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.

What sort of person is going to take that job? We aren't even halfway through the woods yet.

Yes I thought the same. It's impossible to both produce valid results and be ethical.

By their very nature there will be differences between any group that has physical interventions and those who don't (unless randomly allocated/controlled) which would be deem unethical regardless of you are within the ideology or not.

Which means the medical pathway group will have higher rates of distress, more parental pushing or something which makes them more likely to be chosen for that group. There's no way that group will be equivalent to the less motivated group.

In some ways if the above happens and there is still a high degree of desistance or lack of improvement in mental health markers then that would be pretty conclusive as a result. If those children undergoing the most treatment seemed the most certain then you can draw conclusions about the subjects that were less motivated. Same is true if the unmedicated group do better then the medicated group long term.

Overall though it all seems very difficult to justify unless you believe in the base (impossible) premise of the ideology.

I don't understand why they don't start with more basic studies or meta studies e.h. observational studies where they gather all the tavistock patients from the past or something and use that to work out a hypothesis/informed model for any trials going forward.

I don't understand how medical personal can be aware of previous studies showing harm or lack of improvement from medical interventions but still think that a study into medical interventions can be ethical.

Why not do a trial just on psychological intervention first rather then set yourself up for liability. Do they think we are in some kind of golden age where medical scandals like Dr money, thalidomide, the tainted donated blood issue, just can't happen anymore?

I think @Cerialkiller is right and it’s that kind of psychological intervention trial, perhaps with more analysis of existing data, that they’ll set up to kick this into the long grass. Whoever said early in the thread that this BBC piece may well be a sign of the wind turning in that direction, I reckon that’s likely. There’s got to be a search for ways out now.

Its just like the sports issue. Assume its all fine and let the change happen, THEN start testing.

This clinical trial is a terrible idea. We don’t need more evidence
https://genspect.org/call-to-action-help-genspect-uk-stop-the-nhs-puberty-blocker-study/

Discussion with Michael Biggs Louise Irvine and Susan Evans:

The NHS Puberty Blocker Study – Necessary evil or medical scandal in the making?

https://www.youtube.com/live/tAiOUhs_FEM?si=FGbgrZgDF8qJ29Ao&t=1

Just had another look, as of this evening, the NHS England CYP Gender Dysphoria Research Oversight Board hasn't been updated with information about the trial:

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/

Updated the archive version in case it's relevant in the future:

https://archive.is/wip/O9AbI

For completeness, this report was published 24 Jan 2025: Commission on Human Medicines report on proposed permanent order to restrict the sale and supply of GnRH agonists in children and young people under 18 years of age for the purpose of puberty suppression in gender incongruence and/or gender dysphoria

I'm quoting this recommendation because it's relevant to the trial:
Recommendation 7
The planned puberty suppressing hormone trial will recruit children and young people under 18 years who have not had previous exposure to GnRH agonists. A clear exit strategy needs to be put into place for continuation of GnRH agonists when exiting the trial if this is the pathway agreed with the patient and/or parents or carers. This should be accompanied by data collection on the efficacy and safety of the GnRH agonists.

https://www.gov.uk/government/publications/chms-report-on-proposed-changes-to-the-availability-of-puberty-blockers/commission-on-human-medicines-report-on-proposed-permanent-order-to-restrict-the-sale-and-supply-of-gnrh-agonists-in-children-and-young-people-under-1