The NHS England is demanding data from adult gender clinics in response to a landmark independent review which found there is “very limited evidence on the longer-term outcomes” associated with the medicalized transition of minors.
The NHS England commissioned an independent review of gender-related medical services for minors and young adults in 2020. The final report, released on Wednesday, found that previous studies on the topic are of “poor quality.”
“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Hilary Cass, the former president of the Royal College of Paediatrics and Child Health who led the review, wrote in the introduction.
The Cass Report notes the lack of available data in addition to poor quality studies.
“One of the most problematic data gaps for the Review has been trying to obtain robust data on the numbers of young people who go on to a hormone pathway at GIDS [NHS Gender Identity Service], and what care pathways or interventions are available for those who do not,” the report states. “This seems unacceptable in the digital age.”
In response to the report, the NHS sent a letter to the seven trusts that host adult gender clinics in the U.K. informing them that they’re being investigated.
“We will be launching a review into the operation and delivery of the adult GDCs [gender dysphoria clinics], alongside the planned review of the adult gender dysphoria service specification,” reads the letter, obtained by the Guardian.
The Cass Report states that six of the seven NHS adult clinics for gender-related care in England declined to participate in a study by the University of York.
“These data would have provided children and their families with vital information on the different options for managing gender related distress and provided evidence for clinicians and policy makers delivering services for these children and young people,” reads an appendix in the Cass Report. “Ultimately, the study was not carried out, as the cooperation of all adult gender identity clinics could not be secured.”
Some of the clinics declined to participate because “the study outcomes focus on adverse health events, for which the clinics do not feel primarily responsible” and “the unintended outcome of the study is likely to be a high-profile national report that will be misinterpreted, misrepresented or actively used to harm patients and disrupt the work of practitioners across the gender dysphoria pathway,” according to the Cass Report.
“It is disgraceful that adult gender clinics have not cooperated with the vital University of York research to link data on children at the Tavistock so that we can understand their journey into adulthood,” Victoria Atkins, the U.K. Health Secretary, wrote in The Telegraph.
Atkins added that she has written to the chief executive of NHS England to emphasize “the need for swift delivery across Dr Cass’s recommendations.”
The NHS’s Gender Identity Development Service (GIDS) was established in London in 1989, and later moved to the Tavistock and Portman NHS Foundation Trust. In 2018, ten GIDS clinicians concerned about the treatment of children approached psychiatrist Dr. David Bell, who worked in adult services at the Tavistock clinic; Bell released a whistleblowing report that year. The NHS England announced its intention to close the Tavistock clinic in 2022.
The Cass Report cites that, from 2009 to 2016, the number of adolescent females referred to GIDS rose from 15 to 1071, and the number of female children referred rose from two to 138. Meanwhile, the number of adolescent males rose from 24 to 426, and the number of male children rose from ten to 131. Prior to 2009, GIDS saw fewer than 50 children a year, and even fewer underwent medical procedures.