NHS Drafts Stricter Guidelines For Trans Youth Care
October 18, 2022The National Health Service in England has drafted new guidelines for treating trans youth that would call for local authorities to be alerted in some cases where young people have obtained puberty blockers and hormone therapies on the private market, according to a copy of the guidelines reviewed by Reuters.
The guidelines are part of a review of treatment for young transgender people. The current approach, which can include medical interventions, has been criticized by both practitioners, who said it rushed people onto medication, and by families, who complained the service could not manage fast-growing demand.
The NHS has declined to comment on the draft guidelines. It said it would soon share its preliminary guidelines with the public to allow for feedback and revision. The changes are necessary, the NHS said, to provide timely care for young people who seek medical help, while ensuring that the system is robust and treatments safe.
The draft stressed that “there is now an urgent need” to finalize the guidelines and help set up new services for transgender youth “as quickly 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 removed. An NHS spokesperson declined to say when a finalized version will be made public.
In England, the wait for gender care has led some young people to seek medications from unregulated online pharmacies, or seek treatment privately. These include puberty blockers or hormone treatments for older people, which are used to help transgender adolescents develop secondary sexual characteristics aligned with their gender identity. GenderGP, a private provider of treatments for transgender patients, told Reuters it has prescribed such medications to hundreds of youth.
The guidelines suggested that if NHS professionals decide a patient should not be taking puberty blockers or hormone treatments obtained privately, they can advise the patient's primary care doctor to initiate “safeguarding protocols.” Under NHS protocols, “safeguarding teams” are made up of representatives of the police, medical, and social services professionals who are responsible for ensuring a child's safety and wellbeing.
The NHS has previously said it “strongly discouraged” people from sourcing gender-affirming medications online from providers that are not regulated within the UK. “No one should be purchasing illegal, unknown and potentially life-threatening drugs online,” said NHS England medical director Dr. Stephen Powis in a statement earlier this week.
The drugs used in the UK are prescribed “off-label,” which means they are not licensed for gender care. A lack of long-term scientific evidence around how to help transgender youth has contributed to a highly politicized fight in many countries.
A spokesperson for Gendered Intelligence, a national transgender-led charity which provides training, support and policy advice, said the charity did not want to comment directly on the draft document. Any new guidelines must avoid a “rehash" of the current system, which has “so many administrative barriers and capacity issues that it became unsustainable,” Cleo Madeleine said. “It is crucial that the new services focus on […] actually facilitating access to treatment and support rather than leaving young people and their families in limbo.”
Other changes in the draft guidelines include allowing only NHS professionals to refer youth for gender care, proposing teams with wider professional expertise within the clinics, and requiring meetings between referring staff and a clinic to establish if gender clinics are the best route for treatment.
Currently, there is one gender care clinic for young people in England. The London-based Tavistock and Portman NHS Foundation Trust declined to comment on the planned changes to the guidelines. Referrals to Tavistock have surged to more than 5,000 patients in the most recent financial year from 210 a decade ago and he wait time to see gender care professionals is now about three years.
After an independent review called for England to offer regional services, the NHS said in July that it would move gender care away from Tavistock to two clinics, one in London and one in north west England.
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