I generally find the news overwhelming, depressing and unhelpful these days, so I only minimally keep up with it, but this morning I somewhat belatedly learned, through my parents’ copy of The Week (issue 1395, p. 17) of the upcoming closure of GIDS (the Gender Identity Development service, the NHS’s provision for trans people under the age of 18) following a report by Dr. Hilary Cass (NB: this does not mean trans young people will be left without access to care; see end of post). The Week generally shares multiple viewpoints on a story, but in this article offers more than twice the amount of column-space to those who are delighted by this news. Many seem to be celebrating this as cutting off children’s access to gender-affirming healthcare (which should actually be a huge concern, given what we know about the way access to gender-affirming healthcare improves mental health for young trans people). The article, and therefore presumably the articles it quotes and paraphrases, are full of the usual misinformation and I feel duty- and moral-bound to challenge it.
Puberty Blockers
The Week summarises a Times article saying that the Cass report suggests GIDS “had recklessley prescribed puberty blockers to many children”. In fact, although the report notes that the long-term effects of puberty blockers are under-researched, it contains no criticism of GIDS for having prescribed them. In addition, it states that “[i]n 2019, GIDS reported that about 200 children and young people from a referral base of 2,500 were referred on to the endocrine pathway” (puberty blockers and hormones) – less than 10%. This is in contradiction to the argument that GIDS mindlessly places patients on a conveyor belt through medical transition with no thought for the individual case.
Suzanne Moore in the Daily Telegraph claims that (paraphrased by The Week) “[c]hildren were put on an irreversible medical pathway (puberty blockers, cross-sex hormones, double mastectomies)”. As well as again neglecting to mention that this applied to fewer than 10% of the children referred to GIDS, this suggests that once children begin puberty blockers, they are trapped on a journey to hormones and surgery. The Cass report notes (p.38) that 96.5-98% of children and young people who are treated with puberty blockers go on to have hormone therapy, but also that the reasons for this “need to be better understood”. While it is possible young people get “locked-in” to a treatment pathway, it’s also possible that the diagnostic criteria are working and the young people who get given puberty blockers are the young people who want and need hormone therapy further down the line. It could as much be a sign that GIDS’s system was working exactly as it should as it could be the opposite.
Due Diligence
The Times article goes on to claim, according to The Week, that “[i]t seems the institution had been captured by a clique of trans activists, who accepted declarations by children that they were born in the wrong gender at face value, ignoring other possible explanations, and seeing any dissenting opinion as a form of bigotry”. This viewpoint is not supported or endorsed by the report, which acknowledges that the system was overwhelmed by rapidly increasing referrals and this was the main factor that had “severely impacted on the capacity of the existing service to manage referrals in the safe and responsive way that they aspire to” (p.32).
Meanwhile, Dr. David Bell in The Mail on Sunday claims that it wasn’t just about waiting lists and suggests that Cass’s conclusion that GIDS could not provide a “safe or viable” service (p.69) was a reflection on the service’s ideology and intent to medicalise trans young people. However, the point that Bell quotes above explicitly states this is a result of increased demand on a single specialist provider, as well as gaps in peer-reviewed research (again, note that this refers to the evidence base for treatments being small, not that there is no evidence nor that there is a preponderance of contrary evidence).
As ever, much of the discussion comes back to detransitioners (people who begin gender transition and then, for whatever reason, change their minds) – it was a court case brought against GIDS by Keira Bell, who regretted her transition, that brought the issue to the public. Dr. Bell states that “[c]hildren with complex problems – autism, abuse, trauma, depression -” were being directed towards gender transition rather than those other factors (the description of autism as a “problem” raises a lot of red flags) being addressed. He adds “[m]any were simply gay, but confused”. While a small number of trans people do detransition (see table below), that does not mean that any comorbidities or neurodivergences invalidate a person’s gender identity. It is also disingenuous to suggest that a lack of support for other factors is a separate issue from service overload at GIDS – a service with increased capacity (and a better-supported and more accessible CAMHS service) would allow for additional support such as counselling to be provided.
It is also very worth being aware of the reasons why people detransition (table from p111 of this report) – it is very rarely because they realised they were wrong about their identity or their treatement):
Going Forward
Dr. Cass herself has stated, in response to the public reaction to her report, that it was not intended to “shut down” access to treatment or to suggest wrong-doing by the staff at GIDs: “The staff working at GIDS have demonstrated compassion and a strong professional commitment towards their patient population … Advancement in medicine is all about reducing uncertainty and risk through research, clinical experience, peer review and clinical networks.” The intention of the review was not to remove access to trans healthcare for under-18s, but to improve it and to actually make it more accessible through the creation of regional hubs, which should “be developed, as soon as feasibly possible, to become direct service providers, assessing and treating children and young people who may need specialist care” (p.21).
I hope this increased emphasis on evidence-informed care for trans young people carries through to the general population so that we will see less and less of the inflammatory and inaccurate reporting that currently surrounds the subject.
For those interested in this subject, a thread of research supporting access to healthcare for trans young people can be found here:
Trans Teacher 
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