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.

Barry Wall has analysed the advert and sounds quite optimistic. He is very gender critical.

I agree with Barry. A study is not a clinical trial. I ran clinical trials for many years as well as designing and running studies and clinical audits. A well designed and run study can put the brakes on risky or badly designed trials. It remains to be seen who gets the job and then the detail of the study.

I don't regard this as being aligned with gender ideology but rather saying that there is some evidence that suggests some YP may benefit from physical treatment, and these would likely be those for whom trauma, autism, sexual orientation, mental health conditions etc. do not account for their distress.

But what are the causes of this 'gender distress' if it's not the known ones you mention (or Malaga Airport or social contagion or any other identifiable causes)?

A mental condition (with no discernable cause) is being treated. The treatment given will have a profound effect on the child's life as an adult. Shouldn't we try to discover what exactly the condition is that is being treated before giving this treatment to children? Children cannot give properly informed consent to a treatment which will leave them infertile with impaired sexual function, and to give this treatment when we only have a diagnosis which says that it's not due to various causes, without stating which causes it is due to seems negligent.

Gender dysphoria has more in common with Body integrity identity disorder than with any other condition. We don't treat that condition by amputating limbs, even though that is often what the patient wants. Why are gender issues treated differently?

I think Barry is being overly optimistic, he missed this crucial part of the job advert:

• Be able to demonstrate an understanding of and commitment to the Trust’s Equality and Diversity principles relevant to the post and practice in a gender affirming manner in line with WPATH SOC 8

They are stating that the psychologist must be committed to practicing in a gender affirming manner in line with WPATH.

This seems even worse than the Tavi! Where this was not explicit even if the reality of practice was that was waht was happening.

The only psychologists who would agree to apply for a job where your practice was prescribed and directed in this way would be ideologues committed to gender ideology.

I cannot see how they will get any psychologists who want to practice in the holistic way Cass reported was needed, would either apply for this job or have any hope of being appointed.

This is all very odd, given Cass, the oversight board and the proposed 'study'. Something is afoot and I can't work out what.

I missed the WPATH bit. That is sinister.

Just re-reading the SEGM response to Cass which I stumbled across looking for something else:

"As we noted earlier, the NHS intends to conduct research into puberty blockers, and there has been much speculation about research design in general, and the eligibility for research in particular. The quote below from the final Cass Report suggests that eligibility may be limited only to natal males with early-onset and long-lasting gender dysphoria. It appears to suggest that natal females may not be eligible, as they can successfully undergo convincing masculinization with the help of testosterone at virtually any age:
14.56 Transgender males masculinise well on testosterone, so there is no obvious benefit of puberty blockers in helping them to ‘pass’ in later life, particularly if the use of puberty blockers does not lead to an increase in adult Height.
14.57 For transgender females, there is benefit in stopping irreversible changes such as lower voice and facial hair. This has to be balanced against adequacy of penile growth for vaginoplasty, leaving a small window of time tо achieve both these aims
14.58 In summary, there seems to be а very narrow indication for the use of puberty blockers in birth-registered males as the start of a medical transition pathway in order to stop irreversible pubertal changes. Other indications remain unproven at this time."

https://www.segm.org/Final-Cass-Report-2024-NHS-Response-Summary

The quote below from the final Cass Report suggests that eligibility may be limited only to natal males with early-onset and long-lasting gender dysphoria.

So basically those boys who are effeminate from a young age who want to play with dolls and wear fairy outfits; who are now being brainwashed from nursery age to believe that the only explanation for this is that they are in fact a girl. And still nobody is able to explain how you ensure that when you block a boy’s puberty you are not accidentally preventing a future gay man from maturing sexually. I cannot fathom how this could conceivably pass ethics when the only diagnostic criteria is that a boy has been persuaded by adults they have been born wrong and the toys they play with are considered by society to be girl toys. It’s barmy.

Well exactly.

The obvious hypothesis for such a boy would be that he is gay. So you'd first have to find some way of validly rejecting this hypothesis.

And even if you could 'prove' this little boy is not gay, then what is now the hypothesis/ theory to explain his experience?

Is it that we
A) Conclude he really is a girl/ has the wrong body?
or
B) that he is experiencing a delusion that he is a girl to such a degree that we beleieve the distress should be alleviated through altering his body?

How could any ethics board agree to permanently altering children's bodies to relieve distress from a delusion?

The unspoken truth is that they are implying that once you've rejected all other hypothsese A) is true for some children.
Which is idelogy not science. .

How would the study be screening out boys simply reacting to a sexist or homophobic environments, at home, school, in wider culture? Would they interview parents about their views on gender stereotypes?

The adult GIC at Nots is basically the U.K. centre for WPATH.

Will they be actioning the Eunuch recommendations from WPATH SOC 8?

I’d like to think a minor presenting to the NHS to have their genitals amputated to physically manifest their Eunuch identity would be immediately referred to social services on suspicion of being a victim of CSA?

Yes, if you believe that this treatment is right for some children, you must first believe that it's possible for someone to have a gendered brain (or soul) which doesn't match the sex of their body, and that the best or only treatment is to correct the appearance of the body to match their brain (or soul).

This is the only explanation which could make you believe that this treatment is appropriate. A quasi religious belief in a gendered soul.

This is the only explanation which could make you believe that this treatment is appropriate. A quasi religious belief in a gendered soul.

Yes. The Cass Report has a whole section on gender identity, which means the document is written from the perspective of a believer that "we all have a gender identity".

Even though I'm not a believer myself, I accept others are. The good part is that even a believer (I assume Baroness Cass is, given she wrote the report) and I can agree that it's important that any medical intervention is evidence based.

However, it does somewhat take us round in a loop that we have no way of knowing whether someone's belief is actually just a manifestion of their autism-related puberty distress, trauma from sexual abuse, internalised/family led homophobia etc etc.

Even though I'm not a believer myself, I accept others are. The good part is that even a believer (I assume Baroness Cass is, given she wrote the report) and I can agree that it's important that any medical intervention is evidence based.

But if interventions are evidence based, they can't rely on gender identity as evidence, because gender identity is a belief, not evidence. Evidence must be objective and based on science, not belief.

As soon as you provide treatment based on a belief in gender identity, you have rejected science in favour of an ideological belief.

I agree, that’s how it seems to me too.

I’m always surprised that the sceptics and campaigners who fought to get things like homeopathy and chiropractic removed from NHS funding and provision have never brought their ire and scepticism to bear on gender identity beliefs informing medical procedures.

https://archive.ph/23GAr

'An NHS transgender clinic doctor endorsed procedures such as enabling patients to have both male and female genitalia, leaked messages reveal.

...The Telegraph has been sent unredacted screenshots of the leaked messages, which identify a leading NHS doctor, Jonathan Arcelus, a professor in mental health and transgender health at the University of Nottingham, as among those discussing and endorsing controversial procedures which are currently not allowed on the NHS.

...Prof Arcelus suggests that such controversial procedures may become “standard” in future, and, as such, should not be referred to as “non-standard”.
According to the unredacted screenshots, Prof Arcelus said: “Is ‘non-standard’ procedures the best term to use? They may become standard in the future… any more possible terms that could be used to describe these kinds of procedures without having to describe them?”

...In 2022, WPATH, which is a self-regulated membership body, published its updated Standards of Care: Version 8. Prof Arcelus was the co-chair of the guidelines'

I have neither words nor emojis to adequately express my horror at Jonathan Arcelus’ endorsement of the worst of WPATH.

Let’s hope the review of the adult services scrutinises the NHS-WPATH relationship

@ArabellaScott shudder - so you end up with a fully intact male human being with a faux vagina and hormonally engineered breasts. OMG if that isn’t a paraphilic idea what is?

Image below is from a US surgical practice offering phallus preserving vaginoplasty. "Its often an important consideration for individuals who wish to maintain the option of using their Penis for sexual function or other reasons"
Not sure what the other reasons are.

I’m just wondering, if the new study requires that young people don’t have serious mental health issues will all the advocacy groups start to distance themselves from the suicide narrative and start advising young people to hide mental health issues from clinicians so they don’t risk making themselves ineligible for the study?

Interesting thought, Sig

thinking back to that study on the Exeter GIC, the number of comorbid conditions was massive and the average FtM patient was only 20, so not so different from the current adolescent cohort.

Might be hard to recruit eligible study participants if preexisting MH or physical health and adverse childhood events are exclusions!

pmc.ncbi.nlm.nih.gov/articles/PMC8503911/

If those on the gender affirming pathway have no mental health needs and wanting to transition isn't a mental health need then why would they need psychological support?

Surely the suggestion then is: we've decided modifying your body is the solution to your problems.
Not therapy?

What problems?

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

"What problems?

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

The diagnosis of gender dysphoria is conceptualised as a condition that can lead to distress, as opposed to a mental health issue.

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.

Body dysmorphic disorder is classified as a mental health disorder and making changes to the body/ surgery is not a recommended treatment. It is understood as arising from faulty perception (caused by internal and/or external factors).

Gender dysphoria is considered to be an atypical variation in identity development that can lead to understandable alienation from one's sexed body.

https://www.mumsnet.com/talk/womens_rights/5057269-5057269-puberty-blockers-how-exactly-did-we-get-here?

A thread on puberty blockers if you've not read it.

Gender dysphoria is considered to be an atypical variation in identity development that can lead to understandable alienation from one's sexed body.

As I said earlier in the thread, it seems to be a similar condition to body integrity identity disorder (BIID) which is also called body integrity dysphoria. Body dysmorphia is a different condition which is not particularly relevant to this discussion.

Body integrity dysphoria is characterised by an intense and persistent desire to become physically disabled in a significant way (e.g. major limb amputee, paraplegic, blind), with onset by early adolescence accompanied by persistent discomfort, or intense feelings of inappropriateness concerning current non-disabled body configuration. The desire to become physically disabled results in harmful consequences, as manifested by either the preoccupation with the desire (including time spent pretending to be disabled) significantly interfering with productivity, with leisure activities, or with social functioning (e.g. person is unwilling to have a close relationship because it would make it difficult to pretend) or by attempts to actually become disabled having resulted in the person putting his or her health or life in significant jeopardy.

In the 90s, a surgeon in Scotland amputated the limbs of some sufferers. More recently, a psychologist 'helped' a sufferer to become blind by pouring drain cleaner in her eyes. This 'treatment' is generally condemned, even though those who have received it declare that they are happier after the treatment.

An interesting article about this condition, which mentions the similarity with gender dysphoria.

https://www.theatlantic.com/magazine/archive/2000/12/a-new-way-to-be-mad/304671/