Exclusive: NHS drafts stricter oversight of care for young trans people

LONDON, Oct 14 (Reuters) – England’s National Health Service has drafted new guidelines for the treatment of transgender young people which would call on local authorities to be alerted in certain cases where young people have been granted puberty blockers and hormone treatments in the private market, according to a copy of the guidelines reviewed by Reuters.

The guidelines are part of a wider review of the treatment of young transgender people who seek NHS care. The current approach, which may include medical interventions, has been criticized by some practitioners who said it was rushing people to medication, and by families who complained the service could not handle the growing demand fast.

Asked about the project by Reuters, the NHS declined to comment on its content. The service previously said it would soon share its draft guidelines with the public to allow for comments and revisions. He says the changes are needed to provide timely care to young people seeking medical help, while ensuring the system is robust and treatments are safe.

The draft prepared by NHS England seen by Reuters stressed that “there is now an urgent need” to finalize guidelines and help get new services in place for young transgender people “as soon as possible”. It was briefly uploaded to the NHS England website at the end of September, with plans for a 45-day public comment period, but later deleted. An NHS spokesperson declined to say why, or when a finalized, more comprehensive version will be made public.

In England, a years-long wait for gender care has led some young people to seek medication from unregulated online pharmacies or privately. These include therapies that block the onset of puberty or hormone treatments for the elderly, which are used to help transgender adolescents develop secondary sex characteristics aligned with their gender identity. GenderGP, a private provider of treatments for transgender patients, told Reuters it had prescribed such drugs to hundreds of young people.

The draft guidance says that if NHS professionals decide a patient should not take puberty blockers or privately obtained hormone treatments, they can advise the patient’s primary care physician to initiate ‘backup protocols’ .

The draft does not specify why safeguard measures would be taken or what this would entail. But according to NHS protocols, “safeguard teams” are made up of representatives of the police, medical and social service professionals responsible for ensuring the safety and well-being of a child.

The NHS has previously said it “strongly discourages” people from sourcing gender-affirming medicines online from suppliers who are not regulated in the UK.

“No one should buy illegal, unknown and life-threatening medicines online,” NHS England medical director Dr Stephen Powis said in a statement earlier this week.

Cleo Madeleine, spokesperson for Gendered Intelligence, a national transgender-led charity that provides training, support and policy advice, said the charity did not wish to comment directly on the draft document. Any new guidance must avoid an “overhaul” of the current system, which has “so many administrative hurdles and capacity issues that it has become unsustainable”, she said.

“It is crucial that new services focus on … facilitating access to treatment and support rather than leaving young people and their families in limbo,” she said.

Other changes in the draft guidelines include: allowing only NHS professionals to refer young people to gender care, providing teams with wider professional expertise within clinics and requiring meetings between referring staff and a clinic to determine if gender clinics are the best route to treatment.

There is currently only one gender care clinic for minors in England, the London-based Tavistock and Portman NHS Foundation Trust, which declined to comment on the planned changes. Referrals to Tavistock jumped to more than 5,000 patients in the last financial year, from 210 a decade ago, according to NHS data. The wait time to see gender care professionals is now around three years.

In July, after an independent review asked England to offer regional services, the NHS said it would initially move gender care from Tavistock to two clinics, in London and in the north -west of England, to operate under the new guidelines.

Gender-affirming care can include social transition, which recognizes a child’s preferred name, pronouns, and dress. A growing number of young teens are also seeking puberty blockers and hormone treatments, according to a Reuters study of US data.

Medicines used in the UK are prescribed “off label”, which means they are not authorized for gender care. The lack of long-term scientific evidence on how to help transgender youth has contributed to a highly politicized struggle in many countries.

Prime Minister Liz Truss has repeatedly said that children under 18 should not be allowed to make “irreversible” decisions about their gender identity.

Reporting by Jennifer Rigby in London; Edited by Michele Gershberg and Sara Ledwith

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