Scottish GPs have been told to refer children who wish to change gender to an LGBT activist group for “affirmative” counselling despite the findings of the Cass review.
New guidance issued to family doctors by NHS Lothian, Scotland’s second-largest health board, urges them to send 16-year-olds questioning their gender to LGBT Health and Wellbeing, a group which has promoted the transition of a five-year-old.
The charity states that it offers “LGBT+ informed and affirmative counselling” which does not involve
“inappropriate curiosity or incorrect assumptions” about a person’s gender identity. Critics said the move contradicted the findings of the landmark Cass review, which the Scottish NHS had previously pledged to adopt.
If following the “affirmative” sessions patients as young as 16 still wish to transition, GPs are told to refer them to the Chalmers Gender Identity Clinic, which can recommend prescriptions of hormone treatments as soon as they turn 18.
Dr Hilary Cass’s review was seen as endorsing a
move away from the “affirmative” model of care, which originated in the US and reinforces a patient’s “subjective gender experience”, which was previously widespread in gender clinics.
Her report for NHS England instead urged caution over social transition, for example when a young person changes their name and pronouns, raising fears it could push patients onto a
potentially unnecessary medical pathway.
Dr Hilary Cass said the “toxic” transgender debate made the work of her review harder,
write Michael Searles and Laura Donnelly.
The paediatric consultant said the report, which she has been working on for four years, resulted in her being “criticised” by all sides of the debate for considering the other’s viewpoint.
Dr Cass said the “toxicity of the debate is exceptional” in the foreword of the long-awaited report.
She said there were “few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour”.
Dr Cass, the former president of the Royal College of Paediatrics and Child Health, began her review into children’s transgender health services in January 2020.
Her final report, published more than four years later, came with a plea for the toxic debate to come to end. “This must stop,” she said.
“Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional,” she wrote. “I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution.”
She said the “polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse”.
She also said the toxicity around the subject would “hamper the research that is essential to finding the best way of supporting” those affected.
An underlying theme of the Cass review is the vast amount of missing evidence available from which to draw any conclusions, including the use of powerful puberty blocking drugs and other hormone treatments, as well as social transitioning – where children are allowed to use the pronouns of their preferred gender, dress accordingly, and choose which facilities such as toilets and changing rooms to use –- and other interventions.
“This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint,” she said.
“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender related distress.”
Writing for the BMJ she concludes: “Gender medicine for children and young people is built on shaky foundations”.
Rather than an exclusively affirmative approach, Dr Cass called for in-depth “holistic and personal” assessments to interrogate underlying reasons for gender distress.
“Telling GPs to send confused 16-year-olds to activist groups for ‘affirmative’ counselling flies in the face of the Cass review findings and the assurances the health board had given at Holyrood as recently as last month,” Trina Budge, a director at the For Women Scotland campaign group, said.
“For the NHS to be sending
vulnerable patients to partisan lobbyists which promote the transition of five-year-olds and have described puberty blockers as ‘wonderful’ is utterly reckless.”
Elsewhere in the new guidelines, it is stated that GPs in Lothian, Borders and Fife will be expected to assume responsibility for prescribing hormone treatments, following an assessment at the Chalmers clinic.
Many GPs have warned that they do not have the expertise to prescribe the treatments, which are often unlicensed for gender dysphoria, while there is also a lack of credible evidence for their long-term safety.
The NHS Lothian guidelines also recommend that
16 to 25-year-olds are referred to a group run by LGBT Youth Scotland, a controversial charity which opposes Cass and has described puberty blockers as “wonderful”.
https://archive.ph/o/N4pBb/https://...s-trans-care-must-be-slower-says-cass-report/
A West Lothian group called “Glitter Cannons” has also been recommended for children as young as 12, with GPs directed to a social media page that includes attacks on JK Rowling and ideological statements such as “trans men are men”.
Family doctors have been told that they must not include information on “gender history” in reports to insurance companies, which are often sought to assess the health of patients before offering cover.
Last month, Tracey Gillies, NHS Lothian’s medical director, told MSPs at Holyrood that assessments for those reporting gender dysphoria needed to have “really quite significant rigour”.
The prescription of puberty blockers and hormones to under 18s has been suspended in Scotland following
the findings of the Cass review, though groups such as LGBT Youth Scotland are lobbying for the ban to be lifted.
Ms Budge added: “It appears that rather than Cass review being adopted in full, as had been promised, ideologues are still calling the shots in the Scottish NHS.
“It is high time that the adults in the Scottish Government and Scotland’s NHS stepped in and put an end to this scandal.”
The
new guidelines published by NHS Lothian state that the Chalmers, set up to deal with adult patients, are “happy” to see patients from 17 and will accept referrals for 16-year-olds.
While it is stated 17-year-olds cannot receive gender-affirming hormones,
they can “still be seen for assessment and to provide other treatments”, the guidelines state.
It is advised that those under 16 are sent to the Sandyford in Glasgow, which has been branded the “tartan Tavistock”.
LGBT Health and Wellbeing includes on its website a positive account from a parent who allowed their daughter to transition to live as a boy called Freddie at five years old.
The article states: “In 2013 I let my five year old change their name, choose their own clothes, cut their hair short and style it like Robin from Batman. They learnt to swim in trunks, not a costume.
“I let them tell others they were a boy now. I told others they are a boy now. I allowed a child to believe what they felt was maleness absolutely is maleness even if their tiny body didn’t match.”
Dr Tracey Gillies, Medical Director, NHS Lothian said, “We are fully supportive of the Cass Review and its recommendations, as well as the DCMO report.
“NHS Lothian GPs do not make patient referrals to third party community-based organisations in relation to gender identity. GPs are provided with information on a number of established and mainstream LGBT organisations that may be helpful for patients and which they can signpost them to.”
