The UK National Health Service recently made a significant change in their approach to caring for children with gender dysphoria, releasing new “service specifications” that emphasize psychotherapy rather than medical interventions. The NHS previously implemented the “affirmative care” model, which involved diagnosing a child with “gender dysphoria” based on the child’s self-report, affirming the child’s new, desired identity, and referring children for medical interventions such as puberty blockers and hormone therapy.
A pediatric review (the “Cass Review”) conducted, beginning in 2020, proved to be the catalyst for this change. The Cass Review was developed to analyze the NHS’s treatment of care towards children with gender dysphoria. It concluded that the standard practice of “affirmative care” was “neither safe nor sustainable in the long term.”[1] England now joins Finland and Sweden “as the three European countries who have explicitly deviated from WPATH guidelines and devised treatment approaches that sharply curb gender transition of minors.”[2]
This change in the UK might seem sudden or unexpected but has been developing for some time. According to the Society for Evidence Based Medicine (SEGM), four reasons drove the restructuring of gender services, including: “a significant and sharp rise in referrals; poorly-understood marked changes in the types of patients referred; scarce and inconclusive evidence to support clinical decision-making, and operational failures of the single gender clinic model.”[3]
As the NHS begins to structure their formal program, they have implemented an Interim Service Specification that outlines their plan to take a more “integrated approach” to gender dysphoric children, prioritizing psychotherapy.
In the program, patients will undergo a “multidisciplinary assessment” that allows medical professionals to conclude a diagnosis, gender incongruence or gender dysphoria they are not interchangeable), and develop the best type of intervention.[4] This team of experts will include “gender dysphoria specialists, [as well as] experts in pediatric medicine, autism, neurodisability, and mental health,”[5] who will assess the child’s needs on an individual basis by evaluating previous health issues, including autism, mental health, and other disabilities. The Interim Service Specification report states “a significant proportion of children and young people who are concerned about or distressed by issues of gender incongruence experience co-existing mental health, neuro-developmental and/or family or social complexities in their lives.”[6] Using psychotherapy as the primary treatment allows for children to properly heal from any familial or mental suffering, which initially led them to seek a medical transition.
The NHS further cautions clinicians to be “mindful that this may be a transient phase, particularly for pre-pubertal children” as “medical interventions will not be considered at least until puberty has been reached.”[7] This is a step in the right direction by prioritizing mental health treatment over medical interventions. However, the prospect that the NHS will provide medical interventions later, on older, gender-dysphoric adolescents, is a continuing cause for concern.
Other notable changes in the NHS notice include cautions against “unregulated sources of puberty blocker drugs and masculinizing / feminizing hormone drugs,”[8] a welcome refocusing on biological sex, recognizing the DSM-5 definition of “gender dysphoria,” and stating, “that those who choose to bypass the newly established protocol will not be supported by the NHS.”[9]
In a recent article by the Catholic News Agency, PIP Director Mary Hasson states “The NHS decision is a critically important step in the right direction, because it recognizes the lack of evidence to support the ‘gender-affirming’ protocol, which endorses psycho-social transition, puberty blockers, hormones, and even surgery on minors.” However, there are lingering concerns because the NHS is continuing “to permit some of these medical interventions in a research setting.” Ultimately, this is still problematic because one’s biological sex cannot be changed and “any attempt to embark down a medicalized path to alter a child’s appearance and destroy or impair the body’s natural function is unjustified.”
[1] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937_iii_equalities-health-impact-assessment-interim-service-specification.pdf
[2] https://segm.org/England-ends-gender-affirming-care
[3] https://segm.org/England-ends-gender-affirming-care
[4] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937-ii-specialist-service-for-children-and-young-people-with-gender-dysphoria-1.pdf
[5] https://segm.org/England-ends-gender-affirming-care
[6] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937-ii-specialist-service-for-children-and-young-people-with-gender-dysphoria-1.pdf
[7] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937-ii-specialist-service-for-children-and-young-people-with-gender-dysphoria-1.pdf
[8] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937_iii_equalities-health-impact-assessment-interim-service-specification.pdf
[9] https://segm.org/England-ends-gender-affirming-care
