Do not ban gender transition treatments for under 18s

The Government should not restrict trans health care treatments to under 18s in the UK. Treat these trans minors as human beings and do not use their age to justify restricting medical treatment.

The Minister for Equalities has stated that she wants to make sure that the under 18s are protected from decisions that they could make, that are irreversible in the future. Trans minors are already unable to have gender transition surgery, but there are concerns the Government will restrict access to current treatments, such as hormone therapy, hormone blockers and psychiatric evaluations. This could severely affect the mental health of trans minors, and should not happen.

The Government has no current plans to change access to care or services for people under the age of 18 displaying gender dysphoria and wishing to transition to a non-natal sex. Currently, gender development services for under 18-year olds are run by Tavistock and Portman NHS Trust, through their Gender Identity Development Service (GIDS). GIDS offers holistic care to patients referred to its service, offering individualised treatment plans that recognise that no two cases of gender dysphoria are the same.

Treatment plans at GIDS can include, but are not limited to, psychiatric support, puberty suppressants and cross sex hormones. Medication such as puberty suppressants and cross sex hormones are only prescribed upon gaining consent from a patient. How this consent is determined is dependent on a patient’s age, as when a young person has reached 16, they are presumed in law to be competent to give consent for themselves.

Patients under the age of 16 are not automatically presumed to be legally competent to make decisions about their healthcare. The courts have stated under the Gillick competence, that under 16-year olds will be competent to give valid consent to a particular intervention if they have “sufficient understand and intelligence to enable him or her to understand fully what is proposed”.

We understand that mental health support for young people who are questioning their gender identity is very important. To ensure the safety of young people who are referred to GIDS an initial assessment takes place, which allows clinicians to understand individual’s needs and offer support tailored to that individual. After this assessment young people can access local services such as CAMHS (Child and Adolescent Mental Health Services). CAMHS supports patients with depression, anxiety, self-harm and suicidal thoughts. To improve the mental health support offered, studies have been commissioned which will inform how gender development services can better meet the needs of patients.

Gender identity services for people under 18 are commissioned by NHS England Specialised Commissioning who update nationally commissioned services every few years. To this end a review was commissioned in January 2020 looking at the service specification of gender development services for children and young people. This review was agreed in 2016 when NHS England put in place its current service specification for gender development services for children and young people. As a part of this, an independent expert group has been established, they will make recommendations on evidence relating to the prescription of puberty suppressants and cross sex hormones.

NICE (National Institute for Health and Care Excellence) in conjunction with the review detailed above, have been asked to develop guidance that will help identify when to refer children and young people into specialist services. NICE will take into account new evidence and learning from gender services over the last four years as well as parent, patient and expert views. These reviews will ensure that the services the NHS offer are up to date in such a fast-developing area of medicine. These reviews are expected to report in the near future.

The aim of these reviews are to ensure that individuals feel supported at all times and are confident that they are making the most informed choices for themselves and their health.

More can be read about this review on the NHS website, available at: https://www.england.nhs.uk/2020/01/update-on-gender-identity-development-service-for-children-and-young-people/

Department of Health & Social Care