Evidence for Children’s Gender Care ‘Remarkably Weak’: UK Review

Dr. Hilary Cass, Chair of the Independent Review of gender identity services for children and young people, submitted a report to England’s National Health Service (NHS) regarding gender-related medical care for minors.

“There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop,” she wrote.

Discussing “gender care” for minors and young adults, Cass wrote there is “remarkably weak evidence” for transitions.

“This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint,” Cass explained. “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

The report follows a surge in children and young people being referred to the NHS for gender issues.

Between 2009 and 2016, the number of adolescent females referred to the NHS Gender Identity Service (GIDS) rose. The number of adolescent males referred to GIDS increased from 24 to 426 during that same period.

Only 2 female children were referred to gender identity services in 2009, but 138 were referred in 2016. Ten male children were referred in 2009, and 131 were referred to GIDS in 2016.

Cass added that the rise in transgenderism may be attributed to greater acceptance of gender identity struggles.

“A common explanation put forward is that the increase in presentation is because of greater acceptance. While it certainly seems to be the case that there is much greater acceptance of trans identities, particularly among younger generations, which may account for some of the increase in numbers, the exponential change in referrals over a particularly short five-year timeframe is very much faster than would be expected for normal evolution of acceptance of a minority group,” the report states.

The report recommended that children and young people referred to the NHS undergo a “holistic assessment” that informs an “individualised care plan.”

A “holistic assessment” includes “screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” the report states. “The framework should be kept under review and evolve to reflect emerging evidence.”

Last month, England’s NHS announced that it was ending its distribution of puberty blockers for minors.

“NHS England has carefully considered the evidence review conducted by NICE (2020) and has identified and reviewed any further published evidence available to date,” a report states. “We have concluded that there is not enough evidence to support the safety or clinical effectiveness of PSH to make the treatment routinely available at this time.”

The withdrawal of puberty blockers comes as an investigation revealed that the drugs are ineffective treatments for gender dysphoria.

“In January 2020, a Policy Working Group (PWG) was established by NHS England to undertake a review of the published evidence. As part of this process, the National Institute for Health and Care Excellence (NICE) was commissioned to review the published evidence on Gonadotrophin Releasing Hormone Analogues (GnRHa). Nine observational studies were included in the evidence review (NICE 2020),” the report explains. “Overall, there was no statistically significant difference in gender dysphoria, mental health, body image and psychosocial functioning in children and adolescents treated with GnRHa (2020). The quality of evidence for all these outcomes was assessed as very low certainty using modified GRADE. There remains limited short-term and long-term safety data for GnRHa.”