Britain’s National Health Service this month began restricting sex-specific treatments for children, becoming the fifth country in Europe to restrict the drug, citing a lack of evidence about its benefits and concerns about long-term harm.
Changes in England were the result of four years review The announcement was made Tuesday night by independent pediatrician Dr. Hilary Cass. “For most young people, health care is not the best way to address gender-related distress,” the report concludes.related Editor Published in a medical journal, Dr Kass said the evidence that gender treatment in young people is beneficial is “built on shaky foundations”.
The NHS will no longer offer puberty-blocking drugs, except to patients enrolled in clinical studies. The report recommends “extreme caution” when prescribing hormones such as testosterone and estrogen to minors that promote permanent physical changes. (This guideline does not apply to medical practitioners who are healthcare professionals) small portion of population)
The UK move is part of broader changes in Northern Europe, where health authorities are concerned about a surge in demand for gender treatment among adolescents in recent years. Many patients also have mental health conditions that make it difficult to identify the root cause of their distress, known as dysphoria.
In 2020, Finnish health authorities recommended psychotherapy as the main treatment for adolescents with gender dysphoria, restricting treatment. Two years later, Sweden limited hormone treatment to “exceptional cases”.
In December, Norway’s regional health authorities designated gender medicine for young people as an “investigational treatment.” This means that hormonal drugs are only prescribed to young people during clinical trials. And in Denmark, new guidelines Due to be finalized this year, hormone treatment will be limited to transgender youth who have experienced dysphoria from an early age.
Several European transgender advocacy groups have condemned of change, argued that it violates civil rights and exacerbates the problem of an overstretched health care system. Around 5,800 children were on waiting lists for gender services in England at the end of 2023, according to the NHS.
“Waiting lists are known to be hell,” said N, a 17-year-old transgender boy from the south of England who asked that his full name not be used to protect his privacy. He was on the waiting list for five years, during which time he was diagnosed with autism and depression. “On top of the transgender panic that our government is promoting, we feel forgotten and left behind,” he said.
In the United States, Republican politicians have cited the backlash in Europe to justify legislation against gendered health care for young people. But the European policy differs markedly from the outright bans on juveniles passed in 22 U.S. states, some of which threaten doctors with prison terms and investigate parents for child abuse. There is also. European countries continue to allow gender-specific treatments for certain adolescents and mandate new clinical trials to study and better understand their effectiveness.
“We are not banning treatment,” said Dr. Mette Ewers Haar, a psychiatrist leading Denmark’s only treatment. Copenhagen Youth Gender Clinic. Effective treatment requires consideration of human rights and patient safety, she said. “You have to weigh both.”
In February, the European Academy of Pediatrics Admitted Concerns about gender medicine among young people. “The fundamental question of whether biomedical treatments for gender dysphoria (including hormone therapy) are effective remains controversial,” the group wrote. In contrast, the American Academy of Pediatrics last summer said hormone therapy is essential and should be covered by health insurance companies, reaffirming its support for the treatment and commissioning a systematic review of the evidence.
Europeans pioneered the use of gender therapy for young people. In the 1990s, an Amsterdam clinic began administering puberty-suppressing drugs to young people who had identified as a different gender from an early age.
Doctors in the Netherlands reasoned that puberty blockers could give young patients with gender dysphoria time to explore their identity and decide whether to continue taking hormones to eventually transition. . For patients facing male puberty, the drug helps prevent physical changes, such as a deeper voice or thicker facial hair, that can make it more difficult to live as a woman in adulthood. It will prevent it. A study first published in 2011 by a team of Dutch researchers that followed a carefully selected group of 70 young people found that the combination of puberty blockers and therapy improved psychological functioning.
This study was so influential that clinics around the world began to follow the Dutch protocol.introduction to these clinics It started to increase rapidly around 2014, but the numbers are still small. For example, in a clinic in Sweden, the number of referrals increased from about 50 in 2014 to 350 in 2022. In the UK, the number of referrals increased from 470 in 2014 to 3,600 in 2022.
clinic World wide report that The increase is roughly driven By patients who were raised as girls. And unlike the participants in the original Dutch study, many of the new patients did not experience gender troubles until adolescence and had other mental health conditions such as depression and autism.
Given these changes, some clinicians question whether the initial Dutch study results are relevant for today’s patients.
“Based on research, thousands and tens of thousands of young people are being treated with this treatment all over the world,” she says, who has led a youth gender program in Finland since 2011. vocal music critic Of care.
In Dr. Cartiara’s own research, approximately 80% of Patients at a Finnish clinic Born female, she began experiencing gender issues in late adolescence. Many patients also have psychological problems, not helped She discovered hormone therapy. In 2020, Finland strictly restricted drug use.
Around the same time, the Swedish government Rigorous research review The evidence for hormone therapy in young people was found to be “insufficient”. In 2022, Sweden recommended hormones only in “exceptional cases”. Quote In part, there is uncertainty about how many young people will choose to discontinue or reverse their medical transition (known as detransition) in the future.
Even the original Dutch clinic is facing pressure to limit the number of patients it can treat. Open to the public in December documentary A series of studies in the Netherlands questioned the basis of the treatment. And in February, months after far-right parties won a landslide election victory in a country long known as socially liberal, the Dutch parliament passed a resolution to conduct a study comparing the current Dutch approach with that of other European countries. did.
“I wish the Netherlands were an island,” said Dr. Annelou de Vries, a psychiatrist who led the original study in the Netherlands and now heads a clinic in Amsterdam. “But, of course, we’re not like that. We’re part of a global world, too. So in a sense, if everyone is starting to get concerned, that naturally extends to our country as well.” Masu.”
In the UK, 10 clinicians at the NHS’s only youth gender clinic, known as the Tavistock Gender Identity Development Service, Formally complained They said they felt pressure to quickly approve the use of puberty blockers, including for children with serious mental health problems.
In 2021, Tavistock clinicians: study A study of 44 children who took puberty blockers showed different results from the Dutch. Patients who received the drug had, on average, no effect on their psychological functioning.
Although the drugs did not reduce the severity of self-harm thoughts or discomfort, the adolescents were “very excited to be able to take a blocker,” clinic director Dr. Polly Carmichael said in 2016. He said this in his lecture. meeting. And 43 of 44 study participants later chose to start testosterone or estrogen, raising questions about whether the drugs were serving their intended purpose of giving adolescents time to consider whether a medical transition was right for them. occurred.
In 2020, the NHS asked Dr Cass to conduct an independent review of the treatment.she requested scientific review and considered International guidelines Of care. She also met with young people and their families, transgender adults, detransitioned people, advocacy groups, and clinicians.
The study found that the standard of care on the NHS is inadequate, with long waiting lists for drug treatment and few routes to address mental health concerns that may be contributing to gender distress. I concluded that no. While the NHS closed the Tavistock Center last month and opened two new youth gender clinics, Dr Cass said she would like to see more support for people with autism, depression and eating disorders, as well as support for young people exploring He said a “holistic” approach should be taken, with psychotherapy to help. their identity.
“Children and young people are truly badly served,” Dr. Cass said in the paper. interview A conversation with the editors of the British Medical Journal, released on Tuesday. She added: “I can’t think of any other field in pediatric medicine that provides irreversible treatment to young people who don’t know what will happen in adulthood.”
The changes implemented by the NHS this month are “an acknowledgment that our concerns were in fact valid,” said Anna Hutchinson, a clinical psychologist in London who was among the Tavistock staff who raised concerns in 2018. Ta. We are going to return to a more robust, evidence-based pathway for decisions about these children. ”
Some critics said Europe, like the United States, was affected by the growing backlash against transgender people.
In the UK, for example, a years-long battle over legislation that would make it easier for transgender people to change the gender on their identity cards has led to political movements to exclude transgender women from women’s sports, prisons, and domestic violence asylums. Activated.
“The intention of the Cass review was to be neutral, but I think that perhaps that neutrality has shifted,” said Laurence Webb, director of British trans youth advocacy group Mermaids. “Extremist views have become more normalized.”
Other countries have also seen open attacks on transgender rights and healthcare. Hungarian Parliament 2020 passed it A law that prohibits changing gender identity in legal documents.Last year, Russia Banned It also includes legal gender change and gender-related medical care, with one lawmaker describing gender surgery as a “road to national decadence.”
In France this year, a group of conservative parliamentarians introduced The bill would ban doctors from prescribing puberty blockers and hormones, and would impose a two-year prison sentence and a fine of 30,000 euros (about $32,600). And on Monday, the Vatican condemned gender reassignment as a threat to human dignity.
