GIDS Archives - Mermaids

As LGBTQ+ sector organisations, we are deeply disappointed that the UK Government has decided to continue criminalising the prescription of puberty suppressing medicines for trans children and young people outside of a proposed NHS research study

Every single child and young person, across all nations of the UK, should be able to get the care that they need to grow up happy and healthy. To be supported by well trained, knowledgeable professionals who can make the right decisions with them, and who have access to appropriate medical treatments. To not have to wait too long or travel too far. And right now, that simply isn’t what’s happening for trans and gender diverse children and young people across the UK. This decision will not make things better.

The Government is entirely disregarding the voices of trans youth, who made clear their deep opposition to the restriction of private prescriptions for puberty blockers during consultation. This is particularly concerning given the lack of information about the proposed study and concerns raised about it by the Council of Europe.

The Government’s approach will further harm and alienate trans children and young people and their families, who already experience significant barriers and discrimination when accessing the services that are meant to support them.

We will continue to advocate for timely, supportive and holistic healthcare access for all. It is vital the NHS now steps up its efforts to substantially reduce the 6+ year waiting lists, through a rapid expansion of youth gender identity services that recognise and support trans young people’s experiences, including access to puberty suppressing medicines and gender affirming hormones where appropriate.

To all the trans children and young people reading this: you are not alone – trans and gender non-conforming youth have always existed and found ways to thrive throughout youth and into adulthood. As LGBTQ+ organisations, we are here to support you, listen to your concerns and we won’t stop advocating for your needs.

We know that this decision has had, and will continue to have, a significant impact on the lives of some young people. We encourage people to write and post responsibly about this matter, bearing in mind the impact this can have on the mental health of others.

You can get in touch with any of the services below if you need someone to talk to:

Mermaids Helpline and Webchat services are open Monday to Friday, 1pm-8:30pm on 0808 801 0400

LGBT Youth Scotland available on web chat Monday, Wednesday and Thursday

LGBT Health and Wellbeing Scotland Helpline available Tuesday to Thursday, 12-9pm and Sunday 1-6pm

Papyrus, Samaritans and Shout, who are able to support anyone concerned about their mental health

Organisations

Mermaids

Consortium of Lesbian, Gay, Bisexual and Transgender Voluntary and Community Organisations

Gendered Intelligence

Supported by IGLYO and Transgender Europe (TGEU)

We are incredibly disappointed by yesterday’s High Court judgement to uphold the decision to restrict the prescription of puberty blockers for trans young people.

The ban, which was brought into place under the previous Conservative Health Secretary, will expire on 2 September 2024 and there must be a consultation process if the Government wishes to make it permanent.

We strongly believe that the Health Secretary must now listen to trans young people. This includes recognising the harm that outright bans have, and continue to cause, and making sure harm reduction measures are in place to support the children and young people affected.

In particular, we wish to draw attention to the judge’s concern for young people who had been prescribed puberty blockers prior to the ban, who risk being left without support and are particularly vulnerable.

The Health Secretary must immediately publish a plan that ensures these young people have timely access to holistic, supportive care, including to gender affirming hormones if they so wish.

We are concerned that the judge’s decision relied heavily on findings from the Cass Review, which has been subject to significant criticism and contestation in the scientific community since its publication.

We published our critique of the review earlier this year, and we remain committed to campaigning for access to timely, supportive and holistic healthcare, free at the point of use, for all trans young people who need it.

Please consider donating to our urgent appeal to support this work and ensure we can continue campaigning for a better world to grow up trans.

We recognise that this news will be distressing for many trans young people, and their loved ones. If you need support, please contact our support line. We’re here for you Monday to Friday, 9am-9pm.

What is the Cass Review?

In 2020, NHS England launched an independent review of children and young people’s gender services in England, led by Dr Hilary Cass. The review had a massive scope, including:

What care trans youth received
How they get to and through the service
What medical options are available
How to staff services
How to explain the changes in demand for the service.

They also commissioned a set of research from the University of York.

Mermaids has regularly engaged with Dr Cass, most importantly through platforming trans children and young people’s views directly to the team through a series of focus groups. We have, however, been disappointed with the review’s consistent engagement with groups who deny the existence and legitimacy of trans youth.

What did the Interim Report say?

In 2022, Dr Cass produced her Interim Report. She wrote to trans youth saying “I think that more services are needed for you, closer to where you live”, and that success would be measured by “timely, appropriate and excellent care… from every healthcare professional they encounter”.

Mermaids supported the proposal to expand services across England’s regions, to better train healthcare professionals, and to build a consistent, holistic approach to healthcare (from GPs to specialised services).

However, we were concerned by parts of Dr Cass’ report, which fell into common misconceptions that gender-affirming care doesn’t allow space for open, supportive exploration.

The report also inferred that being trans could be caused by adverse childhood experiences, neurodiversity or sexual orientation, which we wholly reject.

Finally, her report was clear that preventing social transition is “not a neutral act”, but her words have been widely used by anti-trans activists to argue against trans youth’s self-expression.

While skeptical of the review’s approach, including the lack of trans people or experts in trans healthcare in the team, Mermaids conducted research with trans youth to ensure the Cass Review heard directly from them.

What do trans youth want?

Mermaids works directly with trans children and young people to listen to and platform their voices, with lack of adequate healthcare and support consistently their top concern. We held a series of focus groups specifically on the Cass Review, where trans youth told us they want:

Reasonable waiting times for a first appointment (currently at 6+ years)
Services which help people with their gender dysphoria, to grow confidence, and become more comfortable in themselves
Interact with accepting, supportive and respectful healthcare staff specifically trained in trans-inclusion, ideally including trans people themselves
Ensure neurodiversity doesn’t prevent support for transition
Any assessments should start from a point of respect, and feel less like being on trial
The process should involve asking the patient what they want out of the process, with a wider offer including voice training, laser treatment, and signposting to LGBTQIA+ youth groups
Services should feel welcoming, less clinical, and accessible for disabled people
Referrals into the service should be from a wide variety of sources, based on those the young person is most comfortable disclosing to – including schools, youth groups and family

What happens next?

NHS England did not wait for the Cass Review to conclude before making radical changes to the gender services offered in England for children and young people. The previous provider, GIDS, was closed last week, with two new services (much delayed) opening in the North and South, which will expand to 7-8 regional services.

These services operate under a new set approach (specification), which we fear over-medicalise and restrict care. They have also removed puberty blockers from routine prescribing, which will only be available through a research protocol in the future.

Following the final Cass Review, which is expected in the next few weeks, NHS England will review her recommendations and likely produce an updated set of policies and specifications in the coming year to reflect them.

We’ll be analysing the review closely when published, and will continue to advocate for the young people we support, pressing for timely, holistic and supportive healthcare for trans youth across the UK.

A paediatric doctor and parent of a trans child shares her view on the future of healthcare for gender diverse young people in England.

I have been a paediatric doctor for 10 years. I also have a primary-school age transgender child.

When my child first raised questions about their gender identity (“Mum, how do people know if they are a girl or a boy? Because I think I’m a boy”) I went looking for evidence to help me decide how to respond.

After about six months of being supportive and non-judgemental while they continued to express their questions, my child asked to change their name and pronouns, haircut and clothes to reflect their male gender identity.

Following a further few months of making these changes at home, he made a full social transition at school and all other areas of his life, which was straightforward and joyful. I am confident that this is right for him now and in the future, however his exploration of gender identity turns out.

As an academic health professional I was dismayed to read the recommendations on social transition for pre-pubertal children in the NHS England commissioning documents that are currently out for consultation.

The document states that in most cases “gender incongruence does not persist into adolescence” and that we should be “mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty” – discouraging a social expression of the child’s gender identity.

What is really shocking to me is that the specification ignores a whole body of evidence that has been published in the last five years which directly contradicts their recommendation.

The specification relies on one source to support their claim about the low likelihood of “persistence” of transgender identity, the Endocrine Society guideline published in 2017. The evidence base indirectly cited in this guideline is made up of small and low-quality studies, including material published as far back as 1967 with titles including “the cissy boy syndrome”, focused on how to prevent homosexuality.

However in 2022, we have evidence reporting the gender journeys of larger and more relevant cohorts of kids. One study found that 97.5% of socially transitioned North American kids (first assessed around eight years of age) retained a transgender identity at adolescence and after an average of five years follow-up.

Another study showed that even among the kids who “retransitioned”, social transition was primarily a positive experience, for example strengthening parent-child relationships through the demonstration of respect for the child’s chosen path.

We also now have evidence that the mental health of the teens who had been socially transitioned since childhood was similar to cisgender teens, especially important considering the poor mental health outcomes of transgender teens in non-affirmative settings.

When making decisions on how to respond to my own child’s request for social transition, this was the most important factor I considered – how can I maximise and protect their mental health right now AND if their transgender identity is persistent? In my mind the answer is loud and clear – listen, trust, respect and affirm their expressed identity.

Put simply, I could not parent my child in a respectful and loving way while simultaneously ignoring their expressions of gender identity.

My child is incredibly happy in their social context and confident that their family and social community support them. They have learnt so much about themselves and felt empowered to form new friendships – things that will be of long-lasting value whatever they decide in the future.

All parents want to do the best for their child and will look to the NHS for guidance. This specification must change to more accurately reflect the evidence in order to avoid further harm to our kids.

The consultation for the proposed specification runs until 4 December 2022. Mermaids has produced guidance to help you respond.

Two young trans people share their views on proposed changes to NHS healthcare services for trans and gender-diverse young people in England

We continue our series of blogs from our communities on the impact of the proposed guidelines with two young trans people, Jamie and Elijah, who have shared their views on the specification.

The consultation on the proposed guidelines runs until 4 December 2022, and we have produced guidance on the consultation to help you respond.

Jamie: “Social transition – it’s a lifesaver”

Social transition saved me as a teenager.

To some, it may seem unbelievable how such simple acts can have such a profound effect on someone’s life. For me, cutting my hair short started the long journey of being able to look myself in the mirror once more.

The new proposals argue for clinicians not to encourage social transition until a diagnosis of gender dysphoria has been made, citing Dr Hilary Cass’ statement that social transition is “not a neutral act” and fears over its long-term psychological impact.

To me, this is a huge step back in trans advocacy and self-determination. A clinical diagnosis to be permitted to cut your own hair short may seem preposterous. And that’s because it is!

All individuals, trans or cis, go through a journey of self-discovery through their lives. Finding what it means to be authentically you is something inherent to the human experience, and it’s only once this authenticity is placed into a transgender context that it’s seen as something to be wary over, something to be medicalised.

When I changed my name to a nickname, this was in a cis context, and thus was permissible, even encouraged. When I changed my name to what it is today, I was told to “think about my future”, and consider whether this was a “permanent” change that I really wanted. Silly considering how easy changing your name is here!

The new proposals will undoubtedly cause harm to trans youth. Dr Cass was right, social transition isn’t neutral. It’s a lifesaver.

Elijah: “a worrying outlook for what is to come for gender-diverse young people”

Holistic support is undoubtedly key for the well-being of young trans people and to make them feel supported there is a need for honesty and openness in communication from both sides.

While young people using unregulated sources of medication is a concern, an approach that attempts to persecute the young person and their support system does nothing to reduce harm.

The proposed guidelines state that safeguarding protocols will be initiated if a young person seeks medication outside the NHS which will make it difficult for young people to build trust with workers involved in their care.

The attitude towards social transition within the report is also concerning, painting it to be a process that requires medical approval rather than a gradual process of presenting in a way that makes you feel most comfortable. Young people know themselves better than a clinician who they only see once every few months.

I think it is ironic that while some claim that “allowing” children to be trans is depriving them of their childhood, in reality, the restrictions placed on trans young people create an environment where they are filled with fear, unable to simply enjoy their youth.

Community support has been crucial in being able to manage the complex and overwhelmingly negative feelings I felt in relation to this consultation and has reaffirmed the importance of specific services for trans young people such as Mermaids.

Although the specification seems to provide a worrying outlook for what is to come for gender-diverse young people in the UK, there is still hope and solidarity within the community, and we will push even harder for progress.

Read more about the proposed changes in our explainer blog, and find guidance to help you respond here.

“It sounds like they are trying to stop trans youth existing”

This month, we published a blog summarising some of the proposed changes to the NHS healthcare services for young trans and gender-diverse people in England.

The new guidelines were met with anger and frustration by the young people and families we support, with those on our support lines and forums expressing deep concern about the implications to their future wellbeing.

In response, we held two online engagement sessions, one for trans and gender-diverse young people, and one for parents to listen to their views.

What struck us most was the message that, in their current form, the proposals categorically fail our communities. Participants strongly felt that NHS England appears committed to denying trans young people the right to be their authentic selves.

“Literally everyone transforms themselves socially in some way or another”: The right to socially transition

Under the new guidelines, clinicians are now advised to only consider supporting “social transition” – i.e. changing name, pronouns, clothing – if a young person experiences what is described as “clinically significant distress“.

There was shock amongst young people at this inclusion within the guidelines, who felt this is reflective of efforts to “medicalise” trans people. In other words, it opens up the possibility that a person will require permission from a doctor to dress how they please, and use their chosen name and pronouns.

As one young person remarked, social transition is “a thing that people should be allowed to do freely because people, even children, have bodily autonomy.”

Both parents and young people recognised the enormous benefits that social transition can bring to a child’s mental well-being, so far as to be life-saving for some.

There was bewilderment that someone could only access support if they reached the point of showing “significant” distress. “Why would they want young people to get to that point?” one young participant observed.

Rather than uplift and support trans youth, our participants felt the proposed changes deny them the right to express themselves as they choose – something one parent suggested could be seen as “conversion therapy”.

“I don’t think it’s about increasing the capacity to help more people”: The right to access care

Currently, young people can be waiting over three years to just have a first appointment with gender services.

Everyone we heard from felt it is a priority to urgently reduce the waiting lists but there was concern that the guidelines would create additional barriers and delays to care.

Under the proposals, a young person can only be referred to gender clinics via their GPs or NHS professionals. Both young people and parents shared negative stories from local doctors, with some having to deal with GPs with no knowledge of trans healthcare, while others had experienced outright hostility.

The requirement for an additional assessment stage before joining the waiting list will not only create further delays, but also risks retraumatising young people seeking healthcare.

One young person mentioned that the “whole process is a hoop-jumping and emotionally taxing exercise which is inevitably going to be a problem for those with additional needs” such as those who are neurodiverse.

This view was echoed by a parent who told us how her child had “already had to speak to 10 or 12 people” about their body. “Why should I force my child to traumatise themselves just to get medication?”

“Not acting is not neutral: hearing your children saying I am, you know, whatever gender they are, and doing nothing, that’s where you need to go to social services”: The right to be heard

These excessive delays and barriers are leading families, who can afford it, to seek out private healthcare for their young person.

The proposals encourage a GP to make a local safeguarding referral if a young person accesses medications through a private provider, putting families in the unenviable position of choosing between either listening to what their child wants and needs through private care, or being unable to access vital support from their GP.

Far from reducing possible harm to trans young people, the guidelines are a dereliction of the duty of care towards an already marginalised community.

Both young people and parents were very clear that the proposed changes reflect a complete lack of understanding of the experiences of trans people and those who support them. “If you are trans, or you have a loved trans person in your family, you get it. But if you don’t, you don’t. And that’s the problem” one parent told us.

We asked our young people if they could encourage the NHS to change one thing, what it be. “We know ourselves better than you ever will” was one response.

It’s time we started listening to, trusting and believing trans and gender-diverse young people and their supportive families, placing their needs front and centre in the design of new healthcare services.

These proposals are not final and we have produced guidance to help those wishing to take part in the consultation.

Regardless of the outcome, Mermaids will continue to campaign for a world where trans young people can thrive in every aspect of their lives.