Last week in The Spectator, James Kirkup revealed that the NHS had amended its transgender guidance for children. It is unclear whether or not this is directly related to the legal challenges currently being mounted by children, parents and young adults who say that transitioning has adversely affected them, but it is certainly interesting timing.
The most significant change comes in the section on hormone therapy. The NHS guidance used to say:
If your child has gender dysphoria and they’ve reached puberty, they could be treated with gonadotrophin-releasing hormone (GnRH) analogues. These are synthetic (man-made) hormones that suppress the hormones naturally produced by the body.
The effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time…
Which is all very reassuring if you are a parent of a child experiencing gender dysphoria.
However, Kirkup points out that experts have ‘been saying for some time that we simply do not know enough about the long-term effects of GnRH analogues on children, not least since these drugs were not, in fact, formulated for this purpose.‘
The updated NHS guidance reflects that, saying:
Hormone therapy in children and young people
Some young people with lasting signs of gender dysphoria and who meet strict criteria may be referred to a hormone specialist (consultant endocrinologist) to see if they can take hormone blockers as they reach puberty. This is in addition to psychological support.
These hormone blockers (gonadotrophin-releasing hormone analogues) pause the physical changes of puberty, such as breast development or facial hair.
Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.
Although the Gender Identity Development Service (GIDS) advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.
It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones. Side effects may also include hot flushes, fatigue and mood alterations.
From the age of 16, teenagers who’ve been on hormone blockers for at least 12 months may be given cross-sex hormones, also known as gender-affirming hormones.
These hormones cause some irreversible changes, such as:
breast development (caused by taking oestrogen)
breaking or deepening of the voice (caused by taking testosterone)
Long-term cross-sex hormone treatment may cause temporary or even permanent infertility.
However, as cross-sex hormones affect people differently, they should not be considered a reliable form of contraception.
There is some uncertainty about the risks of long-term cross-sex hormone treatment.
The NHS in England is currently reviewing the evidence on the use of cross-sex hormones by the Gender Identity Development Service. [Emphases mine]
While CMF is pleased to see this considerably clearer and more accurate guidance on the NHS website, it is not clear whether the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust agrees with the concerns, or intends to change its practices around the prescription of cross-sex hormones for children.
It is likely, too, that this information may cause significant distress to patients (and their families) who have already gone through hormone treatment and are now concerned about the long-term health effects it may have. This is on top of the worrying statistics and anecdotal evidence that ‘those who have had transition surgery are 19 times more likely than average to die by suicide‘ and many experience ‘crippling levels of depression‘.
We hope that this change in the NHS guidance, the indication that NHS England is reviewing the Tavistock Centre’s use of cross-sex hormones, and the Keira Bell court case will lead to a significant reduction in the number of children rushed too quickly onto the medical treatment pathway.