The next battle

[HelenaWaiting]

No gender-affirming treatment on the NHS. My father died waiting for surgery, the NHS is on its knees and taxpayers' money is going on non-essential treatment.

Although of course, Cass stated that affirmation was not neutral, so should really only be considered alongside a diagnosis/treatment plan. This is especially important given the significant long-term harms associated with the hormonal/surgical treatment it appears to bias towards

Well EHRC are gunning for NHS Scotland with Neil Gray being hauled in and over the coals about the new trans policy (and the old often unwritten one) with threats of sanctions and possible prosecution, as such I'm hoping that they make an example of NHS Scotland and Neil Gray. It would be a very effective way of ending the trans madness in Scotland and the rest of the NHS in a two birds 1 stone kind of way.

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/review-of-adult-gender-dysphoria-services/

We will hopefully hear more from the review of adult 'gender' services, soon.

from the 'Key lines of enquiry':

'Is the process of clinical diagnostic assessment robust and meaningful?'

'Is there robust and safe clinical decision-making throughout the service’s pathway?'

'Is the process of clinical assessment for referral for suitability for surgery robust and thorough?'

https://www.england.nhs.uk/long-read/key-lines-of-enquiry-review-of-the-nhs-adult-gender-dysphoria-clinics-in-england/

Nobody should be receiving any "gender affirming care" of any type.
What we need to do is stop calling it gender dysphoria and go back to referring to it as a form of body dismorphia, which it is. The treatment for body dismorphia is talking therapy to discover the root causes, because its almost always a symptom of underlying issues and/or unmet needs, trauma and/or abuse (look at the Tavistock cohort breakdown it hasn't changed) though now we also have the social contagion group to deal with. Once, we go back to what was known as watchful waiting and stop affirming disorderd and delusional thinking, along with not promoting it things will get better for everyone.

It isn’t healthcare.

Excerpts are not in the order they are in in the document, sorry, I've just copy pasted for info:

'The clinical approach to assessment and treatment is holistic and individualised, takes account of complexity, alternative diagnoses and the risk of diagnostic overshadowing, makes no presumptions about whether or not individuals referred to the service experience gender dysphoria as part of their incongruence, and makes no presumptions about a patient’s treatment goals or about patients based on gender stereotypes or on their gender identity (for example if they are nonbinary).'

'Endocrine interventions may be recommended “where they are essential for the purpose of harm reduction and where they are in the individual’s best interests for reducing gender dysphoria”. There must be evidence of “persistent, well documented gender dysphoria”.'

'The clinical approach to assessment of suitability for surgery is holistic and individualised, takes account of complexity, and makes no presumptions about the best treatment pathway for any individual, keeping open the possibility that there may be no benefit to medical intervention for that individual.'

'The process of obtaining informed consent must “enable the individual to make informed decisions about the treatment options, benefits, material risks, and the alternatives to the treatments proposed (including the option of having no treatment). Individuals must be given sufficient time to reflect on the clinical advice and the potential treatment options before deciding what is best for them.”'

keeping open the possibility that there may be no benefit to medical intervention

That's an interesting sentence.

I'd be interested to understand what you mean by gender affirming healthcare.

I understand gender affirming hormones and surgeries to mean giving cross-sex hormones and cosmetic surgical interventions to enable someone to suppress or remove their sex characteristics and gain a simalcrum of the sex characteristics of the opposite sex.

Wider gender affirming healthcare might mean using their preferred names and pronouns in a clinical setting. Possibly including changing their 'gender marker' on their health record. Or it might be psychosocial support aimed at helping them live as a person of the opposite sex, or voice training to pass better.

Am I missing some healthcare that you believe falls under the gender-affirming umbrella? Is any of it the above well-evidenced? As PP has pointed out, Cass states clearly that affirming is NOT a neutral act in children. Is there any reason to think that in adults it would be different? Particularly the kind of young fragile adults that form the majority of the current cohort.

One of the fundamental problems with starting healthcare from a gender affirming basis for me is that is shuts down any talk of WHY. The aetiology of gender dysphoria, that Cass outlines very well - what is a patient's personal story that means that they are gender incongruent/dysphoric and wish to change their secondary sex characteristics? As multiple studies have shown, the current cohort of patients are genderally young/same-sex attracted/neuordiverse/traumatised or several of these. By not being able to start from an open neutral stance, but being obliged to 'affirm', the possibility of addressing some of the underlying issues - and who knows? potentially resolving the dysphoria - is shut down. This to me is the real tragedy of gender affirmation. So yes, I agree with OP, all gender affirming care should go. That does NOT mean all care should go.

To be completely and baldly clear - I am not saying that we should, as clinicians, say 'trans is not a thing'. It is possible, I would hope, to hold a sympathetic and neutral space for open discussion and the options of multiple ways of addressing the distress. Which should be evidenced.

It's a discussion forum.

Where people discuss issues.

There is a lot of experience and expertise here.

Well, we have the Cass Review, led by a highly qualified medical professional. And now the new adult services review, also led by a highly qualified medical professional. I'm sure Waffle is delighted to see the NHS is in safe hands and will support the findings of both reviews.

I think the SC judgement has been really helpful, even though it said nothing about medicine. It has asserted the primary importance of biological sex, where this was being undermined, including within medicine. It is empowering to clinicians to say "look, your sex is important, it needs to be recorded, it doesn't change just because you have transitioned." That opens the door for a much more sensible discussion about what we are and are not trying to do with transition.

But this already is the case in the NHS. Breast reduction surgery a classic example. Many with my disability have 'probable' in their diagnosis because we're told straight out, the trust won't spend the money on the expensive tests, scans and processes to confirm it. Trying to get physiotherapy or scans etc, there's a very high bar. The criteria for a hip replacement involves pretty much losing all mobility first.

The amount of tax payer funding and whether it's an unfair allocation is a valid question.

Treatments that decrease the health of the body enduring them, and lead inevitably to further health needs? No that’s not a good use of NHS scarce resources.

Elective surgery or drug treatment that does not improve the health of the body have no place in the NHS, any more than tattoos, piercings and other body modifications.

I'd definitely support sterilisation only being available to say over-25s, just as it is in many comparable countries.

i don't really know about the other stuff. I shouldn't imagine that a course of synthetic hormones is desperately expensive?

Can you not misquote me, please? I said gender-affirming care should be banned.

If there was a supply chain issue who do you think would get them first - menopausal women or transwomen (btw this is not a hypothetical scenario; it did actually happen).

Gender confused youngsters may well need treatment of some sort but I don’t think there’s evidence to say it should be ‘gender affirming’ care (whatever that may mean). Help to accept that they can be as gender nonconforming as they wish without harming their intrinsically sexed bodies maybe?

Sorry wrong thread.

And honestly, even speaking as someone who went a long way down the path towards needing IVF, yes, I think the NHS shouldn't be paying for IVF when it's unable to provide prompt cancer care, and yes, I support it looking hard at the economic costs and benefits of all the different things it can do. At the same time I support those of us who can afford to pay more tax doing so to get it (and the social care system) out of its current hole.

It's not 'a course' though, it's taking them for life (unless you detransistion).

As others have said, menopausal women have struggled to get them to treat their physical symptoms.