- Joined
- Feb 28, 2021
The difference is that the NHS is heavily motivated to only use treatments with demonstrably provable positive outcomes, because it doesn't profit off of procedures, it's spending public funds to do them. American cows manage, through insurance, to get all sorts of treatments like boob jobs, nose jobs, forehead recontouring, brow lifts, chin shaves, jaw shaves, cheek implants, lip fillers, hair transplants, hairline modification, body sculpting and occasionally even that insane larynx surgery.
The NHS will prescribe hormones and will offer one amhole surgery - if a patient opts for an orchiectomy, they can't later get an amhole, which is at odds with how a lot of American patients approach it (snip now, hole later). But it does not offer any sort of treatment for facial feminisation (barring extreme exceptions). If someone transitions and complains they've got male pattern baldness and a flat chest, the NHS will treat them like a woman who's balding and flat chested - which is to say "that sucks, but that's something that some women experience, so we can offer you counselling but we're not going to give you cosmetic surgery". The rationale is there's no evidence that the surgery actually provides a long term improvement in wellbeing, or that any wellbeing impact from surgery doesn't outweight the risks and costs compared to counselling someone to make them accept that they don't look like a Hollywood starlet. Separately you could have an argument about how overstretched/mismanaged the NHS is, and how it tends to be more interested in getting people to a minimum level of functional rather than truly happy and healthy, but that's not in any way specific to one group of patients.
This causes a lot of seething because it obstructs the typical cope of "well I just need one more surgery and then I'll feel happy!". But in the case of puberty blockers, there's several reasons why Cass happened
- Trans patient advocacy groups would not shut up about how awful the NHS was, so as soon as the NHS switched from trusts to NHS England being an overall commissioning body, this prompted a lot of specific reviews into transgender healthcare
- There was no national strategy on how to treat trans people or specifically younger trans people - gender identity clinics tended to emerge independently of each other and have their own approaches, and there was no pathway for transition from youth to adult services (whereas it does exist for things like counselling kids with special needs, like downs syndrome, when they're going to age out of a service) - this is something that trans patient advocacy groups specifically complained about
- There was an exponential explosion in referrals to gender identity clinics in the space of about a decade, and the services literally couldn't cope - this is something that trans patient advocacy groups specifically complained about
- There was very little follow up for things like mental health support to patients or analysis of long term outcomes. This is something that trans patient advocacy groups specifically complained about, but only a little bit (the main cause for concern is patients who weren't benefitting from their treatment, but advocacy groups took that as a given)
- Puberty blockers were originally used following the Dutch protocol, which was a pre-pubertal child with no comorbidities and lifelong gender incongruent behaviour and distress over gender being prescribed puberty blockers, and following review they would be allowed to go on cross-sex hormones after a period of puberty blocking. The Tavistock Clinic took that and turned it into "we have to put you on puberty blockers for a couple of years to allow you to take hormones". Puberty blockers began being a box checking exercise for adolescents, many of whom had comorbidities and late and rapid onset gender dysphoria, as a way to get them to qualify for hormones. This decision was made without considering if the puberty blockers had any benefit to these adolescents beyond "makes them qualify for hormones". This was not something transgender advocacy groups complained about, but many clinicians did.
- The Tavistock Clinic (and possibly other youth GICs like Nottingham) was dominated by an unusual number of inexperienced junior clinics and had close links to ideological groups like Mermaids, to the point of literally taking instructions from them. This was something transgender advocacy groups praised... but a lot of other people didn't.
- High profile detransitioners like Keira Bell spoke about how the Tavistock Clinic pushed kids into transition without asking any questions. She was given puberty blockers age 16 as part of that box checking exercise.
Himdia is right, though, this is a remaining loophole. If a British citizen is prescribed a medication by a doctor in the EEC, and goes to any EEC member state, they can have that prescription honoured subject to local laws. There are certain medications illegal in the UK but legal elsewhere in Europe - one example would be the use of flunitrazepam (rohypnol) in the treatment of insomnia. A German doctor might prescribe it to me and I can go to a chemist's in Germany to get it. If I took the prescription back to the UK, I wouldn't be able to get it here because it's banned. I could also arrange to receive a consultation with a German doctor online, get a prescription, then fly to Germany and fill the prescription, although I might struggle bringing that medication back into the country.
This is essentially the loophole that groups are working on right now. Get a kid in touch with an EU doctor, get the doctor to write a puberty blocker prescription, liaise with contacts in any European country to drop off the prescription on their behalf, head to that country once the prescription is in to collect the puberty blockers, do the injection there. It'd be pretty hard to legislate against this, as you'd basically be trying to make a law that British citizens can only take British-approved medications even if they're not in the UK. It's not a situation that's ever come up before, because normally patients aren't so singleminded about getting their hands on a banned medication that they'd regularly take international trips using a network of sympathetic doctors and enablers. It's a pretty expensive option, mind, so I'm sure there'll be some GoFundMes or similar popping up soon.
