After conducting a systematic review of evidence, England’s National Health Service has proposed new guidelines for treating trans-identifying youth, abandoning their previous endorsement of the “gender-affirming” model of care for a more cautious approach to treating gender dysphoria in minors.
The NHS now recognizes that children and adolescents identifying as transgender may be experiencing a “transient phase” and warns that doctors should not encourage them to change their names and pronouns, as “social transition” is not a “neutral act” and could have “significant effects” in terms of “psychological functioning.”
The new guidelines “reflect evidence that in most cases gender incongruence does not persist into adolescence” for young children. The guidance states that instead of encouraging transition, physicians should take “a watchful approach,” directly contrasting the American Academy of Pediatrics’ 2018 policy, equating “watchful waiting” with a “harmful” form of “conversion therapy.”
The NHS guidelines indicate that services will now be led by medical doctors rather than therapists, and will consider the impact of autism and other common co-occurring mental health issues. The new guidance also bans the use of puberty blockers in patients under 18, making exceptions only in certain cases for strict clinical trials.
The new guidelines are set to replace the controversial protocol administered by the now-shuttered Tavistock gender clinic that “affirm” a child’s self-reported transgender identity and prevent medical professionals from exploring possible underlying factors causing their dysphoria.
The “case for change” marking their abrupt deviation from their previous approach is indicated by the “significant and sharp rise in [gender clinic] referrals” and “scarce and inconclusive evidence to support clinical decision-making.”
According to the most recent data released by the Gender Identity Development Service (GIDS) at the U.K.’s Tavistock Centre, child and adolescent referrals have doubled compared to the previous year. GIDS now estimates 5,000+ children and adolescents sought gender-related services in 2021-2022, a 112% increase from 2020-2021.
The Society of Evidence Based Gender Medicine (SEGM), an international group of over 100 clinicians and researchers, released a report on Monday outlining the key highlights of the new NHS guidelines.
“The new NHS guidelines represent a repudiation of the past decade’s approach to management of gender dysphoric minors,” said SEGM. “The ‘gender-affirming’ approach, endorsed by WPATH and characterized by the conceptualization of gender-dysphoric minors as ‘transgender children’ has been replaced with a holistic view of identity development in children and adolescents.”
“With the new NHS guidance, England joins Finland and Sweden as the three European countries who have explicitly deviated from WPATH guidelines and devised treatment approaches that sharply curb gender transition of minors,” SEGM added. “Psychotherapy will be provided as the first and usually only line of treatment for gender dysphoric youth.”
The new guidelines make no mention of gender-related surgeries, but as SEGM notes, surgery has never been a covered benefit under England’s NHS for minors. And although the NHS has not made an explicit statement about cross-sex hormones, they have indicated that they will likely be restricted to clinical trials.
