National Health Service in England announced on Thursday that it was closing the nation’s only youth gender clinic in favor of a more distributed and comprehensive network of medical care for teenagers seeking hormones and other gender treatments.
The closure followed an external review of the Tavistock clinic in London, which has served thousands of transgender patients since the 1990s. Reviewwhich is ongoing, has raised several concerns, including long waiting times, inadequate mental health support and growing number of young people seeking gender treatments.
The overhaul of services for transgender young people in England is part of a marked change in medical practice in several European countries with nationalized healthcare systems. Some doctors there are concerned about the increase in numbers as well as the lack of data on long-term safety and medical transition outcomes.
In the United States, doctors specializing in adolescent gender care have mixed feelings about the reforms in Europe. Although many agree that more comprehensive health care for transgender youth is sorely needed, as are more studies of treatments, they worry that the changes will fuel the growing political movement in some states to ban such care altogether.
“How do we draw the line in order to maintain individualized care while maintaining safety standards for all? That’s what we’re trying to solve,” said Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the incoming president of the World Professional Association for Transgender Health, who is transgender. “It’s the people on the ground who have to make these decisions, not the people in Washington or the state legislatures.”
The NHS said current patients at the Tavistock clinic could continue to receive care there before being transferred to two new centers at children’s hospitals in London and Manchester. The new clinics will expand the country’s gender services by ensuring children are adequately treated for autism, trauma and mental health issues. Specialists will also conduct clinical research on gender-based medications.
There are “significant unanswered questions” about the use of puberty blockers, wrote Dr. Hilary Cass, head of the external review of the country’s gender identity services, in a paper to the head of NHS England last week.
Puberty blockers, which are mostly reversible, are intended to buy younger patients time to make important decisions about permanent medical changes. But Dr. Cass questioned whether most teenagers prescribed these drugs were given support to change course, if they chose to.
Tavistock received more than 5,000 patient referrals in 2021, up from just 250 in 2011. The types of patients seeking referrals have also changed over the past decade. When the clinic opened, it primarily served children who were assigned male at birth. Last year, two-thirds of it the patients women were assigned at birth.
It is unclear why the number of patients has increased so drastically or why transgender boys are driving the increase.
Transgender advocates in Britain welcomed the changes, but pointed out that many questions remained about how they would affect care for young people.
“We are optimistic, cautiously optimistic about the news,” said Susie Green, chief executive of Mermaids, an advocacy group for transgender and gender diverse youth. “There is a two and a half year waiting list for your first appointment. We have seen the distress caused to young people because of this.”
But Ms Green, who has a grown-up transgender daughter, said the group was concerned whether mental health services would be prioritized over medical care. Gender diversity, she said, should not be treated as a mental disorder.
“We would not like further barriers to be put in place regarding access to medical intervention,” said Ms. Green.
In 2020, a former Tavistock patient, Keira Bell, joined a highly publicized lawsuit against the clinic. it claiming that she was put on puberty blockers at 16 “after a series of superficial conversations with social workers” and had her breasts removed at 20, decisions she later regretted.
A high court initially ruled that children under 16 were unlikely to be mature enough to consent to such medical interventions. But that decision was overturned in September last year, with judges ruling that it was “for clinicians, not the court, to decide” whether a young patient could give informed consent.
in 2020, employee in Tavistock raised concerns about medical care at the clinic, prompting the NHS to charge Dr. Cass, a pediatrician in London who was not affiliated with the clinic, for an external review. Its interim report was released in February of this year.
Sweden’s national health service determined this year that gender-specific medical care for young people should only be offered in exceptional cases where children have clear concerns about their gender, known as dysphoria. All adolescents receiving treatment will be required to enroll in clinical trials so that more data on side effects and long-term outcomes can be collected. Finland took a similar stance last year.
“Our position is that we can’t just look at this as a rights issue,” said Dr. Thomas Linden, director of the country’s National Board of Health and Welfare, in an interview in February. “We have to look at patient safety and accuracy in the trial. We really need to be somewhat sure that we are giving the right treatments to the right person.”
While these European countries have placed some restrictions around transgender care, their approaches are much more permissive than those in some conservative US states. or recent Alabama law made it a crime for doctors to prescribe puberty blockers and hormones to minors. In Texas, parents who allow their children to receive gender treatments have been investigated for child abuse. both UNITED are locked in court battles with civil rights groups.
Some American doctors worried that changing standards in Europe would reinforce the notion that gender treatments are dangerous for young people.
“My fear is that this will be interpreted as another level against the provision of gender care for children,” said Dr. Angela Goepferd, medical director of the Gender Health Program at Children’s Hospital of Minnesota. More services are needed, they said, not less. “That’s our challenge here.”