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.

MrsOvertonsWindow · Today 17:16

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.

I don't for a minute believe that she buys into it, I'm of the opinion that she was trying her best to appear even handed, for all the good it did her. Had she appeared partial, it would have damaged her and she had a lot of caveats along the lines of more research, of good quality is required.

Sorry. In haste so not sure if this has been posted. I hope share link works.

How the Cass Review has reshaped care for transgender children

www.thetimes.com/article/4ae7f8f1-7c44-42ef-9db2-5b3371379c19?shareToken=748de711e11daf525ff3000913523077

'Palmer said: “It looks very much like the NHS in England is going to be the world leader on producing the evidence base for this particular sector of child gender medicine, including puberty blockers'

Hmm. 'Producing the evidence base' means 'testing out dangerous drugs on children'.

They will have to be open to the possibility that the trial will fail to show that puberty blocking children is a justified “treatment”.

This isn't a disgression at all, it's spot on IMO.

If Cass isn't a true believer that we all have a gender identity, she's certainly got me fooled! I guess it's possible - the whole section of her report that is dedicated to explaining it does read completely differently from the rest of the report. Weirdly, even some TRAs were mocking it (I remember Katy Montgomery being one who did), asking why a child's choice of toy should be used as evidence of gender identity. I'm not sure Katy et al quite understood the irony in that pushback 🤦‍♀️ This section had lots of references to papers written by "gender affirming" researchers, so perhaps she's playing a clever long game and gave a wry smile at those comments? Equally, perhaps she really does believe in it.

I don't think it matters either way whether she's a believer or not. In many ways, it's even more powerful if a believer in gender identity is saying that we need to stop how this is currently being handled and prioritise standard practices of evidence-based healthcare.

I hope you don't mind but I've added this comment to a thread about "language policing", as the Helen Joyce bit was particularly apt for where the discussion is at the moment. The whole thread is good but this would be a good place to start for its relevance:

https://www.mumsnet.com/talk/womens_rights/5185497-jk-addresses-language-policing?reply=139107788&utm_campaign=reply&utm_medium=share

I was elaborating my answer about medical interventions being used in the context of distress and/or for people who are healthy.

You don't find them satisfactory and I doubt I could persuade you otherwise. I assume that we're both engaging in good faith so I shall leave it there.

Here is a link to the BMJ article critiquing the main American objection to the Cass Review (which was a paper written by McNamara et al of the Yale Law School’s Integrity Project).

This BMJ article was mentioned in the Times posted article above but I thought it merited a link of its own in the thread:

Gender medicine and the Cass Review: why medicine and the law make poor bedfellows
https://adc.bmj.com/content/early/2024/10/15/archdischild-2024-327994

Great Article from Hannah Barnes…

https://www.newstatesman.com/politics/health/2024/10/are-nhs-gender-services-disregarding-the-cass-review

Excellent article. Hannah Barnes, when all this is over, you can be proud that you did a sterling job in trying to protect young people from this misguided ideology and from the consequences of lazy and cowardly politicians.

Jo Bartosch in Spiked, though it seems it may be covering the same ground as Hannah Barnes in the New Statesman (I've not read her article yet)

https://archive.ph/MyTiq bypass the paywall

www.spiked-online.com/2024/10/22/why-is-the-nhs-ignoring-the-cass-review/

This popped up on my newsfeed this evening. Adding it to this thread:

https://www.telegraph.co.uk/politics/2024/12/07/nhs-puberty-blocker-trial-activists-cass-review-safeguards/

Archive link

https://archive.ph/jkaIG

I hope they follow the suggestion of having an equivalent trial of psychosocial interventions for those with early childhood onset gender dysphoria.

I’m torn about whether there should be a trial or not. On one level a trial would give us clean answers we could refer to, on another, PBs are fundamentally a bad idea. Certainly this proposed trial should be paused until they know what they’re doing

Yes great idea to have equivalent trial with psychosocial interventions to compare with

A trial just can’t be done.

To do one, it needs to be possible to identify which children will grow up and still wish they were the opposite sex, as opposed to those who would grow out of it if left alone.

It would need to be deemed acceptable by an ethics committee that children will be sterilised, plus all the other harms, particularly in the context of the point above. I don’t see how any committee can agree to that.

And the children/families would still need to be able to consent to puberty blockers, despite the two points above. Which they can’t.

The only way a trial can be done if these three fundamentals are ignored.

It is envisaged that children and young people in both England and Wales will be able to participate in the study with access through NHS children and young people’s gender services. A multi-disciplinary team approach will be taken to identify those children who, with the consent of their parents, may be deemed clinically suitable for consideration of puberty suppressing hormones through the study. Children participating in the study will also continue to receive comprehensive psychosocial support.
The study will measure a range of potential treatment benefits and harms (for example whether puberty suppressing hormones impact in a meaningful way on levels of anxiety or depression, on body image, or brain development) using a range of validated tools, questionnaires and user feedback. Key measures included in the study, and the way data are collected, will aim to bridge gaps in existing research and will also be shaped by engagement with a range of stakeholders, including children and young people referred into NHS gender services and their families or carers.

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/

Trial stil listed on the NHS England CYP Research Oversight page. Ethics approval is supposed to be due this month with recruitment ready to start in Feb. 2025.

Rumours of something about puberty blockers coming out tomorrow, unclear if it's about the trial or more generally.

A multi-disciplinary team approach will be taken to identify those children who, with the consent of their parents, may be deemed clinically suitable for consideration of puberty suppressing hormones through the study.

I wonder how they will identify children who are clinically suitable for a 'treatment' which will sterilise them and may have serious impacts on their physical health and brain development? These are children who at the time of this assessment are likely to be physically healthy and with normal brain development but who wish they were the opposite sex.

How can this get past an ethics committee? Sterilising children and impairing their physical health and mental development because they want to be the opposite sex (which is impossible).

I'm with Clare Page on this latest from Genspect and I find it very concerning that Levi Pay (Sex Matters, previously Stonewall), would reply to her correct assertion that tactics aren't appropriate in child safeguarding, with defence of use of tactics

x.com/nosecretlessons/status/1865493476755779949?s=46&t=WHoOZ_3Kv5G6-FyQuvE0LQ

x.com/soppystern/status/1865684806484295896?s=46&t=WHoOZ_3Kv5G6-FyQuvE0LQ

sex-matters.org/about-us/advisory-group/levi-pay/

Like Lesbian Labour said recently, we used to care about safeguarding:

x.com/lesbianlabour/status/1864810764332404997?s=46&t=WHoOZ_3Kv5G6-FyQuvE0LQ

Ethics committees are always looking for members. I hope they would be vigilant about infiltration by TRAs.

Lets not forget, the original ethics committee in the late 90s declined this approach. They kept going to different ethics committees until they found one that approved it. And then immediately went outside of their own age range.

And that's before infiltration by activists.

That's a really interesting exchange on X. Thank you for sharing it.

There was a discussion on the Supreme Court thread (#3) which talked about the difference between absolutists and gradualists. In this scenario, Clare Page is the absolutist and Genspect/Levi Pay the gradualist. We need both approaches.

I fully agree that it's abhorrent that we need "tactics" in order to prioritise safeguarding but sadly that's the reality of where we are right now. Parents are being reported to Social Services as abusers (citing safeguarding) if they don't affirm their child's gender identity and/or affirm the belief that we all have a gender identity.

Policy makers are caught in the ridiculous position where safeguarding itself has become the battlefront: at one end of absolutism, there's a group saying that parents are a safeguarding risk to their children if they don't affirm and/or let their child "explore their identity" (whatever that means - most parents are happy to let their children challenge sex-based stereotypes and wear clothes etc that express their personality choices). At the other end of absolutism, there's a group (or individuals like Clare and KJK) saying that schools and healthcare institutions are a safeguarding risk to children if they encourage children to "explore their identity" (again, it's unclear what it means but institutions are telling children that they might not be a girl or a boy, depending on their preference regarding sex-based stereotypes).

Safeguarding is lost in a whirl of confusion.

Gradualists like Sex Matters and Genspect are trying to tactically win it back. Absolutists like Clare Page and KJK are trying to forcefully win it back. Each of these different approaches will help.

Resister - I'm horrified by the disregard for child safeguarding. I recognise Levi Pay's political argument for the plurality of voices and approaches.

My anger lies with the success of Press for Change and Denton that was beyond the wildest dreams of those who implemented it.

It's a different take on the premature anti-[X] argument. No individual or organisation wants to be confronted with being captured by a harmful ideology and it can even lead to punishment to have realised the harms. Golden bridges involve face saving for the people who walk across them. I don't like it but I accept that the current face-saving solution would be to demonstrate the implausibility of running an ethical trial.

premature anti-[X]: https://www.mumsnet.com/talk/womensrights/5222295-jkr-on-more-people-accepting-reality-and-rewriting-history?reply=140258649

NB: I've lost my confidence in the ultimate sense and responsibility of people. I would not be startled if the trial were authorised. I'd like to see if there are any special insurance arrangements for HCPs who put forward candidates for the trials and those that take 'informed consent' from the parents. I'd very much like to see the public-facing materials for the participants who are considering trial participation.

ETA: xd with Bonfire

I don't think SM or Genspect want Repeal. That's the difference. And safeguarding cannot be achieved without it. The GRA and PC of GR have to go.

The GRA definitely has to go. Or be rendered toothless, so that it's simply a £5 certificate that affirms someone's belief but changes nothing factual e.g. sex on official documents.

The PC of gender reassignment is already toothless in law. It just needs to be explained better to organisations, once the EA has been tidied up to clarify that sex means biological sex. Someone with the PC of gender reassignment has the same legal rights as someone of the same sex, age and religion (or lack of religion) as someone without that PC. It doesn't supersede any of the other PCs. For example, an adult male who identifies as a woman has the same right to single sex spaces as an adult male who does not identify as a woman. Organisations need to use these existing single sex exemptions much more effectively. It's absolutely proportionate that such a male does not belong in female spaces, services and sports. The single sex exemption is about sex differences (fact), not gender identity (belief).

The GRA's existence and lack of clarity on the EA are the key issues.

It's unclear whether Sex Matters and Genspect have a view on GRA repeal as an end goal or not.

Edited to add: I fully agree that safeguarding cannot be fully achieved without this being sorted.

Don't think we are miles apart, Bonfire. But if both the GRA and PC of GR don't go - ie we keep the latter - activists will just keep on and on. Safeguarding won't be achieved.

Organisations purporting to do safeguarding, get it, or use it to advance their arguments that are not behind this, are now (on a lot of reflection and back and forth, and am I a dreaded Ultra), a red flag for me I'm afraid.