Doctors feel pressured to take an ‘unquestioning approach’ to children wanting gender-change, report says

• It says doctors have been left ‘nervous’ about offering ‘more robust support’
• The NHS-backed report says youngsters are not always given the best care 
• Dr Hilary Cass says there are ‘significant gaps in the research and evidence base’
• Formal recommendations are expected to be develop over the coming months

Doctors feel under pressure to adopt an unquestioning approach to children seeking to change their sex, a review found yesterday.

It said a lack of formal clinical guidance and stifled debate have left many medics ‘nervous’ about offering the ‘more robust support’ they want to deliver.

The NHS-backed report said the situation means youngsters are being given the controversial puberty blockers or sex-swap hormones they ask for – when they may benefit more from waiting or other care.

Report author Dr Hilary Cass wrote: ‘Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach – and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.’

Doctors feel under pressure to adopt an unquestioning approach to children seeking to change their sex, according to a new report (file photo)

The Cass Review into gender identity services for children and young people was commissioned by the NHS following a surge in demand for appointments and calls for better guidelines. 

The Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust in London is currently the only specialist service of its kind in the UK for young people. 

Referrals have rocketed from 50 a year in 2009 to 2,500 in 2020, with 4,600 on the waiting list. There is a waiting time of more than two years for a first appointment.

The review’s interim report warned that the service has struggled to cope with the rise in demand, leading to ‘considerable distress’ for those waiting. 

It said there is a lack of evidence on the best way to manage children with ‘gender incongruence and dysphoria’ and highlighted concerns with the way they are assessed, the drugs used and poor record-keeping.

Dr Cass, a former president of the Royal College of Paediatrics and Child Health, wrote: ‘Within the UK, the single specialist service has developed organically, and the clinical approach has not been subjected to some of the usual control measures that are typically applied when new or innovative treatments are introduced.

‘Many of the challenges and knowledge gaps that we face in the UK are echoed internationally and there are significant gaps in the research and evidence base.’

The report said a lack of formal clinical guidance and stifled debate have left many medics ‘nervous’ about offering the ‘more robust support’ they want to deliver (file photo)

She described a need for regional clinics, clear criteria for referral to ensure fair access and more research. Formal recommendations will be developed over the coming months.

A spokesman for the Bayswater support group for parents of children with gender dysphoria said: ‘This interim statement gives us hope that our children will in future receive care that is based on scientific evidence and accurate data rather than on ideological views.’

He stressed: ‘Our children deserve the same level of healthcare as any other child.’

The spokesman said that parents currently encounter a mixture of views from mental health experts, adding: ‘Some areas push immediate unquestioned affirmation of the child while others are willing to be more cautious.

‘We support the move to a standardised approach to training, which should remove these inconsistencies.’

A Tavistock spokesman said of the Cass Review: ‘We will work with her and NHS England to support her recommendations.’

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