Population, Intervention, Comparator and Outcomes (PICO)
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- Topic details
Intervention: Feminising medicines comprising oestrogen monotherapy
Indication: Children and young people with gender incongruence who identify as a
female gender and wish to undergo a binary physical transition
...
In the ICD-11 (WHO, 2025), under conditions related to sexual health, gender
incongruence is split into that identified in childhood (Gender incongruence of
childhood – HA61) and that identified in adolescents and adults (Gender
incongruence in adolescents and adults – HA60).
How many other conditions related to sexual health are there in children?
Previously, feminising medicines for CYP comprised of oestrogen, preceded by
puberty suppressing hormones (PSH). PSH, which is gonadotrophin releasing
hormone analogue (GnRHa) for the indication of puberty suppression, are no longer
available as a routine commissioning treatment option for treatment of CYP who
have gender incongruence because there is not enough evidence of safety and
clinical effectiveness. NHS England and the National Institute of Health and Care
Research (NIHR) are working together to set up a study into the potential benefits
and harms of PSH as a treatment option for CYP with gender incongruence. PSH
are not covered by this PICO.
Population and Indication
Gender incongruence is not uncommon. A survey of 10,000 people undertaken in
2012 by the Equality and Human Rights Commission found that 1% of that
population had either gone through part of a process to change from the sex they
were assigned at birth to the gender they identified with, or they intended to do so.
Estimates for the proportion children and young people (CYP) with gender
incongruence vary considerably. This reflects a number of factors such as: variable
data reporting by providers; differences in diagnostic thresholds applied and
inconsistent terminology; the methodology and diagnostic classification used –
population surveys give a much higher estimate than numbers based on service use;
and the year and country in which the studies took place. Additionally, a significant
proportion of referred CYP have co-occurring conditions such as autism spectrum
disorder or mental health difficulties (Stynes et al. 2021).
At current referral patterns 69% of referrals to the current commissioned service are
of natal females and 31% are of natal males1
. This data accords with figures
published by the Cass Review in March 2022, which show a trend since 2011 in
which the number of natal females is increasingly higher than the number of natal
males being referred. That change in the proportion of birth assigned females to
males is reflected in the statistics from the Netherlands (Brik et al. 2020).
The number of referrals into the CYP Gender Incongruence Service is currently likely
to be around 1 per 2000 population per year. The current referral profile suggests
that the majority of referrals will be of adolescents following the onset of puberty.
Data from January 2025, shows the current CYP waiting list as 6,2462'
[Bolding and italics mine - AS]