NHS to open detrans clinic

[fromorbit]

Amazing news:

NHS to launch first service for trans patients wanting to return to birth gender
Cass Review found children were being hurried down pathways involving powerful drugs and medical interventions

NHS officials said the next step was to “define an NHS pathway for those individuals who choose to detransition” because currently no guidance on how to care for them exists.
The health service said: “There is no defined clinical pathway in the NHS for individuals who are considering detransition. NHS England will establish a programme of work to explore the issues around a detransition pathway by October 2024.”
It said this would include examining the rate at which patients detransition and their reasons for doing so, as these are currently unknown, and would recognise “that individuals who choose to detransition may not wish to re-engage with the services they were previously under” as per the recommendations.

Dr Cass said a lack of long-term data made it impossible to know how frequently people detransitioned, although anecdotally it was “increasing”.
The lack of long-term evidence was also why the review said puberty blockers should not be prescribed outside of a clinical trial.
That trial is now set to begin from early 2025, the NHS confirmed, with the first patients enrolled from April next year.

https://www.telegraph.co.uk/news/2024/08/07/trans-first-service-detransition-cass-review-birth-gender/

This is good news, but I heard a few days ago that they were going to open six gender clinics for young people!

Yes, exactly 🤨

I hate it too. It fills my heart with such sadness every time I hear the horror stories of people who were rejected and harmed by parents who caught Rapid Onset Online Transphobia, and they're still so bleakly common. It's such a devastating thing to have to do and I'd desperately urge anyone considering it to try and find a way to reconcile with their parents if at all possible. Sometimes it's possible, after deradicalization, to recover that relationship but it's extremely difficult and requires immense willpower on the part of the victims. I'd advise always leaving the door open, but really it's up to the parents themselves.

And in the future we will be able to help people detransition by telling them to change their jumper or take off their nail varnish.
Because that's the most we should allow people to undergo.

It is shocking the lies that have been told to convince innocent people that surgery and drugs was a good idea.

It's certainly tantamount to admitting the power of the anti-trans healthcare lobby

Which people and organisations pushed children into transitioning?
I recommend you talk to some detransitioners.if you want details.

By emotional manipulation, do you mean warning parents suffering from Rapid Onset Trans Panic that trying to stop young trans people from transitioning due to trans-hostile ideology won't actually prevent them from doing so - it is just an extremely effective way of driving them away and going no-contact once they hit 18, then spending the rest of their lives decrying the people who could have saved them enormous suffering and expense?
I mean parents being told that their children would commit suicide if they were not allowed to "transition". These children had problems which were not addressed and instead they were funnelled into a one-size-fits-all treatment pathway.

There is no "trans-hostile ideology". What you are railing against is compassion, medical ethics, evidence-based treatment and common sense.

By unrealistic expectations - do you mean the collective grief freely shared by the trans community over the limitations of current treatments?
I mean - for example - being told that they would be accepted as people of the opposite sex; that surgically created prosthetic sexual organs would look and function like the real thing. I should have added - that the seriousness of surgical procedures like double mastectomies, penectomies and orchidectomies were downplayed.
You admit that the community knows the limits of the surgeries and the effect of cross-sex hormones and puberty blockers. I think this means the community should have urged caution.

I do agree that in a properly equpped and funded health service uniformly staffed by professional, consistent and conscientious staff who are able to comprehensively support their patients, the notion of coaching young people on the gotchas used to trip them up and deny them treatment would be unnecessary.
All patients, especially young patients, should be assessed properly and treatment based on clinical need and suitabllity.
Gate-keeping significant medical and surgical interventions is essential and ethical. You admit that kids and young people were coached in how to bring about a specific outcome - to get a course of treatment which has not been shown to be effective and has been shown to cause harm.

A detrasition clinic would surely suggest that that is possible. Can you grow back breasts? Reverse removal of a penis? Reverse the effects of cross sex hormones? Have a puberty after it was stopped? Reverse bone damage?

It will be interesting to see levels of demand. And whether this demand increases over time. And whether detransition is more common after taking a private transition pathway.

Acknowledging the need for a detransition clinic and therefore legitimising detransition, is great in its own right.

If there is no demand, then the service won't last long.

Why would anyone trans have a problem with this?

Well I don't think that's true. I think it will have a different position in that it will be able to gather data on poor practice...

I don't understand what you want? You think all children should be able to go straight down the medicalised route but you don't see that as them being wrongly 'pushed'? Don't you think they should be having therapy to see if they have MH issues, Autism, are being bullied, body dysmorphia, a fear of being gay or any other reason that might make them wrongly think they are trans? Or would you consider that 'conversion therapy'? You know that up to 94% of gender dysphoria cases resolve on their own or with puberty?

How do you suggest the genuinely trans kids are teased out from the large majority that aren't and will grow out of it? Do you think they should all be medicated regardless?

I think it's awful that detransitioners even exist OP, they obviously should never have been able to go down the path of transitioning in the first place. The impact on their life may be enormous if they've had surgery and or cross hormones. It's a huge mess IMO.

Butterfly is one of those who has transitioned, Nothingeverything, and he/she is coming at this topic from that angle.

That doesn't make current transition rates any more medically justifiable but it may explain the tone of the post.

It's great but I do have mixed feelings about the way this has been framed. A lot of the people who have been wrongly transitioned either can't or don't want to "detransition" because there is no physical way back, reconstructive surgery is incomplete and can be retraumasting, and sometimes also because they are just fed up with the whole gender identity business. But they may still need a lot of help for their health and for their psychological wellbeing.

Really it should be framed more broadly than just "detransition".

I'm coming at this topic from the angle of someone who transitioned as a GIDS patient decades before it became a culture war headline-driver, and has thus been in a position to observe the trajectory of this entire saga from its early days.

Yes; and you are therefore not typical of the current batch of mostly female, mostly teenage, mostly neurodiverse transitioners.

There are those being caught up in transition who will not, long-term, benefit from it. So they need help during detransition. Some of my favourite young people may well benefit from this clinic in future.

Not every young person is you.

The way nonlinear gender-affirming care needs have been treated in the press is absolutely atrocious. There are small numbers of people who experience surgery regret or (these are two different things) wish to entirely 'detransition' (effectively transitioning a second time). They need to be taken seriously, listened to and given space to continue their own extremely personal journeys, rather than turned into a divisive political football. They should be able to get support from gender clinics that are actually able to do their job and are currently being failed just as badly as the rest of the population who are experiencing gender incongruence.

It's infuriating - and so bizarrely self-defeating - to see the damage that has been done to the clinics that should be sufficiently resourced that they can take complex, nonlinear journeys in their stride.

@ButterflyHatched did you ever make your mind up about whether a 12 year should be allowed to take cross sex hormones if they met all the tests below?

1. Are they actively and directly asking to be?
2. Have they done so consistently and coherently for an extended period of time?
3. Are they able to describe the long-term, permanent implications of doing so?
4. Have they demonstrably reached Tanner stage 2 at an appropriate age?
5. Have they been on a course of GnRH agonists for at least a year's 'cooling off period' since the initial request

One of the terrible pressures put onto Ritchie Herron is that he was threatened that if he didn't transition surgically he would lose the support of his gender therapist. He was older than a child but mentally extremely vulnerable.

Thanks all for your responses.

I completely agree that those detransitioning have been let down by those who should have properly supported them, now we are understanding what 'proper support' really means.

And my heart aches for those whose hopes may be raised that the harms they have suffered may be reversed, when sadly it may just be about support, monitoring and important data collection.

It's so incredibly dependent upon the individual young person's needs that I would never want a uniform, axiomatic approach without very, very careful evaluation. 12 seems extremely young to embark upon the less-reversible parts of this journey (puberty, whichever way, isn't fully reversible after all), especially since it's still well within the window covered by normal delays. I'd be most comfortable advising blockers until 14 and then evaluation for CSH if persistent incongruence remains from there?

No, there is no "transitioning a second time" for these young people. I am not going by the press but what they say for themselves.

Can I ask what you mean by "puberty, whichever way". I'm not sure if it's slightly odd phrasing or whether you are saying there's more than one way to go through puberty.

Yes YABU. People dont usually do this stuff for fun - they come to it because they are desperately unhappy. As humans we are really bad at knowing why we are unhappy and what is best to do about it. Every generation there is a new fashion to explain our unhappiness - at the moment it is gender. It is not the fault of these vulnerable people that they fell down that rabbit hole.

What do you consider to be effective healthcare for people expressing gender distress?

You talk about placating an unevidenced minority - what evidence do you consider necessary to confirm the existence of detransitioners? What evidence do you consider necessary to confirm the gender-distressed individual's claim to be the opposite sex? Do you consider that such individuals deserve treatment with well-evidence medical care? If so why aren't you up in arms at the substandard treatment these people receive compared to others receiving medical care, considering how poor the evidence is concerning gender-affirming treatment?

Have a look at what this detransitioner has to say about herself and her experiences. A young woman who was allowed to make irreversible decisions about procedures that would cause permanent, harmful changes to her body - while she was still too young to legally buy cigarettes. I wonder why cigarettes are are-restricted? Could it be anything to do with the fact that they can cause permanent, harmful changes to the smoker's body?

^For Hineman, the whole project of gender identity was “kind of like a punk thing,” she says. But rather than sex, drugs, and rock and roll, it was just drugs. And surgery. “It’s a medicalized version of normal teen rebellion. And I got completely sucked into that.”
…
Occasionally people assume she’s male, but she’s made a conscious decision to shrug it off because getting “emotionally bogged down about being misgendered” is what led to transition in the first place, she tells me. “I had the realization that I can’t continue to let this bother me in any direction.”
…

Anna also looks back with bafflement that her depression and other medical factors didn’t give providers pause. “I was lost. I was hurting. I was a fucked-up teen who needed help,” she told me.
…
she wants young people like herself, their parents, and the providers who are pushing ideology over good care to know that there are safe and humane ways to address the kind of distress she suffered. “The answers are not just transition or suicide. There are ways to work through these feelings without altering your body,” she says.^

https://www.thefp.com/p/how-did-planned-parenthood-become?r=615mx&triedRedirect=true

puberty, whichever way, isn't fully reversible shit after all

I'd be a bit more sensitive if this utter bullshit wasn't being made up on the spot to argue for child sterilisation.

Puberty is only ever one way.

Puberty is not and never was reversible.

Stop fucking making shit up.