National Health Service in England announced On Thursday, it announced it was closing the nation’s only youth sex clinic in favor of a more widespread and comprehensive network of medical care for adolescents seeking hormone and other sex treatments.
The closure came after an external review of the Tavistock clinic in London, which has served thousands of transgender patients since the 1990s. reviewongoing, long waiting times, inadequate mental health support and increasing number of young people seeking sex treatments.
The overhaul of services for transgender youth in the UK is part of a remarkable shift in medical practice in some European countries with nationalized health systems. Some doctors out there are concerned that the numbers are rising, along with the lack of data on the long-term safety and consequences of medical transitions.
In the United States, doctors specializing in gender care for adolescents have mixed feelings about reforms in Europe. While many agree that more comprehensive healthcare for transgender youth is sorely needed, they worry that the changes will fuel the growing political movement in some states to ban such care altogether, despite more work being done on treatments.
“How do we draw the line to individualize care while maintaining safety standards for everyone? We’re trying to figure that out,” said Dr. Marci Bowers, a gynecological and reconstructive surgeon and the new president of the World Professional Association for Transgender Health, who is transgender. “It’s the people on the ground that need to make these decisions, not the people in Washington or state legislatures.”
The NHS said existing patients at the Tavistock clinic could continue to receive care there before being transferred to two new centers at children’s hospitals in London and Manchester. The new clinics will expand the nation’s gender services while ensuring that children are adequately treated for autism, trauma and mental health issues. Experts will also conduct clinical trials on sex drugs.
Dr. Hilary Cass, head of external audit of the nation’s youth gender identity services, said: letter To the head of NHS England last week.
Largely reversible, puberty blockers aim to give young patients time to make important decisions about permanent medical changes. But Dr. Cass questioned whether most adolescents who were prescribed these drugs were given the support to reverse the course if they wanted to.
Tavistock received more than 5,000 patient referrals in 2021, up from 250 in 2011 alone. The types of patients seeking referral have also changed over the past decade. When the clinic opened, it primarily catered to children assigned as male at birth. two-thirds last year patients appointed woman at birth.
It is not clear why the number of patients has increased so sharply or why trans boys are driving this increase.
Transgender advocates in the UK have welcomed the changes, but stressed that many questions still remain over how it will affect young people’s care.
“We’re optimistic about the news, we’re cautiously optimistic,” said Susie Green, CEO of Mermaids, an advocacy group for transgender and gender-diverse youth. “There’s a two-and-a-half-year waiting list to be seen for your first date. That’s why we saw the plight of young people,” she said.
But Green, who has a female transgender adult daughter, said the group was concerned about whether mental health services should be prioritized over medical care. She said that gender diversity should not be viewed as a mental disorder.
“We don’t want any more barriers to accessing medical care,” said Ms. said green.
In 2020, Keira Bell, a former patient at Tavistock, participated in a publicized lawsuit against the clinic. HE alleged She said she was put on puberty blockers at age 16 “after a series of superficial conversations with social workers” and had her breasts removed at age 20, decisions she later regretted.
A supreme court initially ruled that children under the age of 16 were not mature enough to consent to such medical interventions. But that decision was reversed in September of last year when judges decided “it’s up to the clinicians rather than the court” whether a young patient can provide informed consent.
in 2020 employees At Tavistock, she raised concerns about medical care at the clinic, and the NHS’s Dr. Cass, a non-clinical pediatrician in London, for an external review. his interim report released in February of this year.
Sweden’s national health service determined this year that gender-related medical care should be provided to young people only in exceptional cases where children have a marked problem with their gender, known as dysphoria. All adolescents undergoing treatment will need to enroll in clinical trials to gather more data on side effects and long-term outcomes. Finland took a similar stance last year.
“Our position is that we can’t just see it as a matter of rights,” Thomas Linden, director of the nation’s National Board of Health and Welfare, said in an interview in February. “We have to see patient safety and certainty in the decision. We really have to make sure to some degree that we are giving the right treatments to the right person.”
While these European countries have set some limits on transgender care, their approach is much more tolerant than some conservative US states. AND latest Alabama law made it a crime for doctors to prescribe puberty-blocking drugs and hormones to minors. In Texas, parents who allow their children to receive sex therapy child abuse investigation. both states They are tied in court battles with civil rights groups.
Some American doctors worry that changing standards in Europe will reinforce the idea that sex treatments are dangerous for young people.
“My fear is that this could be interpreted as another notch against providing gender-affirming care to children,” said Dr. Angela Goepferd, medical director of the Gender Health Program at Children’s Minnesota hospital. They said they needed more services, not less. “That’s our struggle here.”
