Five Staff Resign at Leading UK Transgender Youth Clinic

Becky McCall

April 12, 2019

Allegations of misdiagnoses and unsubstantiated use of puberty blocking and cross-sex hormones in young people has led to the resignation of five clinicians from the UK's only publicly funded Gender Identity Development Service (GIDS) according to an investigation by The Times newspaper. 

The article, published earlier this week, says the five unnamed staff believe some children were misdiagnosed as "transgender" when they were actually experiencing same-sex attractions. The young people were referred for hormone treatment without proper exploration of the possibility that they may be gay instead, the clinicians claim.

The staff were responsible for deciding which young people accessing the clinic with gender dysphoria should receive hormone blockers to prevent the onset of puberty associated with their biological sex at birth. Hormone blockers have been approved for use in precocious puberty, but not for gender dysphoria.

Many of these young people then go on to receive cross-sex hormones to transition to the their preferred gender.

A number of other physicians have expressed concerns about the hormonal treatment of children and adolescents with gender dysphoria in western countries, as detailed in a recent in-depth feature by Medscape Medical News.

And Carl Heneghan, MD, director of the Centre of Evidence-Based Medicine at Oxford University, UK, told The Times this week: "Given the paucity of evidence, the off-label use of [puberty blocking] drugs in gender dysphoria treatment largely means an unregulated live experiment on children."

But physicians treating children with gender dysphoria have previously defended their approach, saying it is easy for other physicians, who don't see these kids, to be "armchair critics."

The UK staff resignations appear to be one the first instances of clinicians who are actually treating these children objecting to the care they receive and going as far as leaving their jobs in protest.

And according to another report, in the Daily Mail, at least 18 staff in total have reportedly quit the clinic over the past 3 years over concerns that not enough checks are being done to correctly diagnose child patients.

GIDS told The Times that care is taken at every stage to ensure young people understand the potential consequences of their choices of therapy, and that discussions around sexuality "now form a more explicit part of our approach to assessment and exploration."

Protecting Children

In The Times article, one of the resigning staff members said they had stayed in their job for longer than intended because of "the sense there was a huge number of children in danger. I was there to protect children from being damaged."

"This experimental treatment is being done not only on children, but very vulnerable children," another of the five whistleblowers told the newspaper.

The London GIDS clinic, run by the Tavistock and Portman National Health Service (NHS) Foundation Trust, manages gender dysphoria in children in the UK, along with its sister clinic in Leeds. It has seen a record number of annual referrals of children with gender dysphoria, at around 2500 in 2018, a 50-fold increase from 12 years ago.

According to GIDS, their policy is for a child to only commence hormone blockers once puberty has begun (Tanner stage 2). 

This is not the first time the clinic has come under fire. Last year, a report by clinician and former governor at the Trust, David Bell, MRCPsych, claimed children accessing the clinic were not receiving a proper assessment. Details were first reported in the Observer newspaper in November.   

In February this year, the results of that internal report were submitted to the Trust’s board. The response led to the resignation of Marcus Evans — a governor and consultant psychotherapist who had worked at GIDS for over 30 years — because he was concerned about how Bell's report was handled.

"I think there isn't sufficient time and thoroughness in the examinations to understand what's going on with these children and young adults, and with their families," he told BBC Radio at the time.

As quoted in The Guardian, Bell's report states: "The GIDS service as it now functions [is] not fit for purpose and children's needs are being met in a woeful, inadequate manner and some will live on with the damaging consequences."

Bell said some children take up a trans identity as a solution to multiple problems such as historic child abuse in the family, bereavement, homophobia, and a very significant incidence of autism spectrum disorder. Bell's report states many children questioning their identity may have "learnt through online resources [or] coaching from parents or peers exactly what to say in order to get the results they want."

Bell added that while the treatment of gender dysphoria in young people is complex, it is hindered by the fact that any debate is often shut down as being "transphobic."   

Studies Into the Long-Term Effects of Transgender Hormones

It is acknowledged that there is a lack of robust long-term evidence to support the safety of medications used to block puberty in children with gender dysphoria, and concerns include fertility, bone health, and development of the adolescent brain.

There are some ongoing studies trying to fill the evidence gap of long-term data, both for puberty blocker use and use of cross-sex hormones (estrogen or progesterone) for transition.

The Tavistock and Portman NHS Foundation Trust was recently awarded £1.3 million to help unravel some of the complexities surrounding care and treatment of children, young people, and their families experiencing difficulties with gender identity, as reported by Medscape UK.

The Tavistock and Portman Trust said it wanted to explore some key questions surrounding the issue, including whether early transition was always helpful for gender diverse young people, at what age physical interventions should be considered, and how young people in that position could be best supported.

And the National Institutes of Health is funding a 5-year, multicentre study to the tune of $5.7 million — the first of its kind in the United States — which aims to evaluate the long-term outcomes of medical treatment in transgender youth.

According to the University of California, San Francisco, their center is recruiting 280 young people seeking relief for gender dysphoria and experience negative effects such as anxiety, depression, and substance abuse.

Young children in early puberty will receive hormone blockers and older adolescents will received cross-sex hormones to transition. In the younger participants, bone health will be investigated in addition to other parameters.

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