In 2015, when I first started learning about the health and well-being of trans people, I knew very little. I went on a journey of discovery, and what I discovered wasn’t good. I was shocked, appalled, and disgusted by what I was reading, hearing, and later, experiencing. Trans people – including youth – in the UK were being harassed, bullied, victimised, shunned, picked on, and discriminated against. That was by people working in my profession – healthcare workers, nurses, doctors, and psychologists – who had formed an unhealthy relationship with these patients and this significant patient group.
Trans Youth Healthcare in the UK: From Bad to Worse
In 2016, the Women and Equalities Commission found, and I quote, “The NHS is letting down trans people, with too much evidence of an approach that can be said to be discriminatory and in breach of the Equality Act.”
Back then, it was so bad I assumed that once we recognised the real issues that were present that things could and would start to get better. But they haven’t.
The true-world experts on trans healthcare have continued to work tirelessly, updating their standards of care and clinical guidelines. The Endocrine Society published new guidelines in 2017 and the World Professional Association of Transgender Health (WPATH) updated their Standards of Care in 2022. America, Australia, and expert researchers in other countries all produced gender-affirming recommendations and guidelines. They clearly explained the need for gender-affirming care and the benefits it provides to people of all ages. They reviewed the research, discussed the matter as experts in the field, and produced extensive guidelines.
But, sadly, this has not been the case in the UK or for trans youth here. Isn’t it time to ask ourselves, our government, our healthcare regulators and practitioners: why not? How come these very studies, pivotal in shaping legislation worldwide, have been disregarded, neglected, and rejected here? How can we justify this as our response to a sizable and expanding global community?
Anti-Trans Discourse in the UK and Political Motivation
The UK is currently entrenched in a troubling anti-trans discourse. Individuals claiming to defend women’s rights are, in practice, excluding and causing harm to transgender individuals. There’s a disturbing tolerance for active discrimination against trans people. Even with their protected characteristics, they’re failing to receive the necessary safeguarding.
Gender reassignment is a protected characteristic under the Equality Act (2010). Despite these protections, people who are undergoing gender reassignment are feeling less than protected. Here’s why:
UK Government Chooses Political Expediency Over the Equality Act
- In 2022, the government’s top legal adviser, Suella Braverman, claimed it’s “lawful” for schools to discriminate against trans children, comments which trans advocates and allies rightfully condemned as “evil”.
- Our Minister for Women and Equalities, Kemi Badenoch, co-authored ‘”Gender-Questioning Children: Non-statutory guidance for schools and colleges in England” in December 2023. This paper stated that the increase in the number of children questioning the way they feel about being a boy or a girl “has been linked to gender identity ideology, the belief that a person can have a ‘gender’ that is different to their biological sex”.
- Our Prime Minister, Rishi Sunak, commented in his speech to the Tory conference, saying “we shouldn’t get bullied into believing that people can be any sex they want to be. They can’t. A man is a man and a woman is a woman. That’s just common sense.” According to the Equality Act, gender reassignment means proposing to undergo, undergoing, or having undergone a process to reassign your sex. In January 2023, the House of Lords Constitution Committee reconfirmed, “It is fundamental to our constitution that the Government acts according to the rule of law and that ministers prioritise the rule of law over political expediency.” How has our current prime minister not yet resigned on this single issue alone? Instead, he opts to jibe, poke, and joke at this already underserved community.
- Our Health Secretary, Victoria Atkins, reportedly said she’s had “enough” of a “culture of secrecy and ideology” around gender care for children and that she welcomes the pause on treatments being available.
Trans Youth Betrayed by Fair-Weather Progressives
It’s confounding to see individuals who have historically fought for equal rights, including people of colour, individuals from diverse ethnic backgrounds, and women, now participating in denying trans people their rights to recognition, acceptance, and healthcare.
But the final blow came when the Secretary of State for Health and Social Care and the Minister for Health, acting jointly, made an emergency order to start on June 3, 2024 to restrict the prescribing and supply of puberty blockers to under 18s. The order was made to “avoid serious danger to health”.
So, while experts across the world publish evidence-based guidelines to make puberty blockers and gender-affirming hormones more accessible to trans youth, the UK government ignores medics and imposes bans. This will not avoid serious danger to health, it will cause serious danger to health, and it will cause death.
New Generations Question Old and Rigid Gender Paradigms
Furthermore, it completely sidesteps the issue at hand. Just as mental health challenges overwhelmed the NHS before, gender questioning, determination, and dysphoria are genuine concerns for the younger generations — those beyond the Baby Boomers and Gen X. Today’s Gen Z and Alpha cohorts view self-identity and lifestyle choices through a wholly different lens. Addressing this isn’t something we can achieve through rash bans or denial of its existence. Such actions lack foresight and are potentially harmful.
Instead, we ought to focus on comprehending how to offer optimal support and guidance to this burgeoning demographic. These conditions, already present, are emerging on an unprecedented scale. We must cultivate empathy to embrace diversity and establish effective support structures for the present day.
Let me emphasise: if we fail to act now, if we persist in our current approach, not only will innocent individuals suffer harm, lives will be lost. The responsibility for this outcome will squarely rest on our shoulders, collectively, for we will have failed those in need.
How the Cass Review Catalysed the Attack on UK Trans Youth
NHS England and NHS Improvement were concerned over the services that were being provided to transgender young people on the NHS. They were right to be. However, instead of working with patient groups, experts in the field, and international expertise, they commissioned an independent review to make recommendations on the services provided to children and young people who are exploring their gender identity or experiencing gender incongruence.
However, the person they chose to carry out the review is not an expert on the care of trans people. Furthermore, according to WPATH, the review “relies on selective and inconsistent use of evidence, and its recommendations often do not follow from the data presented in the systematic reviews”.
WPATH in conjunction with the European Professional Association of Transgender Health (EPATH) have given their opinion: “The Cass Review deprives young trans and gender diverse people of the high-quality care they deserve and causes immense distress and harm to both young patients and their families.”
Read More: Response to the Cass Review
New Law Excludes Expert Medical Voices and Criminalises Families of Trans Youth
Those are very loud words, loud and scary, but the voice of the medical profession seems to be missing. Where is the GMC, the Academy of Medical Royal Colleges, the Royal Colleges, the University Deans, and the UK gender specialists? Why are we not hearing them shout very loudly that patients are going to suffer and hearing the steps they are going to take to prevent that?
The NHS has written to families waiting on their enormously huge waiting list to tell them that they will criminalise anyone who seeks the care they need, that medical specialists recommend, and that the NHS won’t provide. Not “here is how we will help you get this care”. Instead, “this is what we’ll do to you if you get the care elsewhere that we aren’t providing for you”. Mind-blowing. And let us not forget: these impersonal letters are written by real people with a real duty of care for public health, for our health, collectively.
The findings of the Cass Review, both the interim recommendations and the final report have had, and are having, a devastating effect on trans people. The death toll will be countable in the future, with young lives spoiled and lost as a direct result. We know that gender-affirming care saves lives. It prevents life threatening mental health problems, and it relieves thoughts and acts of self-harm and suicide.
Severe Mental Health Consequences for Trans Youth and Family Members
I have spoken to so many parents of UK trans youth and teenagers, over the years, who have told me of their anguish. They have told me of being on suicide watch, of witnessing their child’s mental health flounder due to a lack of medical support and care. I have also heard what a difference gender-affirming care has made. I have heard how those young lives have seemed worth living again. The joy when puberty blockers prevent the development of secondary sex characteristics associated with the wrong gender. The delight when the right secondary sex characteristics develop with gender-affirming hormones. I shall never forget those families because they are the highlight of my career as a doctor. They are why I founded GenderGP.
As a result of the Cass Review, there’s now no NHS medical service for trans children and young people. There’s little to no hope that puberty blockers and hormones will be available to them, as WPATH and the Endocrine Society recommend. These are the organisations that the GMC held to be the paradigm with which my practice with trans youth should be compared and contrasted. Yet, their recommendations are not in place for the trans youth trying to access care on the NHS.
The final blow has come now that the government has used this rare power to place an emergency ban on the prescribing of puberty blockers by GPs and overseas doctors. This means that young people receiving these will have to stop them and the effects of that will be disastrous. I haven’t seen a risk assessment on the effects of stopping or restricting this treatment: was there one? There should have been! Victoria Atkins, have you seen one?
UK Puberty Blockers Ban: A Soon-to-Be Story of Desperation, Perseverance, and Survival
I have spoken to parents and families who are desperate to help their children stay alive. (I know that some people will scoff at this sentiment but let me tell you, it’s true.) So many parents have told me that the care and help they received by getting the information they needed from GenderGP has saved their child’s life. Being transgender is not a life-threatening illness, but being denied essential care is. And sadly, the statistics continue to support that sad and unnecessary outcome.
One mum told me that they’d take their paper prescriptions abroad. They’d continue to use foreign specialists to prescribe for them. They’d take their prescription to a foreign chemist while they were on holiday. Or, they’d book a low-cost flight, just to go to the chemist. Another family described the lengths they went to to obtain a prescription in an adult’s name and details so that a UK chemist could legally dispense it.
I have heard about frantic internet searches to find unregulated pharmacy options in Canada, India, Russia, and Asia. That is scary. Parents are asking for alternatives to the medicines: what other medications can they use? There are options but their safety and effectiveness profile is less established than the safe and reversible puberty blockers that are now inaccessible to many.
The stories I am hearing are of families that won’t give up. They want the best for their child. Living in the UK should give them access to the most positive options, not the worst.
My heart goes out to these families, and I urge them to stay strong.
GenderGP Continues to Fight for Trans Youth Healthcare in the UK
I will use my medical knowledge and skills to provide education and inform them of alternative options to help their children. I will continue my fight to normalise gender-affirming care.
If puberty blockers are deemed safe for cisgender children, why are they considered a significant risk for transgender children? Could it be that this concern isn’t truly rooted in safety, but rather in a reluctance to accept the reality of transgender identity? Perhaps it’s inconvenient, politically speaking, to embrace a more enlightened perspective on transgender individuals – especially in an election year.
We should expect and demand more from our government, our members of parliament, and ourselves. This emergency ban is a direct and unfair attack on people’s lives and the equal rights to healthcare they are entitled to receive in the UK.
And if puberty blockers are potentially so unsafe, why was the NHS exempt from the ban?
Read More: GenderGP Statement on the UK Puberty Blockers Ban, FAQ: Blocking Puberty, and How to Support a Trans Child: FAQ Answered by GenderGP Specialists