Closure of UK gender clinic does not mean change needed in Australia

The treatment of children and adolescents experiencing gender dysphoria is back in the news following the closure of a prominent gender clinic in the UK. This has led to much commentary about how to best help transgender youth, and whether this will affect how gender clinics operate in Australia.

The Gender and Identity Development Service (GIDS), run by the Tavistock and Portman NHS Trust – the only children’s gender clinic in the UK – was closed after it was criticised in an independent review led by paediatrician Dr Hilary Cass. The report found that the rapid increase in the number of children requiring support and the complex case-mix, including neurodiverse young people and those with mental health needs, meant that the current clinical model, with a single national provider, is not sustainable in the longer term.

The treatment of children and adolescents experiencing gender dysphoria is back in the news following the closure of a prominent gender clinic in the UK.Credit:iStock

The review also found the clinic did not have consistent data collection, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service; there was lack of open discussion amongst staff about the appropriate clinical response; and because the specialist service had evolved rapidly in response to demand, the clinical approach and overall service design had not been subjected to usual quality controls.

On face value, and without taking the time to read the review, it would be easy to interpret this as a condemnation of children’s gender clinics in general. However, I submit that this is not an accurate evaluation.

The most compelling statement in Dr Cass’s interim review was that the Tavistock clinic was failing in its prime objective – to see young people in a timely fashion and assess their needs regarding gender. The major issue was the unacceptable time young people languished on the up to two-year waiting list.

There has indeed been a large increase in the number of young people being referred to gender clinics worldwide (the number of referrals to Tavistock jumped from 250 to 5000 over a decade to 2021). There are several reasons for this, including greater trans visibility, increased societal acceptance and awareness of gender diversity, and consequently better recognition and understanding by young people of their own gender identity. The single specialist provider model of the Tavistock clinic, overwhelmed and underfunded, cannot hope to meet this demand or serve its clients well.

In her review, Dr Cass recommended a fundamentally different service model – one that is decentralised and has multiple local and regional hubs, with strong links to local services, such as mental health and GPs. This represents an expansion of gender services, and signals a positive shift in how the NHS will deliver services to trans youth.

This decentralised model of care is already being adopted in various states in Australia, including Queensland, NSW and Victoria – in other words, we are already doing what Cass has recommended. An example is Maple Leaf House in Newcastle, a multidisciplinary service for trans youth, affiliated with John Hunter Hospital.

Cass also had concerns about the use of puberty blockers, citing the lack of research, but ignoring the decades of experience and widely held consensus amongst organisations outside the UK, such as the American Academy of Paediatrics, the Endocrine Society, the World Professional Association for Transgender Health and the Australian Professional Association for Trans Health (AusPATH).

Her advice was that research protocols be put in place to collect long-term data on outcomes for trans and gender diverse young people receiving puberty blockers and hormones. Several Australian children’s gender clinics are already doing this.

Let me bring you back to the most important concept here – we are talking about the health and wellbeing of young people. We have ample published evidence that shows access to gender-affirming care leads to improved health, especially mental health.

The Trans Pathways report, published in 2017, is the largest study conducted on the mental health of trans young people in Australia and found this group experiences extremely high rates of poor mental health and self-harm, and that almost half of all trans youth have attempted suicide. This is a shocking statistic. Most of these young people felt isolated from medical services and felt that their providers did not understand or respect their gender identity.

Critics who are sceptical of providing gender-affirming care for children portray young gender-diverse people as confused, and gender affirmation as a negative thing which forces young people down a path to transition. They use stories of people who regret their decision to transition as evidence of the dangers of affirming therapy. But true regret, whilst unfortunate, is rare.

In fact, affirmation does not force anything on anyone. It does not push blockers or hormones. It’s simply the process of supporting and allowing a young person to express themselves and their gender identity by using different names and pronouns, choosing how they dress, and avoiding irreversible physical changes of puberty if they wish. In my professional career, I’ve met many hundreds of older trans people who were denied this opportunity as children, and have suffered throughout their lives as a result.

So, what are the implications of the Tavistock closure for Australia? Really, it just vindicates that the gender clinics here are on the right track, working towards changing their service model to better meet the needs of their patients.

There is no doubt – gender affirmation is not only evidence-based, it is vital, life-changing and life-saving.

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