New children's gender identity clinic, clinical trials and Cass

[VegasVagabond]

I'm a regular here but have named changed.

I have come across an advert for a psychologist at the new GI clinic for children in Nottingham. I am concerned that the advert says that the psychologist would be supporting children on 'gender affirming pathways' for children receiving hormones under endocrinologists.

My understanding had been that children should no longer be 'gender affirmed' or given puberty blockers and that psychological support should be exploratory to understand the child's context and wider needs?

I also thought clinical trials had not been agreed and were unlikely to be agreed?

Does anyone have any clarity on the current situation in terms of medical pathways, the new clinics, psychological support and the clinical trials?

Here is an extract from the job advert:

Job overview

Due to the development of a new young people’s gender service, there is an exciting opportunity for a Clinical Psychologist (Band 8a) to join The Nottingham Young people’s Gender Service (NYGS) at the forefront of delivering care and support to young patients. You will receive in-depth training and clinical supervision whilst working with our experienced nurses and MDT within a forward thinking and supportive NHS Trust.

NYGS are recruiting to a new team comprising Consultant Psychiatrist, Paediatrics, Advanced Clinical Practitioners, Clinical Nurse Specialists, Psychologists and Research assistants. You will have the opportunity to work with a progressive team leading the way nationally and international in children and young people’s Transgender Health.

NYGS is a multi-disciplinary service offering psychological support to young people on the gender affirming medical pathway and looked after by the adolescent endocrinologist service, some of them will be awaiting to or prescribed hormone blockers or hormones by the NHS following an assessment by the Gender Identity Development Service.

Main duties of the job

The new service will provide multi-disciplinary care and support to young people aged from 11 to (and including) 17 years old who are about to receive or currently receiving gender affirming medical treatment from the Specialist Paediatric Endocrinology services (SPES) which is the endocrinology arm of the Gender Identity Development Service (GIDs) which will be closing on the 31st of March 2024.
This new service (NYGS) service will work to NHS England’s published interim service specification for specialist gender incongruence services for children and young people (Interim Service Specification).
NYGS will sit within the established NCTH Network which provides the Nottingham Centre for Transgender Health Adult Service, the East of England Gender Service, the Linked Clinic activity with Indigo Gender Service and the Linked Clinic activity with the Sussex Gender Service.

https://www.telegraph.co.uk/news/2024/10/18/nottingham-gender-clinic-trans-cass-report-tavistock-wpath/

Archive…

https://archive.ph/MSz40

Well done OP for spotting this.

Dr Walter Pierre Bouman, a senior doctor at the Nottingham Centre for Transgender Health and past president at WPATH, described the review as “poorly reasoned”. He added that there was “a fine line between naivety, narcissism and psychopathy”.

This is an incredible admission Dr. But do please explain how it was 'poorly reasoned'.

Some suggests that the demand for affirmative care' will lose power and momentum if/when medical insurance providers are forced to commit to providing life long cover for medical needs arising post provision of 'affirmative treatment', including treatment for detransitioning and side effects such as vaginal atrophy. It's believed that if/when this is brought into the legislature in the US, insurers won't fund and 'affirmative care', the money will dry up for those who drive the WPATH specification, and once the gravy train disappears, so will the lobbying.

Signalbox - thanks for the Telegraph piece. Good to see these issues being covered. Good to see MN FWR concerns and MSM converging at times.

This is interesting.

It's so frustrating when people caught up in this refuse to have any curiosity about how we've got to the current mainstream position on trans rights.

To me it seems so obviously US driven, because one rarely encounters a pro trans ideology stance that doesn't misunderstand the feminist position on gender. It's always a binary choice between religious right wing gender stereotypes and post modern "left" wing gender stereotypes. Just like US politics. No understanding that one can, gasp, believe both viewpoints on gender are harmful for women and centre males.

It's an extremely concerning indictment on the critical thinking skills of so many adults when you have, for example, the Green Party, willing to destroy itself over an ideology so inherently capitalist and anti environmental.

I agree. As soon as it starts costing money rather than making money the pharmaceutical industry, insurers and healthcare providers will re-evaluate.

In England I hope the Ritchie Herron case will make the NHS think again.

If they don't have mental health needs and their body is physically healthy, what are they trying to achieve with the body modifications?

I agree with Brainworm. For the same reason that people need support with

• plastic surgery
• major life transitions like bereavement.

There are people whose distress is located in (say) a disfigurement and it's generally accepted that plastic surgery or removing the disfigurement is not sufficient of itself, somebody may need support to come to terms with their new reality.

Even cosmetic surgery is supposed to involve pre-screening and follow-up support (may vary with scale of the intervention).

Good work by the Telegraph in holding their feet to the fire here. It’s hard to believe an old ad was used in error given this has been such a high profile issue in connection with the treatment of gender identity issues.

I wonder how many children in the UK are still on puberty blockers or cross sex hormones. It makes me sick to think of it.

So what are they trying to achieve with the body modifications? Your reply only makes the case for therapy as well as (or instead of?) body modification.

I wasn't asking whether they needed therapy. I want to know the reason for body modification in someone whose body is healthy.

Like autism, many with the diagnosis feel very strongly that it is just a natural variation within the species and should not be pathologised. Often, the distress that typically comes with the 'condition' is framed as being caused by society being designed with just 'normies' in mind.

Are you really seeing a parallel between autism and someone who thinks their sexual organs are 'wrong' or one of their limbs doesn't belong to them?

Surely if someone truly believes they should have one of their limbs amputated or that their sexual organs are 'wrong', this is not 'natural variation within the species', it's pathological. How is this feeling of the body being 'wrong' caused by society?

As the Cass Review says there is also no/ little evidence that psychological therapy can cure gender dysphoria either.
Not all gender dysphoria can be explained by depression or autism and not all children grow out of it.

Also not all research can have a control particularly where it’s not ethical. That doesn’t mean you don’t do the research. There are just more cautions when it comes to interpreting or generalising from It.

Great post ⬆️⬆️⬆️

Wow. That's a phenomenal article. Thank you for sharing.

(Am currently catching up on this thread. There is some great stuff from PPs above too about "if it's not a mental health issue, what is it?" vs "if it is a mental health issue, why is the recommended treatment physical?")

Agreed.
The other clues are that many of the supporting materials for "gender affirming care" and trans rights use US language somewhere within them, even when used within UK documents e.g. in NHS leaflets. Use of "bathrooms" and "mailman" for example. Mailman was used in a recent (awful) LGBTQ leaflet about how the removal of cancerous parts of the body could in fact be "gender affirming".

It is hard to believe. The advert is still live so clearly they aren’t that bothered.

Not all gender dysphoria can [yet] be explained by depression or autism and not all children grow out of it.

At the moment, the crossover with known co-morbidities is probably 97.5% (screenshot below).

The therapy book about young people with gender dysphoria written by Sue and Marcus Evans is a really accessible read. I think we'd end up with near enough 100% of cases being explained by other underlying factors if the neutral therapeutic care that they advocate for was properly put in place.

During their time at the Tavistock, the Evans did oversee some children transitioning, but it's clear from both their whistleblowing and their interviews with Benjamin Boyce and Andrew Gold (I think only Marcus has done an Andrew Gold interview) that they would likely welcome a challenge to physical medical intervention in its entirety. For example, Marcus said in the Andrew Gold interview that he didn't think that it would be possible to have an ethical trial for puberty blockers.

In their book, they draw a parallel between gender dysphoria and anorexia, where it's clear that the latter isn't treated by modifying the body to settle the distress. This is the book:

https://firingthemind.com/product/9781912691784/

BonfireLady · Today 14:12

In 2006, Ms Shuping said she found a psychologist willing to pour drain cleaner in her eyes to help her fulfill her wish to become blind.
The psychologist reportedly first poured numbing eye drops into each of Ms Shuping’s eyes, followed by two drops of drain cleaner.
Ms Shuping told the agency the process was extremely painful and that took around six months for the damage to fully take effect.
The psychologist was not named and it is not known if they are facing prosecution.

I mean, you fucking what?!!

Brilliant thread and thank you to everyone for sharing so much expertise.
I was interested to read Dr Cass commenting about "extremes" on both sides in terms of pressure on her and have been musing about what she meant. I assume she's reflecting the unhinged "political" pressure from transactivists on one side versus those appalled that the NHS is involved in any way with sex changes for children and young people?
It seems like she's unravelling this massive knot, one strand at a time. It's taking such long time but it does appear that numerous medics are now retreating or speaking out and that, despite all the bad faith allegations against her, there's slow and steady progress in centring children's needs rather than trans extremism.

Has anyone actually tried to use therapy to cure gender dysphoria? Do sufferers want to be cured?

@Brainworm said that "many with the diagnosis feel very strongly that it is just a natural variation within the species and should not be pathologised". This seems to imply that they don't want to be cured. The comparison with homosexuality (which is implied by adding T to LGB) also implies that it's not something which needs to be cured, as the cure would amount to conversion therapy.

So is gender dysphoria a pathological condition which needs a cure or is it natural variation (like homosexuality) which is not pathological?

If it's not pathological, why does it need medical treatment?

I wasn't asking whether they needed therapy. I want to know the reason for body modification in someone whose body is healthy.

You can be healthy overall and disfigured or have a visible difference that affects the way that others treat you. Some experience distress that can be alleviated by an intervention such as body modification. Others practise self-acceptance or arrive there over time.

Many of these stories are about people with a congenital or acquired condition and their experiences. For some, the interventions did have an intention to reduce the visibility of a condition.

https://www.changingfaces.org.uk/real-stories/

https://www.savingfaces.co.uk//news-media/patient-stories/

If it's not pathological, why does it need medical treatment?

Because there has been an expansion into considering the alleviation of distress or the social model of disadvantage as a sufficient justification for medical treatment? This example involves a young woman who opted for leg-lengthening surgery. From the report and the various follow-ups over the years, she didn't have a pathology that underpinned her short stature.

https://www.dailymail.co.uk/health/article-138865/I-longed-air-hostess--I-legs-stretched.html

There was no medical need for the NHS operation but orthopaedic surgeon Dr Darren Fern decided to go ahead after a psychiatric evaluation.
https://www.dailymail.co.uk/health/article-136909/Girl-growing-dream-job.html

It seems like she's unravelling this massive knot, one strand at a time. It's taking such long time but it does appear that numerous medics are now retreating or speaking out and that, despite all the bad faith allegations against her, there's slow and steady progress in centring children's needs rather than trans extremism.

I think you're right MrsO

(I'm looking forward to the day when Baroness Cass and Baroness Nicholson can openly combine their thoughts from their respective different angles.... judging by Baroness Nicholson's latest genius open letter to Butlins, that would pack some punch! For now, strand by strand will do just fine)

I can't see the similarity between your examples of people with a visible physical difference and people who just want to mimic the opposite sex.

Your examples are not about treating a mental condition with a physical treatment.

I know there's quite a bit of criticism on here about her buying into gender identity in the report. But it seems to be essential. This is a fragile ideology, based on shifting sands with some very mentally unwell people caught up in it. Sticking with a determinedly respectful approach, accepting some of the basic tenets has allowed her to focus on the core of this - the lack of evidence and data and the harm this appears to pose for children and young people.

It's allowed this government to clearly support Cass that a more assertive challenging approach "taking on" some of the activists and their assertions might not have allowed. It's an almighty mess and while we need the blunt clear speaking that many women on here and others adopt, her approach has allowed thousands of medics to speak out in support (thinking of the BMA debacle) in a way that I suspect wouldn't have happened without her calm authoritative approach.

I recall reading something by Helen Joyce where she was musing on the fall out from an interview where she refused to call a transwomen she and had pissed off a commentator who regularly called out trans extremists but thought she was rude because of this. She was wondering whether at times she needed to "play the game" in the interest of moving discussions on (I think the one she was in got brought to an abrupt end because of her refusal). I don't recall her final conclusions but it made for interesting reading given that she's always so clear.

Sorry to digress .....