.'

Hmmmm. Obviously that would be a small chink of light in what is otherwise a gaping dark chasm of shit. However, I'm sceptical. If it was only ever interim, why isn't it a draft consultation? That would allow space for everyone who needed to pass feedback to do so and the Cass Review to follow along and sort it all out. This feels more nefarious than that to me unfortunately.

(and thank you Arabella ❤️ Sadly there are far too many families in this situation, including those whose fears are currently being realised 😪 I'm still at a stage where I think we're just about on the safe side but I still don't know if we'll stay there)

The Nottingham Centre for Transgender Health staff list shows the following entries quoted in full, just for the record - I've bolded key text. WPATH's site is completely down so I can't check their members' list.

Jon Arcelus (pronouns: he/him/his) LMS, GP(T), MSc, PhDMedical Doctor and Transgender Health Specialist
Professor Arcelus, who has been with the clinic since November 2014, is the co-chair of the Standards of Care version 8 (SOC-8) developed by the World Professional Association for Transgender Health (WPATH). He works closely with trans organisations, including Mermaids, Gender Intelligence and Translearning partnership. He is also an Associate Editor of the International Journal of Transgender Health. Alongside this, Professor Arcelus is an Emeritus Professor in Mental Health and Wellbeing at the University of Nottingham, and enjoys travelling in his spare time. As a patient, you may see him for first or second assessments, or when getting surgery recommendations or hormone advice.

Dr Walter Bouman (Pronouns: he/him/his) MD MA MSc UKCPreg PhDConsultant in Trans Healthcare
Dr Bouman, who has been with the Centre since 2007, is the past President of the World Professional Association for Transgender Health (WPATH) and in charge of translating the WPATH Standards of Care version 8 in 25 languages. He is also the Editor-In-Chief of the International Journal of Transgender Health (IJTH), one of the leading academic journals in trans health. Dr Bouman has published widely in transgender health and is the co-author/co-editor of Gender Dysphoria and Gender Incongruence (with Dr Annelou de Vries and Professor Guy T’Sjoen), The Transgender Handbook - A Guide For Transgender People, their Families and Professionals (with Professor Jon Arcelus), Genderqueer and Non-binary Genders (with Dr Christina Richards and Dr Meg-John Barker), and Non-Binary and Genderqueer Genders (with Professor Joz Motmans and Dr Timo Nieder). As a patient, you may see him for first or second assessments, or when getting surgery recommendations or hormone advice. In his spare time, Dr Bouman enjoys travelling.

Sally Robbins-Cherry (pronouns: she/her/hers) RGN, MSc, UKCPregNurse Consultant and Sexual and Relationship Psychotherapist
Sally has worked in Transgender Healthcare for 16 years with the last 12 years being at the Nottingham Centre for Transgender Health.
She works as a lead clinician at Nottingham. Her work involves assessing people for treatments, hormones and surgery, and psychotherapy. Sally has presented nationally and internationally on transgender health and sexuality and is a chapter member of WPATH Standards of Care version 8, and a council member of BAGIS.

I'm currently on the run around trying to obtain medication for a non-sleeping teenager with ADHD and once again it seems it would be easier to access cross sex hormones which can do permanent physical damage to a child, than it would be to access something which is available OTC in the EU and the US.

And then there's this 😵

<a class="break-all" href="https://archive.ph/2024.03.21-221112/www.telegraph.co.uk/news/2024/03/21/pro-trans-website-for-children-backed-by-nhs-investigated" rel="nofollow" target="_blank">https://archive.ph/2024.03.21-221112/www.telegraph.co.uk/news/2024/03/21/pro-trans-website-for-children-backed-by-nhs-investigated/

‘Pro-trans’ website for children given £3m a year by NHS is under investigation. Kooth site accused of directing users to information about hormone use and breast binding

Just been rifling through my inbox looking for my livestream link for the conference 23 March but found a note I'd made that they're not distributing it before 09:30.

https://can-sg.org/can-sg-conference/

I shall be there in virtual companionship with anyone else who is there.

This is encouraging but I shudder at the thought of the protests. Anyhow, I’ve signed up for the livestream. Maybe it can be the start of a counter argument.

This is an insane and wrong-headed decision. We know that giving girls and women anabolic steroids such as testosterone causes severe and permanent damage to their health and fertility. There is no excuse for prescribing them.

The interval music is a selection of unmatched choices.

Opening has been interesting so far.

I've just found this. It's France. I don't know how influential or niche (or evil) the organisation is that commissioned the reports but possibly a hopeful sign

https://www.telegraph.co.uk/world-news/2024/03/23/french-les-republicains-medical-report-sex-reassignment/

https://archive.ph/ApX4Y