'All those where hormones were initiated before the age of 16 years will be
offered a local clinical endocrinology assessment, and the specialist
endocrinology team will provide expert support to discuss individual case
management. The endocrinology service will identify the potential harms that
will need to be considered, the investigations that might be required (e.g.
DEXA scan), and the guidance for local management of endocrinology
prescription withdrawal.'
...
'A decision by a practitioner to initiate / assume responsibility for prescribing of GnRHa or masculinising / feminising hormones in the absence of an extended multi-disciplinary assessment has many risks.'
...
'The Cass Report describes that the absence of an extended assessment and / or absence of ongoing therapeutic relationship with a specialist clinical team risks a premature and inexorable commitment to a medical pathway, with potentially irreversible physical and psychological effects (including impaired physical growth, sexual functioning and cognitive development), and loss of body autonomy in later life. The absence of advice or support from a specialist consultant-led paediatric endocrinology team increases the risk of physical harms, including where prescribing is contraindicated because of the individual’s
specific circumstances; incorrect dosage resulting in irreversible physical harms (such as accelerated skeletal development); and where there are inadequate arrangements in place for physical investigations and monitoring (baseline and follow-up).
...
The absence of an extended assessment and diagnostic process, and access to specialist medical advice, increases the risk that a child or young person is not sufficiently informed of, or understanding of, the potential risks, benefits, harms and outcomes of GnRHa or exogenous hormones (and of the limited evidence base) for the purpose of giving informed consent to the administration and prescribing of the intervention; and there may be increased risk of lack of capacity to consent.
In view of the risk of infertility, harm may be caused if the young person is not referred to a specialist fertility and reproductive practitioner including for the purpose of advice on gamete preservation options.'
What have they done.