National Health Service in England announced on Thursday that it is closing the country’s only youth gender clinic in favor of a more distributed and comprehensive network of care for teens in need of hormones and other gender-based treatments.
The closure follows 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, insufficient mental health support and a sharp increase in the number of young people search for gender procedures.
An overhaul of services for young transgender people in England is part of a notable shift in medical practice in some European countries with nationalized health systems. Some physicians are concerned about the growing number of patients, as well as the lack of data on long-term safety and outcomes of the medical transition.
In the United States, physicians specializing in gender-based care for adolescents are ambivalent about reforms in Europe. While many agree that more comprehensive health care for transgender youth is urgently needed, as is more research into treatments, they fear that these changes will spur a growing political movement in some states to ban such care entirely.
“How do we draw the line to keep individual care while maintaining safety standards for everyone? That’s what we’re trying to figure out,” said Dr. Marcy Bowers, plastic surgeon and future president of the World Professional Association for Transgender Health, transgender. “These decisions should be made by the people on the ground, not the people in Washington or the state legislatures.”
The NHS said current patients at Tavistock could continue to receive treatment there before being transferred to two new centers at children’s hospitals in London and Manchester. The new clinics will expand gender services in the country by providing adequate treatment for children with autism, trauma and mental health issues. Specialists will also conduct clinical trials of gender drugs.
There are “critical unanswered questions” about the use of puberty blockers, Dr. Hilary Kass, head of external review for national youth gender identity services, wrote in a report. letter head of the National Health Service of England last week.
Puberty blockers, which are largely reversible, are designed to buy younger patients time to make important decisions about permanent medical changes. But Dr. Kass doubts that most teens who have been prescribed these drugs have been given support to change course if they so choose.
Tavistock received over 5,000 referrals from patients in 2021, up from 250 in 2011. The types of patients seeking referrals have also changed over the past decade. When the clinic opened, it mainly served children who were assigned male at birth. Last year, two-thirds of Patients were assigned female at birth.
It is not clear why the number of patients has risen so dramatically, or why transgender boys are the driving force behind this increase.
Transgender advocates in the UK have welcomed the changes but stressed that many questions remain about how they will affect the care of 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 to see at your first appointment. We have seen the suffering inflicted on young people because of this.”
But Ms Green, who has an adult transgender daughter, said the group is concerned about whether mental health services will take precedence over medical care. According to her, gender diversity should not be seen as a mental disorder.
“We would not like to see additional barriers to accessing medical intervention,” said Ms Green.
In 2020, former Tavistock patient Kira Bell joined a highly publicized lawsuit against the clinic. She is argued that at 16 she was put on puberty blockers “after a series of superficial conversations with social workers”, and at 20 she had her breasts removed, which she later regretted.
The Supreme Court initially held that children under 16 were unlikely to be old enough to consent to such medical interventions. But that decision was overturned last September when judges ruled that “it is up to doctors, not the court, to decide whether a young patient can give informed consent.”
In 2020 employees in Tavistock raised concerns about the clinic’s health care, prompting the NHS to commission Dr Kass, a London-based pediatrician not affiliated with the clinic, to conduct an external review. Her interim report was released in February of this year.
This year, Sweden’s National Health Service determined that gender-responsive care for young people should only be provided in exceptional cases where children have a clear concern about their gender, known as dysphoria. All teens receiving treatment will need to participate in clinical trials to collect more data on side effects and long-term outcomes. Finland took a similar position last year.
“Our position is that we cannot see this as just a rights issue,” Dr. Thomas Linden, director of the country’s National Board of Health and Welfare, said in a February interview. “We need to see patient safety and accuracy in judgment. We have to be really, to some extent, confident that we are treating the right treatment for the right person.”
While these European countries have placed some restrictions on transgender care, their approach is far more lenient than some conservative US states. BUT 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 treatment have been investigated for child abuse. Both states involved in legal battles with civil rights groups.
Some American doctors feared that changing standards in Europe would reinforce the perception that gender-based treatment was dangerous for young people.
“I fear this will be interpreted as another move against providing gender-affirming care to children,” said Dr. Angela Goepferd, medical director of the Gender Health Program at Minnesota Children’s Hospital. They say more services are needed, not less. “That’s our task here.”