We entrust doctors with our health. Patients have the right to expect that those doctors will make decisions based on evidence-based clinical guidelines, not modish fads, grounded in the “first, do no harm” principle. That’s perhaps never more important than when it comes to life-altering medical intervention for children.
So it’s hard to make sense of a decision by the governing council of the doctors’ union, the British Medical Association, to pass a motion criticising a groundbreaking evidence review of healthcare for gender-questioning children, led by the distinguished paediatrician Hilary Cass.
It is a highly contested area of medicine, which is why NHS England commissioned an independent review in 2020. Cass published a damning final report in April, concluding that the NHS specialist gender clinic for children – now closed – put an unknown but significant number of gender-questioning children on puberty-blocking drugs and/or cross-sex hormones, undeterred by the lack of evidence of benefit and potentially very serious risks to their long-term health.
This was despite the fact that studies suggest that gender dysphoria resolves itself naturally in many children; is often associated with other underlying factors, including young people processing their own same-sex attraction, neurodiversity, childhood trauma, fear of puberty (especially in girls), and mental health issues; and that a childhood diagnosis of gender dysphoria is not predictive of a lasting trans identity in adulthood. In other words, there is a real risk that putting children on to a medical pathway could cement a temporary distress into something more permanent.
The review recommends a complete rethink of NHS services for........