The UK’s National Health System announced the shutdown of the Tavistock Gender Identity Development Service last week. The upheaval could have seismic implications for similar practices in the US, where activists have promoted “gender-affirming” care for children suffering from gender dysphoria – a condition in which the patient experiences psychological distress due to a mismatch between their physical gender and their inner feelings of man. or being a woman. Gender affirming protocols encourage patients to align their pronouns, names, and outer physical attributes with their inner feelings. Puberty blockers are said to “pause” normal physical changes as a first step toward the ultimate goal of posing as the opposite sex.
The shuttering of the London-based clinic marks a “victory” for “those who say self-proclaimed gender identity should not trump biological sex,” The Economist said after the decision was announced. “The tide in Britain seems to be turning against groups that hold the belief that gender identity trumps everything else, and towards maintaining support for sex-based rights and evidence-based medicine.”
The watchful move followed the release of a damning report by dr. Hilary Cass, former president of the Royal College of Pediatrics and Child Health, who was tasked with investigating claims and questions arising from the clinic’s gender-affirming practices, including providing puberty blockers to children as young as 10 years old. claimed that the clinic was under pressure from transgender activists to jump-start the transition process while not sufficiently considering patients’ mental health histories.
The decision to close the clinic will shift “gender care” for young people to regional children’s hospitals, where a more “holistic” approach has been recommended, and those receiving puberty blockers will be part of a formal clinical trial that will track their progress into adulthood.
In her report, Dr. Cass noted that the impact of puberty blockers on children had not been studied with sufficient scientific rigor. Did the medication “pause” puberty or serve as “a first part of a transitional trajectory?” she asked. Was brain development “temporarily or permanently disrupted by puberty blockers?” US doctors concerned about these practices have raised similar questions, even as professional medical groups have approved the practice.
dr. Paul Hruz, an American academic pediatric endocrinologist and a physician-scientist, the Registry told the Register that the European medical community had more experience developing treatment models for gender dysphoria, so the forced closure of the Tavistock clinic should be a wake-up call for U.S. physicians responding to this issue. area work.
“Treating physicians in the US need to pay attention to what’s going on in Europe,” said Dr. Hruz, “But instead of doing this, the activists are doubling down and claiming the positive approach is established as the most effective approach.”
Sue Evans, nurse and whistleblower who previously worked at the Tavistock clinic and tried to raise the alarm about the practices, said the news offered a cautionary tale about a once-prestigious clinic derailed by “activist-driven medicine.”
“Tavistock specialized in therapy—talking about patient issues—and… we generally didn’t prescribe drugs,” Evans wrote in an Aug. 4 column for Common Sense on Substack. She had expected the same approach to be used in the treatment of gender dysphoria.
Instead, “certain staff members didn’t hesitate to recommend puberty blockers — even for vulnerable children” who had other mental health issues.
In addition, “senior clinicians on the service would regularly meet with Mermaids, a transgender patient group.”
“[A]As time went on, it seemed clear that groups like Mermaids were influencing doctors and clinicians in the service – sometimes dictating the expectations of care for our patients.”
And as these activists began to push back the medical community’s long-standing view that gender dysphoria was a “mental illness,” clinicians were pressured to introduce puberty blockers more quickly.
Evans joined the clinic nearly two decades ago, when the number of young people seeking medical treatment for gender problems was small. But the numbers started to soar and then skyrocketed as social media networks encouraged young people to question and reassess their gender identity.
In 2001 there were only 250 young patients, mostly men. By 2021, there were more than 5,000, and three-quarters were teenage girls with no history of gender dysphoria.
Whistleblowers like Evans were relieved when the NHS finally took action after Dr. Cass had determined that Tavistock was not a “safe or viable long-term option” for the young patients seeking treatment.
dr. Cass confirmed that doctors and clinicians often failed to investigate and address underlying mental health issues, such as depression, autism, and histories of abuse and trauma. That failure put the patients at “significant risk” for future problems, she warned. The report noted “critically important unanswered questions” regarding the provision of puberty blockers to very young children.
It pointed to the lack of patient follow-up, which would have given clinicians an opportunity to evaluate the drugs’ actual benefits over time.
dr. Hruz, the American endocrinologist, noted that Dr. Cass: “were consistent with the conclusions of the Finnish Council for Healthcare Choices (COHERE) and the Swedish National Council for Health and Welfare. Unlike the United States, these countries have chosen to move beyond politics and ideology to best serve the growing population of youth experiencing a sex-discordant gender identity.”
He welcomed the shift in focus to the evaluation and treatment of “associated psychological morbidity, whether primary or secondary to the condition of gender dysphoria.”
But dr. Hruz also stressed that many questions “remain unanswered as to the best approach to address the well-documented suffering in affected individuals.”
He suggested that doctors and clinicians in this area should fully address the “deficiencies in scientific evidence” [supporting] current treatment models’ and called for ‘more rigorous testing considering alternative hypotheses’ as to the cause or reasons for the condition, and ‘psychological intervention’.
Elsewhere in the US, the reaction to the news from Great Britain is mixed, even muted.
“The review of services for transgender youth in England is part of a remarkable shift in medical practice in some European countries with nationalized health care systems,” the New York Times reported last week in a story acknowledging concerns about “the lack of data on long-term safety and outcomes of medical transitions.”
But US doctors who perform gender reassignment surgery told the Times they feared the closure of the Tavistock clinic “would fuel the growing political movement in some states to completely ban such care.”
At the moment, however, there is no sign that this earthquake In the world of transgender medicine, the Biden administration’s outspoken support for gender-affirming care and its equally strong opposition to so-called “conversion therapy” designed to help trans youth resolve the mismatch between their inner feelings and physical sex will be turned upside down. to make.
In June, Biden issued an executive order ordering the Department of Health and Human Services to limit coverage of “conversion therapy” for trans youth in federally funded programs.
Leor Sapir, a fellow at the Manhattan Institute, explained in a June 16 article for City Journal why the executive attacked “conversion therapy” and what that meant for the debate over childhood puberty blockers.
The term “conversion therapy,” Sapir noted, “was initially used by gay rights advocates to describe the efforts of mental health professionals to make same-sex people heterosexual. In recent years, transgender activists have appropriated the term to focus on the use of psychotherapy as a first-line tool to help minors with gender-related distress feel comfortable with their bodies.”
Why do trans activists oppose this psychotherapy as a first step?
“They insist that any attempt to investigate whether a teen’s transgender self-identification could be the result of other factors — for example, a combination of past sexual abuse and depression — has been scientifically proven to be highly damaging.”
But the early history of medical interventions for gender dysphoria contradicts this view:
The original Dutch protocol, which laid the foundations for the gender transition in children, insisted on long-term psychological pre-screening of candidates. … What the Dutch experts knew then, and what researchers know now and know even more confidently now, is that minors seeking transition have an extraordinary number of mental health problems, including anxiety, depression, attention deficit and eating disorders, and autism .
But cracks are forming within an American medical establishment that has allowed activists to establish treatment protocols, just as Tavistock allowed Mermaids to take a seat at the table.
“It may not be a coincidence that the same day the Biden administration made its announcement, the New York Times Magazine published a lengthy article recognizing for the first time that confirmation-only therapy is controversial among medical experts,” Sapir wrote. The paper’s article not only registered “the growing skepticism within the research community about the safety and reliability of ‘social transition’ and puberty blockers,” it cited the work of Abigail Shrier, author of Irreversible damagea book that was once banned from Amazon for violating user protocols.
Gaps in the establishment’s support for gender-affirming treatment are just beginning to become apparent. Let’s pray that the closure of Tavistock clears the way for a much-anticipated reckoning.