gender reassignment tavistock clinic

Gender identity clinic (GIC)

Available in:, we help people with.

• Gender dysphoria

The gender identity clinic is the largest and oldest gender clinic in the UK, dating back to 1966. We accept referrals from all over the UK for people with issues related to gender.

We are a multi-disciplinary administrative and clinical team, including psychologists, psychiatrists, endocrinologists and speech and language therapists. We work together in order to provide holistic gender care, focusing on the biological/medical, psychological and social aspects of gender.

What to expect

In order to assess your individual needs and goals, we ask a number of questions about your background, current circumstances and future plans. The purpose of these questions is to help us gain a clear idea of how we can help you.

Based on your individual needs and circumstances your clinician will explore with you what may happen next with your gender care. For example, if you would like to, but have not yet made a social gender role transition, they may explore with you any possible obstacles in your way and help you consider ways to address these.

Additionally, in order to support you through the transition process, clinicians may discuss with you the possibility of referrals to other services within the GIC or local to you (which your GIC clinician can ask your GP to make).

We will keep your GP up-to-date about your progression through the clinic and you will be copied into the reports sent. Your clinician will also be able to offer you information and advice about other forms of support that you may find helpful as you move along your gender care pathway.

How to access this service

Your GP or another health professional can refer you directly to the Gender Identity Clinic.

We also accept self-referrals via your GP.

NHS e-Referral Service

To locate the service on the NHS e-Referral Service, enter the following in the search fields:

• Priority: Routine
• Specialty: Gender Identity Services
• Clinic Type: Gender Identity
• Organisation or Site Name field: Tavistock and Portman

Waiting times

There is a high demand for appointments, which is common across other gender identity clinics around the UK.

Monthly referral, assessment and discharge data

The gender identity clinic was run by the West London Mental Health Trust prior to April 2018. For data before April 2018, you may request pre April 2017 data by submitting a freedom of information request to West London Mental Health Trust .

Related information

• GIC website

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England Overhauls Medical Care for Transgender Youth

The National Health Service is closing England’s sole youth gender clinic, which had been criticized for long wait times and inadequate services.

By Azeen Ghorayshi

The National Health Service in England announced on Thursday that it was shutting down the country’s only youth gender clinic in favor of a more distributed and comprehensive network of medical care for adolescents seeking hormones and other gender treatments.

The closure followed an external review of the Tavistock clinic in London, which has served thousands of transgender patients since the 1990s. The review , which is ongoing, has raised several concerns, including about long wait times, insufficient mental health support and the surging number of young people seeking gender treatments.

The overhaul of services for transgender young people in England is part of a notable shift in medical practice across some European countries with nationalized health care systems. Some doctors there are concerned about the increase in numbers as well as the dearth of data on long-term safety and outcomes of medical transitions.

In the United States, doctors specializing in gender care for adolescents have mixed feelings about the reforms in Europe. Although many agree that more comprehensive health care for transgender youth is badly needed, as are more studies of the treatments, they worry that the changes will fuel the growing political movement in some states to ban such care entirely.

“How do we draw the line so that we keep care individualized while maintaining safety standards for everyone? That’s what we’re trying to sort out,” said Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the incoming president of the World Professional Association for Transgender Health, who is transgender. “It’s the people on the ground who need to make these decisions, not people in Washington or state legislatures.”

The N.H.S. said current patients at the Tavistock clinic could continue to receive care there before transferring to two new hubs at children’s hospitals in London and Manchester. The new clinics will expand the country’s gender services while making sure children are adequately treated for autism, trauma and mental health issues. The specialists will also carry out clinical research on gender medications.

There are “critically important unanswered questions” about the use of puberty blockers, wrote Dr. Hilary Cass, head of the external review of the country’s youth gender identity services, in a letter to the head of N.H.S. England last week.

Puberty blockers, which are largely reversible, are intended to buy younger patients time to make weighty decisions about permanent medical changes. But Dr. Cass questioned whether most adolescents prescribed these drugs were given the support to reverse course, should they choose to.

Tavistock received more than 5,000 patient referrals in 2021, up from just 250 in 2011. The types of patients seeking referrals have also shifted over the past decade. When the clinic opened, it primarily served children who were assigned male at birth. Last year, two-thirds of its patients were assigned female at birth.

It is unclear why the number of patients has surged so drastically or why transgender boys are driving the increase.

Transgender advocates in Britain welcomed the changes but emphasized that many questions still remained about how they would affect care for young people.

“We are optimistic, cautiously optimistic, about the news,” said Susie Green, chief executive of Mermaids, an advocacy group for transgender and gender-diverse youth. “There is a two-and-a-half-year waiting list to be seen for your first appointment. We’ve seen the distress caused to young people because of that.”

But Ms. Green, who has a transgender adult daughter, said the group was concerned about whether mental health services would be prioritized over medical care. Gender diversity, she said, should not be treated as a mental disorder.

“We would not want any further barriers to be put in place in terms of access to medical intervention,” Ms. Green said.

In 2020, a former patient at Tavistock, Keira Bell, joined a highly publicized lawsuit against the clinic. She claimed that she was put on puberty blockers at 16 “after a series of superficial conversations with social workers,” and had her breasts removed at age 20, decisions she later regretted.

A high court initially ruled that children under 16 were unlikely to be mature enough to consent to such medical interventions. But that decision was reversed in September of last year, with judges ruling that “it was for clinicians rather than the court to decide” whether a young patient could provide informed consent.

In 2020, employees at Tavistock raised concerns about medical care at the clinic, prompting the N.H.S. to commission Dr. Cass, a pediatrician in London who was not affiliated with the clinic, for an external review. Her interim report was released in February of this year.

Sweden’s national health service determined this year that gender-related medical care for young people should only be provided in exceptional cases when children have clear distress over their gender, known as dysphoria. All adolescents who receive treatment will be required to be enrolled in clinical trials in order to collect more data on side effects and long-term outcomes. Finland took a similar stance last year.

“Our position is we cannot see this as just a rights issue,” Dr. Thomas Linden, director of the country’s National Board of Health and Welfare, said in a February interview. “We have to see patient safety and precision in the judgment. We have to be really to some degree sure that we are giving the right treatments to the right person.”

While these European countries have put some limits around transgender care, their approaches are far more permissive than those in some conservative U.S. states. A recent Alabama law made it a felony for doctors to prescribe puberty-blockers and hormones to minors. In Texas, parents who allow their children to receive gender treatments have been investigated for child abuse . Both states are tied up in court battles with civil rights groups.

Some American doctors worried that the changing standards in Europe would bolster the notion that gender treatments are dangerous for young people.

“My fear is that this is going to be interpreted as another notch against providing gender-affirming care for kids,” said Dr. Angela Goepferd, medical director of the Gender Health Program at Children’s Minnesota hospital. More services are needed, they said, not less. “That’s our challenge here.”

Azeen Ghorayshi covers the intersection of sex, gender and science for The Times. More about Azeen Ghorayshi

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Tavistock gender clinic facing legal action over ‘failure of care’ claims

Clinic accused of rushing children ‘into taking life altering puberty blockers without adequate consideration or proper diagnosis’, article bookmarked.

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The Tavistock gender identity clinic is facing legal action over claims children were misdiagnosed and rushed into transitioning at a young age.

The clinic, which is being shut down by NHS England, was criticised by an independent review for the quality of care and services provided to patients, who were predominantly young teenagers expressing an interest in gender transitioning.

Staff, patients and parents have raised concerns that young people using the service were put on the pathway to transitioning too early and before they had been properly assessed.

It is alleged children were “rushed into taking life-altering puberty blockers without adequate consideration or proper diagnosis”, with staff under pressure to adopt an “unquestioning affirmative approach”.

Mass legal action is now being pursued by lawyers against the clinic, named the Gender and Identity Development Service (GIDS), which has treated 19,000 children with gender dysphoria since 1989.

• Ireland bans transgender women and girls from female contact rugby
• Braverman seeks to clarify schools’ legal duties to gender-questioning pupils
• Taika Waititi’s tweets about trans people have raised difficult questions about retroactive shaming

Lawyers at Pogust Goodhead have accused the clinic at the Tavistock and Portman NHS Trust of “failures in their duty of care towards young children and adolescents”.

Head of product liability, Lisa Lunt, said: “While the provision of gender dysphoria treatment for children and young adolescents, where appropriate, is an important service, many have been let down by Tavistock and Portman NHS trust.

“We support the findings of the Cass Review, Interim Report and believe there has been a real level of harm that has been perpetrated towards patients who were rushed into taking life-altering puberty blockers without adequate consideration or proper diagnosis.”

Tom Goodhead, chief executive of Pogust Goodhead, said he expected at “least 1,000 clients will join this action”.

He added: “These children have suffered life-changing and, in some cases, irreversible effects of the treatment they received which has resulted in long-term physical and psychological consequences for them.”

GIDS questioned the scale of the looming legal action and highlighted that around 1,000 patients have been referred to its endocrinology teams, to access hormone suppressants, over the past decade.

Pogust Goodhead said the allegations of negligence are likely to be based on numerous supportive findings from the Cass review, not just the alleged rushed use of puberty blockers.

The allegations of medical negligence are based on the findings of an interim report by Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, who is leading a review of the service.

The Cass review was commissioned in September 2020 due to the rise in demand, long waiting times for assessments and “significant external scrutiny” around GIDS’ approach and capacity, the NHS said.

It concluded that the service was struggling to deal with spiralling waiting lists, was not keeping “routine and consistent” data on its patients, and found that health staff felt under pressure to adopt an “unquestioning affirmative approach”.

Following the closure of the Tavistock clinic , new regional centres will be set up to “ensure the holistic needs” of patients are fully met, the NHS has said.

It comes amid a sharp rise in people seeking GIDS’ help over the past decade, jumping from 250 in 2011 to 5,000 referrals in 2021, according to the service’s statistics.

In her review, Dr Cass said having one clinic was not “a safe or viable long-term option”.

New centres, one based in London and the other in the northwest of England, are due to open in spring 2023.

A spokesperson for Tavistock and Portman NHS Trust said: “GIDS has not heard from Pogust Goodhead about this matter, but it would be inappropriate to comment on any current or potential legal proceeding.

• Tavistock clinic: Failing gender service for children to be replaced by local hubs
• Landmark puberty-blocking drugs ruling will not be challenged at Supreme Court

“The service is committed to patient safety. It works with every young person on a case-by-case basis, with no expectation of what might be the right pathway for them, and only the minority of young people who are seen in our service access any physical treatments while with us.”

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Journalist Hannah Barnes on the inside story of the collapse of Tavistock’s gender identity clinic

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<iframe width="100%" height="124" scrolling="no" frameborder="no" src="https://player.wbur.org/onpoint/2023/03/09/the-inside-story-of-the-collapse-of-the-tavistock-gender-service-for-children"></iframe>

• Jonathan Chang
• Meghna Chakrabarti

Sign up for the On Point newsletter  here . 

The United Kingdom’s only dedicated gender identity clinic opened nearly 35 years ago.

In recent years, those inside the clinic began to raise concerns.

After a scathing independent review, the National Health Service decided to close the clinic.

Today, On Point: Journalist Hannah Barnes tells us what happened.

Hannah Barnes , investigations producer at BBC Newsnight. Author of Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children . ( @hannahsbee )

Also Featured

Dr. Anna Hutchinson , clinical psychologist based in London who was part of the Gender Identity Development Service (GIDS) senior team from 2013 to 2017.

Dr. Marci Bowers , OB/GYN who specializes in gender affirming surgical care. President of the World Professional Association for Transgender Health (WPATH)

Jamie Reed , clinical research manager and former case manager at The Washington University Transgender Center at St. Louis Children’s Hospital.

Read: Jamie Reed's affidavit to Missouri's attorney general. Her allegations have been denied by some families whose youth received care at the St. Louis transgender center.

MEGHNA CHAKRABARTI: Until this past year, the Tavistock Gender Identity Development Service was the U.K.'s only center for treating children suffering from gender dysphoria. In March 2022, an independent report commissioned by Britain's National Health Service found that the type of care provided at Tavistock was, quote, 'Not safe or viable as a long-term option for the care of young people with gender related distress.' It also found that the center had not used customary control measures that are typically in place when new treatments are introduced. Nor had the center collected consistent data on its patients and treatments.

Following the report, the National Health Service decided to close the Tavistock Center and find a new model of care for gender questioning young people. Hannah Barnes is an investigations producer at Newsnight, one of the BBC's flagship television news programs, and she writes about what happened at Tavistock in her new book, Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children. And she joins us today from London. Hannah Barnes, welcome to On Point.

HANNAH BARNES: Thank you so much for having me.

CHAKRABARTI: So when the Gender Identity Development Clinic was first opened in London in 1989, what was its original mission?

BARNES: Its original mission was to provide a space for a very small group of very distressed children and young people to talk about the difficulties they might be having with their gender. So originally, [it] opened at another London hospital, but really in those early years we were talking a couple of handfuls of young people each year. I think actually there were only two in the first year. And it provided a space for young people in their families to go and talk about what they were going through.

The idea was always that it wouldn't aim to change a young person's gender identity but would help them tolerate the distress they were experiencing. Tell them that they weren't alone, that there was nothing wrong with them. Sort of break down stigmas, really provide a safe space, if you like, and predominately provide talking therapies for this very small number, but albeit some of them very distressed children.

CHAKRABARTI: That's why in the book you emphasize that its original mission was to support gender identity development versus change.

BARNES: Exactly. Exactly. And that that aim continued through to the present day.

CHAKRABARTI: Okay. But so then how what how small of a percentage of young people are we talking about that were seen at the service in the early days?

BARNES: It's difficult to know in terms of percentage of the population, but we're talking, you know, a handful of children per annum that were referred out of millions of young people here in the U.K. And at that time, the founder of the clinic, a psychiatrist called Domenico Di Ceglie, he would often talk to the press as we went into the 1990s, saying that the vast majority of these young people would come through their period of gender related distress and a small minority would indeed transition and live their lives as trans adults.

CHAKRABARTI: So then at around approximately 2005, if I remember correctly from your book, there was an internal audit done by the gender service center there. What did that internal audit find?

BARNES: So there are two things here. There was a report into the service in 2005. There was also an audit carried out in about 2000. So I can talk briefly about both of them, if that's helpful. So in 2000, by this point, the service had moved to its current home, the Tavistock and Portman NHS Foundation Trust. And really there was a request made that the trust wanted to learn a bit more about these young people that the trust was seeing.

What other difficulties might they be experiencing? How did they arrive at the clinic? What was happening to them? Basically. So a group, including Domenico Di Ceglie, they audited the first 124 young people that had gone through. So from 1989 to 2000, and they excluded the very current patients. And that showed that the vast majority of these young people absolutely were experiencing distress around the agenda. But actually, so much else besides. A large, very large proportion had been in care.

So not living with their parents or their immediate family, that was up to a quarter. A large proportion had experienced abuse, either physical or sexual. They experience depression, anxiety, all sorts of things. And what they found was that only a very small proportion didn't have any other difficulties alongside their gender distress. But I think what you were talking about in 2005 was that some concerns were being raised at that point within the service about how it was functioning.

And although puberty blockers, as we know them colloquially were available at that point, a young person had to be 16 here at that point. But there was still concern that some people were going forward for these interventions quite quickly. And in some people's eyes, without adequate assessment or talking beforehand. And the then medical director of the entire Tavistock Trust conducted a review, if you like. He spoke to endocrinologists; he spoke to people in the service in the wider trust. It was really thorough, and he called for lots of things.

He called for better data collection. He said, We don't really know any of the outcomes of the young people we've seen so far, even though we've been going at that point, what, 15, 16 years. He said, We need to collect outcomes on those who go forward for the physical interventions. We need to collect data on those who don't. We need to collect data on how the young people who do go forward for physical interventions are using that time on the blocker. Is it that they're using it as time to sink and explore their gender identity or is something else happening?

And he identified this core, not disagreement, but sort of conflict, if you like, in the service surrounding the use of physical interventions, I suppose, and how quickly they should be provided. Who was responsible for it? Was it the mental health practitioners working in the service, assessing the young people, or was it ultimately the endocrinologists? All kinds of things. And Dr. David Taylor was the man who did the report. He made a number of recommendations, and frankly, none of them were really taken forward.

CHAKRABARTI: Well, in your book, you talk about how in this report by Dr. David Taylor, again, this is the 2005 review. That the pressure, he talks about the pressure to provide puberty blockers became much more intense around that time. Where was the pressure coming from?

BARNES: It was coming from all quarters, really. It was coming from trans support groups. Absolutely. But I think there's a danger that especially here in the U.K., that it's felt that all the pressure was coming from them alone, and that isn't the case. It was also coming from clinicians working with gender diverse young people in other countries, particularly in the Netherlands at that time. Some conditions in the United States as well.

And it was also, I'm told, coming from endocrinologists who obviously work with hormones in the body. And the pressure was saying, look, it appears at this moment in time the Dutch are doing this thing where they're using puberty blockers in very highly screened young people who have this distress around the gender. And it appears that it could be a good intervention. So why aren't you doing it? That was the message, really.

CHAKRABARTI: Well, and also around this time, there begin to be quite a significant rise in the number of referrals right to the Tavistock Gender Service in the U.K. We spoke with Dr. Anna Hutchinson, who Hannah, you spoke to extensively for your book, and she was part of the senior team at Tavistock between 2013 to 2017. She went on maternity leave shortly joining after joining the team. And then when she came back at the end of 2014, she had noticed that in that time the number of referrals for hormone blockers had rapidly increased.

ANNA HUTCHINSON: I'd have the referrals from the week on my desk and it was very visceral. The numbers are going up, you know, week to week. That pile of referrals would be getting more remarkably larger. So there was a sense of everybody was really busy trying to keep on top of the deadlines. At that time, we were aiming to see all young people within 18 weeks and the team was just really running around trying to meet young people on time.

CHAKRABARTI: So that's Dr. Anna Hutchinson. Hannah Barnes, If you could sort of summarize, there was also a growing chorus of concern coming from practitioners within the clinic at this time. What were those concerns?

BARNES: So what had happened at this point is because of the pressure that we spoke about before coming from all quarters, GIDS, the Gender Identity Development Service ... had started a research study to say, well, look, let's test this out for ourselves. Are the puberty blockers beneficial to a selective group of young people?

And in 2014 they rolled out the early blocking of puberty as policy anyway, without waiting for that data. So that's the context. So you've got the wider availability of puberty blockers at younger ages. And that point there was no actual lower age limit. It moved to a stage of puberty rather than age. And you had these referrals that Dr. Hutchinson speaks about really increasing at a very, very rapid rate.

And in 2014, in fact, they were sticking to that 18-week target. But as we went into 2015, that was the year that referrals actually doubled. And so, they'd been increasing at 50% per year from 2009. They absolutely rocketed in 2015, they doubled. And at the same time, more and more young people were wanting this medical intervention. There was pressure on them to provide it. They were trying to get through the numbers. Caseloads were absolutely exploding. And a single clinician might have 100 families on their individual caseload. And to put that into some context, that would compare to, I'm told, around 20 to 30 in any other regular National health service setting.

CHAKRABARTI: Hannah, as you well realize, you're speaking to a largely U.S. audience in this program here. And as I'm sure you know, the political situation around the issue of care for gender questioning youth, the political situation in this country is extreme, to the point where the trans community legitimately has fears, existential fears. So I wanted to ask you briefly for all that you spoke with many, many clinicians who worked at the Tavistock Center. Were any of them, you know, even questioning the existence of trans identities, or did they have some kind of, you know, political concern? What was their approach to the whole issue of gender questioning youth?

BARNES: No, absolutely not. And thanks for giving me the opportunity to say that, because really the motivation for these clinicians speaking out and raising concerns over many, many years, both within the service and then outside of it, was really the care of these young people who were often very vulnerable and very distressed. And what they were saying was just as there appeared to them to be different ways, perhaps into a young person's gender related distress, then perhaps there needed to be different ways out of it.

And they were seeing with that increase in referrals, a sort of increase in the complexity of the young people coming forward too, and often they were contending with so much more besides the gender identity difficulties. And that's what was really worrying these clinicians. And at no point will they ever questioning these young people's identity or that trans people exist. Of course they do. And that's absolutely not anything that is questioned in the book. And I've spoken to trans people, their stories, their successful transition stories are in the book, too.

It's just that it was felt that the way the Gender Identity development service was practicing was risky and that perhaps a one size fits all approach, a referral for puberty blocking medication, wasn't the safest route, nor the best one for each and every one of those young people, both for whom you know it will benefit. And we have to provide the best care for them. And we also have to provide care for those for whom it won't.

CHAKRABARTI: Okay. So we spoke with Dr. Hutchinson, who we heard from earlier. We'll hear a little bit more from her in a moment. But we also spoke with Dr. Marci Bowers. She's a leading OB-GYN in gender affirming surgical care. And Dr. Bowers is also the president of the World Professional Association for Transgender Health. And she told us that what happened at the Tavistock Clinic, in a sense, shouldn't have been a surprise because of that really big spike, that increasing demand for this kind of service.

MARCI BOWERS: Like anything that expands rapidly, sometimes we see health systems overrun and this is the case as it is in Tavistock. They saw referrals rise. I think they were like 250, in I believe it was 2012. And then in the last two years, they were over 5,000 referrals for gender related care.

CHAKRABARTI: We'll hear more from Dr. Bowers a little later in the show. But on that point of trying to manage that massive rise of referrals, here's Dr. Anna Hutchinson again, who worked at the Tavistock Center. And she told us, she told you as well, Hannah, that for some young people in their families, once they were on hormone blockers, they would actually disengage from the service, no longer come to Tavistock. But for others who wanted to explore potential consequences of continuing to cross-sex hormones:

HUTCHINSON: We as a service weren't providing any therapeutic space to explore identity once the young people were on the blockers. So I was beginning to really worry. The blockers themselves were possibly and inadvertently shutting down options rather than opening them up.

CHAKRABARTI: Dr. Hutchinson also talked about concerns over the lack of data being collected on the patients, and the services and their effectiveness that were being provided to young people. And she said that one piece of early data, in fact, did find that most people who were on puberty blockers had proceeded on to cross-sex hormones. And Dr. Hutchinson told us that concerned her.

HUTCHINSON: I was being asked to sign off on something and I wasn't sure it was in their long-term best interests. Because there wasn't the data there. But I was beginning to think, okay, so if a young person blocks their puberty early in adolescence and then proceeds to cross sex hormones and maybe or maybe not surgery later on in life, and then it doesn't work out for them because, you know, some of these kids were telling us their identity was fluid. You know, we know that. My concern was, what would that be like for them? You know, it suddenly felt like we had to make a huge sort of cost benefit analysis.

CHAKRABARTI: So Hannah, help us understand how this happened, because as you said earlier, the the Tavistock Center's own internal studies and audits from 200, 2005 found that, you know, perhaps a very small percentage of young people would go on at that time to take puberty blockers and then cross cross-sex hormones. And then most of the other children coming to the center would have hopefully been able to access treatments to assist whatever their other core needs were. But it sounds like later on there was this rush to puberty blockers and then, as Dr. Hutchinson said, to cry onto cross-sex hormones. I mean, I don't quite understand how the Tavistock Center got caught up in all that.

BARNES: I think that's a really difficult question to answer definitively. But I think, you know, it depends who you ask. I mean, I've spoken to dozens of clinicians and they'll give you slightly different reasons. But I think there are a number of factors that explain how things went wrong. And I think it's difficult to deny that things have gone wrong. Partly it's about numbers, as Dr. Bowers said, but it really can't explain it all. And I don't think anyone I spoke to would say it was just that we had too many young people coming forward. Of course, those huge pressure as the numbers really increased very, very dramatically. But it can't just be put down to the numbers.

What happened was, as one would expect in sort of areas of medicine, when new data comes to light that questions the way you think and intervention is working, that should provide pause for thought. And I think what Dr. Hutchinson, what she told me certainly is when that data came back, that early data that showed that at that point, every single one of the young people who started on puberty blockers had chosen to go into cross-sex hormones, that kind of exploded this idea that the puberty blockers were providing time and space to think. Because, as she puts it in the book, what are the chances of every single young person with their very different needs and backgrounds given time to think, and all thinking in the same way?

And GIDS would counter that and say, well, these people that we chose were the ones that we thought were most likely to transition. So it's not surprising. And we picked those who were the most distressed and whose gender related distress was very lasting and had, you know, been going on for years. And we do very thorough assessments. But the difficulty with that is that I have clinicians who have spoken to me bravely, on the record, who say actually our assessments weren't always very good, they weren't always very thorough. They could be two, three sessions. And I've taken part in those. So it's just not the case that each and every one of those young people going forward for the blocker was subject to a very detailed assessment and had lifelong gender dysphoria.

And I think what you saw, what they did was they started to apply an albeit quite limited evidence base from these two early Dutch studies, which only allowed young people who had lifelong gender dysphoria, a very stable, supportive environment in which they lived and who was psychologically stable. They applied that to a completely different cohort of young people. And they didn't pause to reflect on what was happening. I think at the same time, not all of this was their fault. There was very limited oversight, if any, from the Central National Health Service that was commissioning them.

It's something that the independent review, which you referred to right at the beginning has commenting on, that this clinical approach has not been subjected to some of the usual control measures that are typically applied when new or innovative treatments are offered. That just didn't happen here. And a further aspect was the GIDS would say that they were only there. Their job, if you like, was to tackle and addressed a young person's gender difficulties. All the other things that they might be struggling with at the same time should have been dealt with by local mental health services and that didn't happen. And that's because those services themselves were completely overwhelmed. They had their budgets cut.

So there was a whole host of reasons why the model wasn't working. And as Dr. Hutchinson said in one of those clips, not only was the rationale for the blocker exploding in terms of everyone was thinking the same way. But actually GIDS didn't provide any opportunity for those young people to use that time to actually explore their gender identity. Rather than increase the number of appointments. They became very few and far between. And as she said, people would skip them, so they might only check in twice a year.

CHAKRABARTI: Now I want to just clarify something for people who aren't familiar with it, because you mentioned this Dutch study, which it comes up rather frequently in discussions about care for gender questioning youth. The Dutch study was one that was done, I believe the cohort was mostly people who were born male. And then as you specified, they had long term gender dysphoria or gender questioning, mental status, and no other concurrent mental health issues. And it's that group of young people then who were put on puberty blockers and later on, I believe, cross-sex hormones as well, and had largely positive outcomes, correct?

BARNES: Correct. I mean, there were girls as well. I think the majority were male, but not the overwhelming majority. And you're right, these Dutch studies, these formed the basis really of all gender, affirmative medicine, pediatric medicine taking place across the world today in gender clinics, both in the United States, here in the U.K. and in the rest of Europe. And those young people had to be screened in the way that I've suggested, but also, they received ongoing talking therapies at the same time.

And those studies themselves ... they're not the be all and end all. They're the best that we have in terms of longitudinal data. We're awaiting actually an update on those very first group of young people who receive puberty blockers, then cross-sex hormones and then surgery. And those are the criteria. So actually, there were two studies of the same group of people, but we lost 15 out of 70 by the time we got to the second one, one of whom actually died tragically during gender reassignment surgery.

And a close look of those studies really calls into question how robust they are. But, yes, so this arguably limited evidence base has been used as the basis for gender affirmative care in young people. But it did apply to quite a different group of young people than the ones we see today.

CHAKRABARTI: Right. And one of the key differences is all of the concurrent other mental health issues.

BARNES: But also sorry to interrupt, but also the fact that we have this, it's been witnessed in every single gender clinic across the world, this preponderance of females now. But not just females, but females whose gender related distress only started in adolescence or after the onset of puberty. And that absolutely was not the presentation of those young people in the Dutch study. And we're also applying this evidence base, if you like, to young people who identify as non-binary, as other gender identities. And again, there was no evidence for that whatsoever.

CHAKRABARTI: Hannah, I appreciate that clarification because it's an important part of the overall story and especially regarding what later on happened at the Tavistock Center. I want to hear a little bit more from Dr. Hutchinson, because, again, this lack of data, it comes up as a as a regular concern. And Dr. Hutchinson says that, in fact, there wasn't even clear evidence about ... the long-term outcomes of some of the procedures and medications that the young people were taking, about whether or not they were successful.

HUTCHINSON: Once they were referred to adult services or they left the service, or whether they left because they decided not to get on the medical pathway or any other reason, we didn't have data on any of those young people. We didn't have any outcome data. When I was there, we had only had the data of those who were within the service. And you know, what was striking about the early intervention study was that the patient satisfaction was high, but the clinical outcome measures were not particularly positive in terms of reduced distress or reduced dysphoria.

CHAKRABARTI: People like Dr. Hutchinson and others that you interviewed extensively for the book had been raising concerns internally for some time. But what finally triggered that independent commission that the NHS called for a couple of years ago?

BARNES: A number of things, I think. Dr. Hutchinson was one of ten members of staff who took their concerns to a then very senior psychiatrist at the Trust. He's now retired, called Dr. David Bell, and he wrote a report in 2018. And it was really when that was leaked to the media. And in 2019, and we heard some of these concerns that were very, very serious, that clinicians had, really things started to sort of gain momentum. And we started looking at this for BBC Newsnight in 2019.

And our reporting certainly prompted a inspection of the service by the health care regulator in England, which then rated the service inadequate. ... Some court proceedings were instigated against the Tavistock by a young woman who transitioned, then de-transitioned called Keira Bell. And that really brought the world's attention on onto GIDS, if you like, in a way that never had been before. And it really highlighted this absence of data. And I think it got to the point where NHS England just couldn't avoid tackling it head on. They had to do something. And that's what led to the independently commissioned report.

CHAKRABARTI: Hannah Barnes, I had mentioned at the top of the show the independent report that was commissioned by the NHS, and I believe that an interim report was published in March of 2022 that found that the type of care provided at Tavistock was not a safe or viable long-term option for young people with gender related distress. This is the Cass report. So can you tell us a little bit more about what it found?

BARNES: Well, interestingly, it vindicated, I don't know if that's the right word, but it vindicated what so many clinicians had been saying for four years and who hadn't been listened to. So Dr. Cass acknowledged that there was an issue of what she called diagnostic overshadowing. So this was where a young person who may have multiple coexisting difficulties but who had gender related difficulties as well, once the word gender was mentioned, everything else got parked, if you like, it wasn't dealt with.

So she would call this diagnostic overshadowing. And she said this is just not good enough, that young people with gender related distress aren't being given the same amount of care and attention that any other young person would. She said this has got to change. She talked about a real lack of consensus amongst clinicians working in the service. She said there were completely different views within the staff group, some more strongly affirmative and some much more cautious when it came to the use of physical interventions. Again, this is something that clinicians have been talking about for four years and that might be problematic.

I mean, it's quite striking that in the leads that the site that GIDS had in the north of England, there were clinicians whose approaches, if you like, were deemed to be so incompatible that they couldn't work together with any given family, which is quite striking. Dr. Cass found that the service was providing a predominantly affirmative, non-exploratory approach, often driven by a family's expectations and how far or not, the young person had gone in a social transition prior to starting the service.

She found, as you've mentioned several times, that there had not been routine and consistent data collection in the service. And actually it was still difficult writing in 2022 for staff to raise concerns about the service. Now, she absolutely acknowledged, and I do throughout the book, and even the regulator who rated the service inadequate, acknowledged that the staff at the service care about these young people greatly. That has never been called into question. But one clinic dealing with the nation's distressed children could not work.

And there's been a temptation among some in the trans community in particular here to say that all that Dr. Cass said is that we need more services and we can't have one clinic. But I think really any reading of that report highlights a certain number of difficulties that the service is explaining. And she talks about the lack of evidence base as well, particularly for this cohort of young people that we're seeing in gender clinics across the world who are predominately female, whose gender related distress started in adolescence and who have multiple other mental health problems. And she said that's the group which are greatest in number, but actually for whom we hold the least data and the data we have is not persuasive.

CHAKRABARTI: And so as a result of the Cass report, the NHS decided to close down. I don't know if that's the right word, but --

BARNES: It's still open.

CHAKRABARTI: It's open.

BARNES: So that's why they decided to call it. Well, they decided that, you know, when one of the country's most respected and senior pediatricians says we need a fundamentally different service model, then the NHS has listened to Dr. Cass, and that's what they're trying to do now. So it made the announcement in summer 2022 that GIDS would close and be replaced initially by two. But the plan is to have more regional services, which would be far more holistic, if you like, in their approach, taking in all aspects of a young person.

And it's acknowledging the work that has been done as part of Dr. Cass's review, looking at the evidence base for both puberty blockers and cross-sex hormones. And what those systematic reviews have shown is that really the evidence base is wanting and it's not clear really the benefits and harms of those treatments and whether one outweighs the other. So going forward, and these new services are not ready yet. And the plan was to close GIDS in the spring and that isn't going to happen.

But the plan is that no one plans to take away, it seems, obviously the option of transitioning for young people. We talked about this really early on. It's not about denying health care, it's about making it better for each and every one person. But Dr. Cass has said, look, we have to plug these gaps in the evidence base, because they're big. And so the plan, it seems that we haven't heard the final details yet, is that puberty blockers will still be available to young people after a decent assessment, but they will have to be enrolled on a research program to try and get some better data.

It's long term data. And crucially, what Dr. Cass said and what these new services going forward will offer is different treatment pathways, because she has said that not one approach is going to benefit each and every young person experiencing gender related distress or gender dysphoria. And, you know, physical interventions for some. Yes, but that won't benefit everybody. And we need to care for those people, too.

CHAKRABARTI: Well, in fact, Dr. Marci Bowers, again, currently the president of the World Professional Association for Transgender Health and a leading surgeon, OB-GYN, in gender affirming care, she told us that she sees it very similarly. This is a moment sort of accelerated by the Cass report that we should encourage and allow an improvement in care for gender questioning young people. And here's what Dr. Bowers told us.

BOWERS: It's a supportive environment where ongoing evaluation continues. And if they meet certain criteria entering adolescence, at that point, a decision would be made as to whether or not they would be candidates to have puberty blocking. And we have to be mindful that ultimately it has to be informed consent and it has to be a volitional decision on the part of the child.

CHAKRABARTI: So that's Dr. Marci Bowers talking about what improved care for gender questioning young people ought to look like. Now, Hannah, if you could just listen along with me for a minute. We have to acknowledge that obviously, the question about what should care for young people entail is very, very, very urgent here in the United States.

And we recently spoke with Jamie Reed. She's a former case manager at the Washington University Transgender Center at Saint Louis Children's Hospital. And earlier this year, she used Missouri's whistle blower statute to raise public concerns about the care she saw children receive at the Washington University Center. And she closely tracked the cases of at least 600 children.

And some of her concerns mirror what we've been hearing about what was happening at the Tavistock Center, both reported by Hannah Barnes and in that independent review as well. Reed talked about a lack of consensus amongst care providers at the St. Louis Center about the best standards of practice for treating gender questioning youth.

JAMIE REED: The documents that I believe the doctors were working under were routinely cast aside and considered on some level suggestions. Which from a medical perspective felt like it was whatever the doctor decides at that day in time goes. And there was no operating framework or guideline to provide this care.

CHAKRABARTI: Reed also says the Washington University Center lacked appropriate resources to provide comprehensive mental health care for its patients.

REED: The center provides some basic mental health medications ... for some patients, for depression and anxiety. But that's if you get scheduled with that certain provider. The system as a whole did not actually put in place the necessary care availability for patients.

CHAKRABARTI: And Reed says that while some patients may have received longer term mental health support for others, that was not the case.

REED: I do not believe that the quality standard of care to medicalize a child with interventions that are lifelong, that can impact their fertility for life, that the quality of care is two visits with a kid.

CHAKRABARTI: Now, Jamie Reed herself identifies as a queer woman. She is married to a trans man and says that she firmly supports trans rights and has previous experience working with trans youth in clinical environments. She says her concerns, though, were not taken seriously by leadership at the Washington University Center.

REED: Part of the problem with this kind of care right now is it's become ... this huge extreme thing where you can't say anything questioning this care without. I mean, I've basically been told that I'm going to be, like, responsible for children's deaths. You cannot question a care model, and that is not how medicine is supposed to work. Medical staff are supposed to be the people in the room with the doctors who see things going on and have the backup of the medical institution to be able to say, Hey, pause, timeout. Something's not going right here. Without being absolutely vilified. From every angle.

CHAKRABARTI: That's part of our conversation with Jamie Reed, and a longer version will be available in our podcast feed later this week. Now, following Reed's accusations, Missouri's Republican Attorney General Andrew Bailey launched an investigation into the facility at Washington University. And as a result, Washington University is not commenting. The St Louis Post-Dispatch and Missouri Independent have spoken with families who report positive experiences at the center.

... Now, Hannah Barnes, again, just to put a fine point on it, here in the United States right now, we're in a political environment where, you know, in some places like Florida there even, you know, the legislature there is considering violating people's First Amendment rights by banning preferred pronouns. We have other states in the United States, Tennessee, Texas, more who are contemplating making seeking care for gender questioning youth equivalent to child abuse.

So we have parents who are concerned about their children being taken away from them. So it does very much feel like an existential threat, as I said earlier, to members of the trans community. I'm wondering what the political environment around this issue of quote-unquote, gender affirming care is like in the United Kingdom.

CHAKRABARTI: Well, fortunately, not like that. No, I mean that's appalling, isn't it? And as Jamie Reed said, there so many things. You have so many parallels with what clinicians have said and have told me about their time at the Tavistock. And I think I hope that books like mine, that testimony like Jamie Reed's and like Anna Hutchinson and others, and of course, leading trans doctors themselves, like Marci Bowers in the position she has ... everybody working in this field really wants the same thing, which is the best care possible for each and every one of those young people.

Making transition as safe and positive as possible for those for whom it will be the right option, and preventing those for whom it won't be going down that path and making their lives better as well. And it's about having a calm conversation where you can question the standard of care being provided to a group of young people without questioning them themselves, without questioning their identity or their rights, and doing that without being vilified.

And for those concerns to be taken in the spirit in which they're intended, which is from concerned mental health practitioners or clinicians who have dedicated their entire working lives to helping young people, it's just not credible to write them off as transphobic. But we are fortunate here in the U.K., it's obviously very heated as well. But we don't have laws going through our Parliament or even proposed that pronouns shouldn't be respected, or that care be taken away.

CHAKRABARTI: ... I understand that you had trouble finding a publisher or even someone to do the cover art for your book, is that right?

BARNES: The cover art thing is a bit of a misnomer, but yes, it's been widely reported here in the U.K. that the proposal, which was very detailed in itself, and we'd been looking at this together my colleague Deborah Cohen and I for Newsnight for well close to two years. I wrote a 17,000-word book proposal and it was rejected by 22 publishers. And interestingly, the responses didn't they weren't negative. They didn't say, No, this is this is something we don't want to do. Just really this is an important story. But not for us.

And actually, almost half didn't reply at all, which I've been told by my very experienced agent is almost unheard of to get a rate of, you know, almost a half of norm responses. I mean, you'd expect 90% to reply. So it was, it was pretty demoralizing for a while. But fortunately, Swift Press ... did want to take it on and I'm delighted that they have. And it's a Sunday Times bestseller, so I'm really grateful to everyone that's read it and bought it.

CHAKRABARTI: And for the people who spoke with you both.

BARNES: Oh, absolutely. Yeah. There'll be no book without any of those people, and particularly the young people who went through. It's both those who had a great experience and are happily transitioned and those who didn't and frankly have been harmed and those clinicians as well. And I'm so grateful to each and every one of them.

Book Excerpt

Excerpt from Time To Think by Hannah Barnes. All rights reserved. Not to be republished without permission.

Related Reading

BBC : " Tavistock children's gender clinic closure leaves uncertain future " — "There are more than 7,500 children and young people with gender incongruence or gender-related distress waiting for help from the NHS."

This program aired on March 9, 2023.

• Utah's new law bans gender affirming care for transgender youth
• Alabama is using the case that ended Roe to argue it can ban gender-affirming care

Jonathan Chang Producer/Director, On Point Jonathan is a producer/director at On Point.

Meghna Chakrabarti Host, On Point Meghna Chakrabarti is the host of On Point.

More from On Point

Closure of Tavistock gender identity clinic delayed

• Published 11 May 2023

The closure of the only NHS gender clinic for children in England and Wales has been delayed to March 2024, about a year later than first planned.

The Gender Identity Development Service (Gids), based at London's Tavistock and Portman NHS Foundation Trust, will be replaced by two regional hubs.

A southern hub will open in autumn, with the northern hub following next April.

A review said a new model was needed, after Gids was heavily criticised.

No new first patient appointments for those on the waiting list to be seen will be offered until the southern hub opens, but the Tavistock will continue providing care for the roughly 1,000 children it is currently treating.

There is currently thought to be a waiting list of several thousand for children wanting to use the service. An online support service will launch in June to provide support to those waiting to be seen.

The new hubs are being formed with partnerships managed by London's Great Ormond Street Hospital and Alder Hey Children's Hospital, in Liverpool.

Robbie de Santos of LGBTQ+ charity Stonewall said it was "pleased with the continuity of care" for existing patients "ensuring their needs are met until new services are ready" and also welcomed the regional hubs.

"However, we remain concerned about waiting times and urge NHS England to continue to communicate plans and provide further support for those on the waiting list," he said.

Transgender Trend, a UK campaign group that questions the increase in diagnoses of transgender children, said it was also concerned about the number of children on the waiting list as they may have co-existing mental health needs.

"We would like to see some temporary provision put in for children on the wait list to see a mental health professional," it said.

"CAMHS [Child and Adult Mental Health Services] therapists are already adequately trained to deal with such co-existing issues affecting children with gender-related distress."

Service 'unsustainable'

The Tavistock clinic was rated as "inadequate" by inspectors who visited in late 2020 after the BBC's Newsnight programme reported whistleblowers' concerns.

The subsequent review called for more "holistic" care, looking at patients' overall needs.

There has been a large increase in referrals to the clinic in recent years and it has struggled to meet demand.

Many of those referred were recorded as female at birth but developed gender distress in their early teens.

In July last year, NHS England announced Gids would close in spring 2023, following the interim report by Dr Hilary Cass which called the current single service "unsustainable". NHS England said the timetable had since been revised because of the complexity involved.

More than 5,000 patients were referred to Gids in 2021-2022.

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More on this story.

Child gender clinic closure leaves uncertain future

• Published 18 February 2023

What the Tavistock clinic’s closure means for the trans debate

Gender identity clinic to close over safety fears

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The debate about treatments for transgender young people has been reignited by the closure of a controversial NHS clinic that prescribed puberty blockers to children.

The Week Unwrapped: Religious tolerance, trans treatment and police misogyny How Britons really feel about trans equality One in 20 young Americans identify as trans or non-binary

The Tavistock clinic, in north London, has been “accused of rushing teenagers into life-altering treatment on hormone-blocking drugs”, The Times reported. An independent review led by senior paediatrician Dr Hilary Cass was also highly critical of the Tavistock’s Gender Identity Development Service, which is to be wound down by next spring.

The closure means the UK will no longer have a dedicated gender identity clinic for under-18s, but new regional centres will be set up to “ensure the holistic needs” of “vulnerable” young patients are fully met, according to the NHS England .

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Why is the clinic closing?

The clinic is being shut down after review chief Cass, a former president of the Royal College of Paediatrics and Child Health, concluded in a recently published report that the Gender Identity Development Service (GIDS) was not a “safe or viable long-term option”.

NHS England commissioned the review in September 2020 “in response to a complex and diverse range of issues” including a “significant and sharp rise in referrals”. In the decade from 2011, referrals to the Tavistock rose from 250 to 5,000.

Other issues included “scarce and inconclusive evidence to support clinical decision”; concerns about a “significant number” of children “presenting with neurodiversity and other mental health needs and risky behaviours”; long waiting times for assessments; and “significant external scrutiny” of the service, said NHS England.

Cass found that the current model of care was leaving young people “at considerable risk” of poor mental health and distress. According to her review, there were “critically important unanswered questions” over the clinic’s use of puberty blockers, which have been prescribed to children as young as ten, and “uncertainties about the long-term outcome of medical intervention”.

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“The “damning extent of the Tavistock’s failings” had already been “made clear in the Interim Cass report in February”, said Nikki Da Costa in The Telegraph .

These failings included “lack of open discussion among clinicians; pressure to adopt an unquestioning approach; failure to consider whether medical transition really is the best option; overlooking children’s complex needs; limited mental health assessments; failure to identify children who may be vulnerable and at risk; and failure to follow up after treatment”, Da Costa continued. “This would matter if it affected only a handful of children let alone thousands. It is horrific.”

Legal experts are now warning that the Tavistock and Portman NHS Trust could be sued by patients who felt they did not receive the right treatment.

Why are puberty blockers controversial?

The Tavistock clinic “led the way” in prescribing puberty-blocking drugs to children and young people, said The Times. In 2011, the clinic began a “trial” of puberty blockers including Lupron, a drug used “off label” to reduce the production of sex hormones.

According to the paper, there has been “barely any research into the drugs, including long-term side effects such as infertility”.

In her review, Cass said there was a lack of clarity over whether the drugs simply “pause” puberty or act as “an initial part of a transition pathway”. She also warned that brain development may be “temporarily or permanently disrupted by puberty-blockers”.

How will the Tavistock verdict affect the trans debate?

The closure of the clinic represents a “victory” for “those who say self-proclaimed gender identity should not trump biological sex”, said The Economist .

“The tide in Britain appears to be turning against groups who espouse the belief that gender identity trumps all else, and towards maintaining support for sex-based rights and evidence-based medicine,” the paper continued. Critics argue that the next step is to understand “why so many children with mental health problems are identifying as trans”.

With the Cass review, “the tide turned on an ideology that has ruined lives”, said The Telegraph’s Da Costa, who served as director of legislative affairs for both Boris Johnson and Theresa May. “Coupled with warnings about the use of puberty blockers, it should slow the rush to medicalise young people.”

However, tthe BBC ’s social affairs editor Alison Holt warned that the Tavistock closure would be “a source of worry for other young people wanting support with gender dysphoria”.

“The hope is the services that replace it will be more helpful, useful and efficient,” said Holt.

Will the replacement services be better?

NHS England has accepted recommendations by Cass to establish two new clinics for children with gender dysphoria by spring of next year. One of these clinics will be at Great Ormond Street Hospital in London, and the other will be a partnership between Alder Hey Children’s NHS Foundation Trust in Liverpool and the Royal Manchester Children’s Hospital.

Children being considered for hormone treatment will enter into “formal clinical trials” and followed until adulthood to assess long-term outcomes, The Times reported. And a further “six or seven similar services could be opened in other parts of the country”.

But that may come as little comfort to the “thousands of young people and their families” currently awaiting treatment , said The Guardian . “Many report having to go private in order to access timely treatment,” according to the paper.

And with waiting lists remaining “painfully long”, it is “unlikely the impact of the new hubs will be felt for some time”.

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Britain Shuts Down Its Only Gender Identity Clinic for Kids After Furious Debate

The clinic will be replaced by a series of regional centers at specialist children’s hospitals around the country designed to “ensure the holistic needs” of young patients are met.

Dan Ladden-Hall

News Correspondent

Spencer Platt

England’s national health service will close a controversial gender identity clinic for children after a damning independent review and a slew of allegations made by former staff and patients.

The clinic at Tavistock & Portman NHS Foundation in London will be shut down by spring 2023 and replaced by a series of regional centers at specialist children’s hospitals around the country. The new approach is designed to “ensure the holistic needs” of young patients are met instead of running the service through a single provider, which was deemed to be “not a safe or viable long-term option.”

The clinic became a lightning rod for debates on transgender issues and young people on both sides of the Atlantic.

The Gender Identity Development Service (GIDS) at Tavistock is currently the only gender identity clinic for children under 18 in the U.K. It’s been at the heart of a roiling debate in Britain about how to treat children diagnosed with gender dysphoria and has previously been accused by some doctors and patients of rushing young people onto certain treatments.

Dr. Hilary Cass, who is leading the independent review of the clinic, found that patients’ other mental health issues were “overshadowed” if they mentioned gender to clinicians at Tavistock. She therefore called for the center to be replaced with an “appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population,” adding: “Staff should maintain a broad clinical perspective in order to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context.”

NHS England, which commissioned Dr. Cass’ study in 2020, says it will fully implement her recommendations. The health organization says it will launch two new gender clinics for kids next spring, with one in London and another in the northwest. It’s thought seven or eight services could eventually be set up.

Dr. Cass also instructed the NHS to “enroll young people being considered for hormone treatment into a formal research protocol with adequate follow-up into adulthood, with a more immediate focus on the questions regarding puberty blockers.” She also said there was “a lack of agreement, and in many instances a lack of open discussion” about whether gender dysphoria tended to persist after adolescence.

The subject of detransitioning—where a trans person reidentifies with the gender they were assigned at birth—was at the heart of a legal battle involving Tavistock. England’s High Court had ruled that children under 16 were unlikely to be in a position to give informed consent about receiving puberty blockers, only for the ruling to be overturned in 2021 by the Court of Appeal. The original case had been brought against the clinic by a Tavistock patient, Keira Bell, who was given the drugs when she was 16 and identifying as male, only to later detransition to female.

Stonewall U.K. and Mermaids, which supports trans and gender-diverse kids, cautiously welcomed the plan to shift to a more regional system with clinics around the nation rather than centralized in London.

“We welcome the news that NHS England plan to provide a more resilient and robust gender identity service in 2023 by expanding provision and improving the quality of care received by trans, non-binary and gender diverse young people,” Mermaids said on Twitter.

Referrals to the clinic exploded in recent years, especially for children on the autistic spectrum and young girls. While it had 138 referrals in 2010-11, that number jumped to 2,383 in 2020-21.

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I worked at the Tavistock gender clinic. This is why closing it was the right move

Good clinical care is about ensuring we can question practices, to exercise caution with new ideas, and to ensure we develop a sound evidence base for any treatments..

By Sue Evans

12:01 PM on Apr 22, 2023 CDT

Last summer, Britain’s National Health Service issued an order to close the U.K.’s only dedicated gender identity clinic for children and young people. That clinic, the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust in London, had been criticized in an independent review that said it left young people “at considerable risk” for poor mental health and distress.

I worked at Tavistock for years. Closing it was the right decision.

The closure made headlines the world over and was quickly followed by an opening up of the conversation around the validity of the current World Professional Association for Transgender Health recommendations for standards of care. Those standards were predicated on what has become known as the Dutch Protocol, which was developed for the treatment of a very different group of gender dysphoric patients, mostly natal boys who had experienced and expressed feelings of gender dysphoria from an early age, in contrast with many of the children who are now developing gender dysphoria at the onset of puberty.

I have been working in this clinical area since 2003, and it is my experience that each child is unique, and people who experience gender dysphoria often have complex psychological needs and should not be treated in a formulaic affirmation-only way. This can lead to their other needs being overlooked or ignored in the hope that a solution will result from social and medical transition. While in some cases it can, in many other cases it does not.

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Children and consent

I am a psychoanalytic psychotherapist working in private practice. I am retired from the National Health Service, which has allowed me some freedom to speak regarding my clinical experiences and the contentious issues regarding the treatment and care of children who experience gender dysphoria. Before I retired, I was a senior clinical lecturer at Tavistock and senior fellow in education at the University of East London.

Between 2004 and 2007, I became very concerned that hormone treatments prescribed at the Tavistock Gender Identity Development Service did not adequately consider the complexity of the children presenting there. Their cases were, in most cases, psychologically complex, and many had comorbidities.

An article in the medical journal Archives of Disease in Childhood , a six-page review on the Tavistock Gender Identity Development Service, contained these two sentences: “A range of psychometric measures are used to assess behavioral and emotional functioning, including features of autistic spectrum disorder and self-harm. Around 35% of referred young people present with moderate to severe autistic traits.”

I witnessed some children being medicalized after as few as four assessment meetings, during which time very little psychological support or treatment could possibly have occurred. In my clinical experience, it takes much longer to make a full assessment of children and adolescents, and a therapeutic alliance can take months to build. I was shocked by this superficial psychological approach, as it led to irreversible changes, both physical and mental, some of which are as yet unknown, due to the paucity of follow-up data on the children receiving these treatments.

Bell vs. Tavistock Judicial Review

By 2019, Tavistock’s caseload had grown from approximately 80 referrals per year to more than 3,000. There were several child safeguarding issues being raised by staff that were not being adequately addressed by the senior management.

Meanwhile, there was a growing awareness in the U.K. that all was not well with the political influence on medical and psychological approaches to treatment of gender dysphoria in children. One central issue of concern is whether a child or adolescent is able to give informed consent to the medicalized treatment.

That issue came to a head in legal proceedings involving a woman named Mrs. A. who had a teenage daughter with autism who was on a waiting list for treatment. Following an event in the House of Lords where many professionals and parents spoke of their growing concerns in this clinical area, Mrs. A. and I became claimants in the judicial review. I helped the legal team assemble witness statements from professionals throughout the world on the issue regarding standards of care, child development, neuroscience, endocrinology and autism. We built an application to challenge the issue of children being psychologically mature enough to understand the complexities of the consequence of medical treatment in order to give informed consent to the use of puberty blockers and cross sex hormones. As part of the application, I invited Keira Bell, a female who started gender transition following just a few appointments at GIDS. She became a joint claimant in the case and has become an international symbol of the ethical concerns of gender-affirming care.

Bell had been treated at Tavistock beginning at age 16. She started on puberty blockers, advanced to testosterone shots, and eventually had a double mastectomy. But at 21, Bell came to regret the treatment and became one of a rapidly increasing number of patients who have either regretted their transition or decided to reverse it, something called “detransitioning.”

At 23, Bell realized she had not had the maturity and understanding to give informed consent to the medicalized procedures before adulthood. She had also been psychologically vulnerable and felt what she had needed was psychological care.

Like Bell, Mrs. A. did not consider her daughter capable of fully understanding the attendant risks of undertaking gender reassignment treatment due to her autism diagnosis and other psychological conditions.

Our team submitted a huge amount of evidence, which three high court judges reviewed, along with evidence submitted by Tavistock. In December 2020, the judges ruled in our favor. The court wrote, “There will be enormous difficulties in a child under 16 understanding and weighing up this information and deciding whether to consent to the use of puberty blocking medication.” Further, the court said it was “doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences” of this treatment. It ruled that it was “highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers.”

During the period of the judicial review and appeal process, Tavistock board member Marcus Evans and I co-authored a book on gender dysphoria that offers a psychological understanding of some of the factors involved. We hope it offers a therapeutic model to support children with gender dysphoria in their time of distress.

Adolescence and anxiety

In my clinical experience, I have learned that many of these children are managing their anxieties through a system of rigid psychological defenses. They often struggle to be able to think about their internal emotional world, with its attendant conflicts and confusions. For professionals, it may feel anxiety-provoking to explore this with the child, but our and others’ clinical experience strongly suggests that a holistic, empathetic approach can help the child begin to be self-curious and this may help to relieve the distress they are experiencing.

If, however, they are not supported or able to do so, psychic discomfort is often channeled into the idea of making concrete changes to the body as if this will get rid of the difficult issues. It sometimes works in the short term, hence the much quoted “satisfaction surveys” taken shortly after commencement of medical treatment but with little or no long-term follow up to back this claim.

The idea of puberty blockers may be very appealing to put a stop to adolescent development, with its often unwelcome and sometimes terrifying rush of hormones, leading to bodily changes, the emotional demands of becoming more grown up and integrating somehow into the world. This relief at finding the “answer” to the maelstrom of adolescence can appeal to kids, parents and clinicians because it appears to be an easier route out of the chaos and disturbance.

However, the task for us all in life, is to develop from a child into an independent adult. Adolescence, and the accompanying chaos it brings, is a very normal human experience, though not easy. The anxieties some children are hoping to avoid are often around their adolescent physical development and maturation, associated with a difficulty in negotiating sexuality and relationships and also separation from parents. Affirmation and puberty blocking interferes with ordinary human development in all areas.

There has been a push to say that gender dysphoria has nothing to do with mental health. But it is curious to imagine that ideas which develop in the mind in relation to otherwise healthy physical bodies are not of some psychological origin. Good clinical care is about ensuring we can question practices, to exercise caution with new ideas and to ensure we develop a sound evidence base for any treatments, whether psychological, medical or surgical. At the moment we just don’t know enough about any of this.

Desistance and detransition

Current gender-affirming models ignore a growing body of data from detransitioners like Bell and “desisters” — those who simply stop pursuing gender transition.

According to multiple studies, there is a very high level of desistance in children with gender dysphoria if they are offered time and psychological support or alternatives to affirmation such as “watchful waiting.”

A 2021 report from the University of Toronto followed up with a group of people who experienced gender dysphoria in childhood. Thirteen years after their initial diagnoses, 87.8% of them were classified as desisters.

In addition, there is early evidence, such as that published in the Journal of the American Academy of Child and Adolescent Psychiatry , to suggest that this rate lowers, but still remains fairly high , even when children are socially and/or medically transitioned.

We have no true idea of the growing number of children who have given so-called informed consent to this medicalized route, received hormones and/or surgeries, but have lived to regret their transition and will suffer lifelong consequences of this experimental treatment.

The independent review that led to the closure of the Tavistock clinic, called the Cass review after its chair, Hilary Cass, revealed that there is very little gold standard research and follow-up data in this area of medicine. Many desisters and detransitioners speak of the wish that a professional had stopped them in their headlong run toward medical transition. Sadly, however, few go back to tell their medical providers that they have, together, made an irrevocable mistake and caused perhaps irreversible harm. This is probably also true in America.

The medical profession has an opportunity to look more closely at the potential harms being done and also to improve its practices in the care of gender dysphoric patients. Society, too, has its part to play in developing some tolerance for uncertainty and some curiosity to learn more about what is really going on with our kids.

But in order to improve care for all trans-identifying children, we need much more in-depth research with longer follow-up studies before we really know what is best in gender care.

Parents and physicians

In my consultation work with parents, it has become clear to me that many feel tyrannized by gender identity issues, sometimes by their child’s state of mind and subsequent demands of them to accept and conform with the child’s ideas and wishes, but also often by teachers, professionals and wider society.

It is important that parents, who usually know their children very well, have some support to explore their own feelings without judgment, and be helped to understand and process what might be going on between them and their child.

Certainly, my experience to date is that most parents are not transphobes or bigots, but deeply care about their child and hope to avoid irreversible harm. Many are concerned or fearful. Parents often know far more about their child’s complexities, background and emotional intricacies than anyone else, including the child. It is very rarely in the best interest of the child to have parents pushed out or rejected.

There are things that need to be understood from many angles and this requires nonjudgmental professionals to try to keep all ideas open, and allow for differences of opinion.

There is often inadequate or misleading information given to parents and professionals. Asking for better research and improving the evidence base is not transphobia. It’s medicine. It’s about safeguarding children. Until we know more, doctors should remember to “first, do no harm.”

Sue Evans is a psychoanalytic psychotherapist in the United Kingdom. She wrote this column for The Dallas Morning News.

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How to find an NHS gender dysphoria clinic

Trans and non-binary people's general health needs are the same as anyone else's. But trans people may have specific health needs in relation to gender dysphoria.

Your particular needs may be best addressed by transgender health services offered by NHS gender dysphoria clinics (GDCs).

All NHS GDCs are commissioned by NHS England, who set the service specifications for how they work.

A GP or another health professional can refer you directly to one of the GDCs. You do not need an assessment by a mental health service first. Neither does the GP need prior approval from their integrated care board (ICB). 

The websites of the clinics listed on this page also have useful information for you to think about before you see a GP. 

Children and young people's gender services

Children and young people should be referred to the National Referral Support Service for the NHS Children and Young People's Gender Service .

These NHS services specialise in helping young people with gender identity issues. They take referrals from anywhere in England.

Gender dysphoria clinics in London and the southeast

The Tavistock and Portman NHS Foundation Trust: Gender Dysphoria Clinic for Adults

Lief House 3 Sumpter House Finchley Road London NW3 5HR

Phone: 020 8938 7590

Email: [email protected]

The GDC website has an overview of information useful for anyone with gender identity needs, not just those in the area.

Gender dysphoria clinics in the north

Sheffield Health and Social Care NHS Foundation Trust Gender Dysphoria Service

Porterbrook Clinic Michael Carlisle Centre 75 Osborne Road Sheffield S11 9BF

Phone: 0114 271 6671

Email: [email protected]

The  Sheffield clinic's website includes information about referrals, clinic opening hours and links to eligibility criteria.

Leeds and York Partnership NHS Foundation Trust Gender Dysphoria Service

Management Suite 1st Floor The Newsam Centre Seacroft Hospital York Road Leeds LS14 6WB

Phone: 0113 855 6346

Email: [email protected]

The Leeds clinic's website covers referrals, commonly used medicines and information on the clinic's Gender Outreach workers.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Northern Region Gender Dysphoria Service

Benfield House Walkergate Park Benfield Road Newcastle NE6 4PF

Phone: 0191 287 6130

Email: [email protected]

The Northern Region Gender Dysphoria Service website has a range of leaflets, including information about referral, hormones and support groups.

Gender dysphoria clinics in the Midlands

Northamptonshire Healthcare NHS Foundation Trust Gender Dysphoria Clinic

Danetre Hospital H Block London Road Daventry Northamptonshire NN11 4DY

Phone: 03000 272858

Email:  [email protected]

Visit the  Northampton clinic's website for more information about how to get a referral and the role of the GP.

Nottinghamshire Healthcare NHS Foundation Trust The Nottingham Centre for Transgender Health

12 Broad Street Nottingham NG1 3AL

Phone: 0115 876 0160

Email: [email protected]

Visit The Nottingham Centre for Transgender Health website  for more information about how to get a referral.

Gender dysphoria clinics in the southwest

Devon Partnership NHS Trust West of England Specialist Gender Dysphoria Clinic

The Laurels 11-15 Dix's Field Exeter EX1 1QA

Phone: 01392 677 077

Email: [email protected]

The Laurels' website has information about the types of services on offer and the help available during transition.

New gender dysphoria services in 2020

In 2020 new NHS gender dysphoria services for adults will open in Greater Manchester, London and Merseyside.

These services will be delivered by healthcare professionals with specialist skills and based in local NHS areas, such as sexual health services. Full details will be available once each service is opened.

Initially, access to these services will be available to people who are already on a waiting list to be seen at one of the established gender dysphoria clinics.

NHS England will assess how useful these new pilot services are.

Page last reviewed: 13 May 2020 Next review due: 13 May 2023

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Perspective: The tide has turned in the UK on gender-affirming treatment for children

Legal action over puberty blockers prescribed to minors will likely reverberate across the atlantic.

By Valerie Hudson

Over the past few weeks, an amazing turn of the tide has occurred in the United Kingdom, one which has profound ramifications for the United States. It involves The Tavistock Clinic in England, the hub of gender-affirming treatment under the country’s National Health Service.

The term “gender-affirming treatment” refers to the steps of treating gender dysphoria first with puberty blockers, then with cross-sex hormones and finally, for a sizable number of patients, with sex reassignment surgery. 

“Affirming” means that any questioning of whether this stepladder of treatment is appropriate for a particular person expressing gender dysphoria was considered inappropriate, practically akin to “ conversion therapy ,” which has been outlawed in most Western countries.

The first clues that all was not going to end well for the Tavistock model were cases of Keira Bell and Sonia Appleby , both decided several months ago. In the Appleby case, Sonia Appleby was employed in the clinic as the “safeguarding lead” for gender dysphoric children being treated at Tavistock. She raised concerns that medics were not keeping careful records, not screening children for mental health comorbidities, and were being inconsistent in their treatment of children. She was then officially reprimanded — for trying to do her job. The court awarded her damages.

In the more famous Bell case, Keira Bell is the young woman treated at Tavistock who brought suit because she felt she was fast-tracked for gender affirmation treatment by the clinic, even though as a minor she had little understanding of the long-term consequences of what she was supposedly consenting to undergo. Now detransitioned, Bell accused Tavistock of shunting children along a treatment path to irreversible changes they could not possibly understand, such as sterility, bone loss, altered brain development and even inability to ever experience sexual climax.

From Bell’s standpoint, she and other children had been experimented upon in the most cruel fashion. The verdict was unanimously in her favor. The high court found much of the treatment is not based on solid evidence at all, and that children under 16 simply could not consent to a treatment with such major and irreversible consequences.

These two cases presaged the next development, which is known in the U.K. as the Cass Report . Dr. Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, was tasked by the Boris Johnson government with reviewing practices at Tavistock. Cass undertook a comprehensive literature review, a qualitative study of patients and clinicians at Tavistock, and a quantitative study of 9,000 patient outcomes. What she and her team found was disturbing . The evidence base for the treatment Tavistock was providing was found to be shaky and had already been repudiated by several other Western European countries, including Finland , Sweden and France .

Cass also found there was almost no follow-up of patients, and thus very little understanding of whether Tavistock’s treatment helped patients or not. In interviews, a number of patients and staff expressed concerns over the one-size-fits-all approach.  Cass recommended, and the government agreed, that Tavistock be shuttered, that regional centers to treat gender dysphoria in a more whole-of-care fashion be established, and that a firm evidence base be established before puberty blockers, in particular, were used on children.

This week, the big news hit. A law firm in the U.K. is launching a class-action suit against Tavistock, and it anticipates that more than 1,000 clients will be joining the suit. The suit will accuse Tavistock of “multiple failures of duty of care” with regard to its pediatric patients suffering from gender dysphoria. The clinic will also be charged with having “recklessly prescribed puberty blockers with harmful side effects and (having) adopted an ‘unquestioning, affirmative approach’ to children identifying as transgender.”

The days of the “affirmation-only-no-debate” approach to pediatric gender dysphoric patients is over, at least in the U.K. This great turning of the tide in Britain has taken place in the space of approximately 11 months.

Will the same happen in the United States?  I believe it will for pediatric cases. While most Americans take a live-and-let-live attitude toward adult transition, the increasing evidence that puberty blockers do not simply “press pause” on puberty and may have seriously damaging and irreversible effects on children who cannot meaningfully consent, is becoming too great to ignore. The American Association of Pediatrics is already embroiled in a civil war over the issue. In addition to states such as Florida and Texas pursuing investigations of clinicians and pharmaceutical companies, the law firm Girard Sharp appears poised to launch a similar class-action suit; the firm is soliciting reports of adverse effects of puberty blockers from the guardians and parents of children who have been treated with them.

What is currently termed “gender-affirming treatment” for pediatric patients is likely to one day be seen as one of the greatest medical scandals of the 21st century. The light that will be shone on the practice in U.S. courtrooms will see to that, as happened in the U.K.

Valerie M. Hudson is a university distinguished professor at The Bush School of Government and Public Service at Texas A&M University and a Deseret News contributor. Her views are her own.  

Puberty blockers aren’t a sensible option for gender variant people

“There is little evidence of demonstrable harm from [puberty blocking drugs]” observed paediatrician Professor Gary Butler of London’s University College Hospital, who supervised their administration to children referred by the (now closed) Tavistock Gender Identity and Development Services (GIDS) Clinic. 

“We know their effect is reversible, buying time [to decide whether or not to transition with cross-sex hormones] and that they reduce distress.” Further, he adds, their use results in “improved physical and psychological adaptation and wellbeing in young gender-variant people”. That was back in 2019, writing in the influential academic journal Archives of Disease in Childhood .

 The recently published Cass Review , chaired by paediatrician Dr Hilary Cass, took a rather more critical view, judging rather the scientific rationale for puberty blockers to be “wholly inadequate” to be sure they work in the way intended, so for example, a 16-year-old “natal female” after three years will be smaller than her peers who have experienced the pubertal growth spurt, and without the secondary sexual characteristics of breasts and pubic hair. But the findings of 50 studies assessing the outcome – for good or ill – of such an intervention are deemed “inconsistent and contradictory”. “No conclusions can be drawn about their impact on gender dysphoria.”

 Hence Dr Cass ’s insistence on correcting this “evidence deficit” by ensuring in future transitioning drugs only be prescribed as part of a properly conducted research programme. Take 100 adolescents with gender dysphoria and allocate them to two groups – half to be prescribed puberty blockers and the remaining 50, acting as a control group receiving only “psychosocial support”. Monitor the long-term outcome over several years and see which group “does better”.

 There is no other way to come to a reasoned judgement. The obvious difficulty, however, of any such comparison is that whereas 90 per cent of those taking puberty blockers go on to transition with hormones and often reassignment surgery, a similar proportion of those in the control group will not – having become “comfortable with their birth sex”. 

The consequences of these two trajectories being so very different, the outcomes in essence are incomparable. So, contra Professor Butler, puberty blockers can never be demonstrated to be a sensible option for “gender-variant people”.  

Tonsillectomy must be balanced

Back in the 1960s, a quarter of children would have had their tonsils removed (a tonsillectomy ) by their 12 th birthday. Myself included, in Aberdeen Royal Infirmary and I still vividly recall being wheeled down the corridor to the operating theatre with the reward of a boiled sweet under my pillow on my return. 

Around that time doctors began to question whether it was really necessary for so many to have the procedure – to which the answer was clearly no. Since then, the number of tonsillectomies has plummeted by 90 per cent and is now restricted to those who experience several episodes of tonsillitis a year.

 But perhaps this downward trend in the numbers deemed eligible has gone too far? The fever, sore throat – like swallowing razor blades – and painful, swollen glands of tonsillitis are most unpleasant. Each episode usually rapidly improves with antibiotics but sometimes it may not, being of sufficient severity to warrant hospital admission-increasingly common over the past two decades.

 Still, the putative benefits of tonsillectomy have to be balanced against it being a painful operation requiring a couple of weeks off work and the risk of surgical complications. The issue has recently been resolved in favour of tonsillectomy over “conservative management” (treating each attack of tonsillitis with antibiotics) – though not as emphatically as might be anticipated. Those having the operation reported half as many episodes of sore throat over the subsequent two years, but almost one fifth experienced the complication of post-operative bleeding.

Email comments and queries in confidence to [email protected]

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Gagarin Cup Preview: Atlant vs. Salavat Yulaev

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Gagarin cup (khl) finals:  atlant moscow oblast vs. salavat yulaev ufa.

Much like the Elitserien Finals, we have a bit of an offense vs. defense match-up in this league Final.  While Ufa let their star top line of Alexander Radulov, Patrick Thoresen and Igor Grigorenko loose on the KHL's Western Conference, Mytischi played a more conservative style, relying on veterans such as former NHLers Jan Bulis, Oleg Petrov, and Jaroslav Obsut.  Just reaching the Finals is a testament to Atlant's disciplined style of play, as they had to knock off much more high profile teams from Yaroslavl and St. Petersburg to do so.  But while they did finish 8th in the league in points, they haven't seen the likes of Ufa, who finished 2nd. 

This series will be a challenge for the underdog, because unlike some of the other KHL teams, Ufa's top players are generally younger and in their prime.  Only Proshkin amongst regular blueliners is over 30, with the work being shared by Kirill Koltsov (28), Andrei Kuteikin (26), Miroslav Blatak (28), Maxim Kondratiev (28) and Dmitri Kalinin (30).  Oleg Tverdovsky hasn't played a lot in the playoffs to date.  Up front, while led by a fairly young top line (24-27), Ufa does have a lot of veterans in support roles:  Vyacheslav Kozlov , Viktor Kozlov , Vladimir Antipov, Sergei Zinovyev and Petr Schastlivy are all over 30.  In fact, the names of all their forwards are familiar to international and NHL fans:  Robert Nilsson , Alexander Svitov, Oleg Saprykin and Jakub Klepis round out the group, all former NHL players.

For Atlant, their veteran roster, with only one of their top six D under the age of 30 (and no top forwards under 30, either), this might be their one shot at a championship.  The team has never won either a Russian Superleague title or the Gagarin Cup, and for players like former NHLer Oleg Petrov, this is probably the last shot at the KHL's top prize.  The team got three extra days rest by winning their Conference Final in six games, and they probably needed to use it.  Atlant does have younger regulars on their roster, but they generally only play a few shifts per game, if that. 

The low event style of game for Atlant probably suits them well, but I don't know how they can manage to keep up against Ufa's speed, skill, and depth.  There is no advantage to be seen in goal, with Erik Ersberg and Konstantin Barulin posting almost identical numbers, and even in terms of recent playoff experience Ufa has them beat.  Luckily for Atlant, Ufa isn't that far away from the Moscow region, so travel shouldn't play a major role. 

I'm predicting that Ufa, winners of the last Superleague title back in 2008, will become the second team to win the Gagarin Cup, and will prevail in five games.  They have a seriously well built team that would honestly compete in the NHL.  They represent the potential of the league, while Atlant represents closer to the reality, as a team full of players who played themselves out of the NHL. 

• Atlant @ Ufa, Friday Apr 8 (3:00 PM CET/10:00 PM EST)
• Atlant @ Ufa, Sunday Apr 10 (1:00 PM CET/8:00 AM EST)
• Ufa @ Atlant, Tuesday Apr 12 (5:30 PM CET/12:30 PM EST)
• Ufa @ Atlant, Thursday Apr 14 (5:30 PM CET/12:30 PM EST)

Games 5-7 are as yet unscheduled, but every second day is the KHL standard, so expect Game 5 to be on Saturday, like an early start. 

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New NHS children’s gender clinic hit by disagreements and resignations

At least four experts quit Great Ormond Street team after disputes over text of training module for recruits, sources say

A string of resignations from a team preparing for the launch of the new NHS children’s gender clinic has further complicated plans to open the services in April.

Disagreements over the text of a training module for medical recruits to the new gender service have prompted NHS England to remove the training materials project from a team at Great Ormond Street hospital and outsource it to the Academy of Medical Royal Colleges.

Great Ormond Street last year recruited a small team, including paediatricians and child psychologists, to write training guidance for new medical staff who will work in NHS England’s reshaped gender services for children and young people.

But at least four members of the team resigned late last year after disagreements over how children with gender dysphoria should be treated, according to sources close to the process.

The new NHS Children’s and Young People’s Gender Service for London is scheduled to open its doors to patients in early April, a year later than first scheduled and almost two years after NHS England announced the closure of the gender identity development service (Gids) for children at the Tavistock clinic in north London.

Gids was set up at the Tavistock three decades ago to help children and other young people struggling with their gender identity. But after a series of concerns and complaints from inspectors, whistleblowers, patients and families, the clinic is to close and be replaced by a number of hubs, including at Great Ormond Street.

Great Ormond Street is working with the Evelina children’s hospital and the South London and Maudsley NHS trust to pilot the first of several regional hubs that will take on the work previously conducted by the Tavistock clinic.

The team of experts recruited to write the training material included former Tavistock employees who left because they were uneasy about that service’s treatment of young people, plus other clinicians said to be opposed to the NHS’s new approach to handling children and young people with gender dysphoria.

Sources close to the discussions said there was “no consensus” within the team and that their work was incomplete when members resigned.

In 2022, Dr Hilary Cass, the paediatrician charged with reviewing the NHS’s care of children with gender dysphoria, said a “fundamentally different” approach was needed because of rising referrals and a significant change in the case mix, with a sharp rise in adolescent girls presenting with gender incongruence in their early teen years.

She also noted that many children displayed a wide range of other complexities, including mental health needs. Her independent review highlighted uncertainties surrounding the use of hormone treatments. Interim NHS service specifications say the new clinics will take a multidisciplinary approach, offering psychological support.

Some clinicians working on the new training materials are understood to have felt it important to affirm a patient’s gender identity and believed patients could benefit from medication. Others, some of whom resigned their posts, stressed the need to adhere to Cass’s recommendations and take a holistic, “exploratory” approach.

A spokesperson for the Academy of Medical Royal Colleges said the body had agreed to step in to write an interim training module, and was working to meet a six-week deadline, “because our members are keen to help ensure this service can go live as planned” [in April].

He added that because “time is tight”, the body would deliver induction training to let clinicians begin seeing patients, and a more in-depth programme would be commissioned at a later stage.

Great Ormond Street said the team recruited to develop the training and education programme had “now wrapped up its part of the process, having produced a range of high-quality materials. The programme has now been passed on to the Academy of Medical Royal Colleges, who will complete and deliver the induction programme.”

Some parents are turning to private healthcare, frustrated by the continuing turmoil and NHS waiting lists that can stretch to several years.

This week a private hormone clinic for transgender young people said it had become the first UK-based private provider to be registered by the health regulator, the Care Quality Commission, to prescribe cross-sex hormones for patients over 16.

The service is part of the Gender Plus group, run by several ex-NHS former Tavistock clinicians, which also offers psychological consultations, and for those over 18, referrals for gender-affirming surgery.

• Transgender

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635th Anti-Aircraft Missile Regiment

635-й зенитно-ракетный полк

Military Unit: 86646

Activated 1953 in Stepanshchino, Moscow Oblast - initially as the 1945th Anti-Aircraft Artillery Regiment for Special Use and from 1955 as the 635th Anti-Aircraft Missile Regiment for Special Use.

1953 to 1984 equipped with 60 S-25 (SA-1) launchers:

• Launch area: 55 15 43N, 38 32 13E (US designation: Moscow SAM site E14-1)
• Support area: 55 16 50N, 38 32 28E
• Guidance area: 55 16 31N, 38 30 38E

1984 converted to the S-300PT (SA-10) with three independent battalions:

• 1st independent Anti-Aircraft Missile Battalion (Bessonovo, Moscow Oblast) - 55 09 34N, 38 22 26E
• 2nd independent Anti-Aircraft Missile Battalion and HQ (Stepanshchino, Moscow Oblast) - 55 15 31N, 38 32 23E
• 3rd independent Anti-Aircraft Missile Battalion (Shcherbovo, Moscow Oblast) - 55 22 32N, 38 43 33E

Disbanded 1.5.98.

Subordination:

• 1st Special Air Defence Corps , 1953 - 1.6.88
• 86th Air Defence Division , 1.6.88 - 1.10.94
• 86th Air Defence Brigade , 1.10.94 - 1.10.95
• 86th Air Defence Division , 1.10.95 - 1.5.98

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Out of the Centre

Savvino-storozhevsky monastery and museum.

Zvenigorod's most famous sight is the Savvino-Storozhevsky Monastery, which was founded in 1398 by the monk Savva from the Troitse-Sergieva Lavra, at the invitation and with the support of Prince Yury Dmitrievich of Zvenigorod. Savva was later canonised as St Sabbas (Savva) of Storozhev. The monastery late flourished under the reign of Tsar Alexis, who chose the monastery as his family church and often went on pilgrimage there and made lots of donations to it. Most of the monastery’s buildings date from this time. The monastery is heavily fortified with thick walls and six towers, the most impressive of which is the Krasny Tower which also serves as the eastern entrance. The monastery was closed in 1918 and only reopened in 1995. In 1998 Patriarch Alexius II took part in a service to return the relics of St Sabbas to the monastery. Today the monastery has the status of a stauropegic monastery, which is second in status to a lavra. In addition to being a working monastery, it also holds the Zvenigorod Historical, Architectural and Art Museum.

Belfry and Neighbouring Churches

Located near the main entrance is the monastery's belfry which is perhaps the calling card of the monastery due to its uniqueness. It was built in the 1650s and the St Sergius of Radonezh’s Church was opened on the middle tier in the mid-17th century, although it was originally dedicated to the Trinity. The belfry's 35-tonne Great Bladgovestny Bell fell in 1941 and was only restored and returned in 2003. Attached to the belfry is a large refectory and the Transfiguration Church, both of which were built on the orders of Tsar Alexis in the 1650s.  

To the left of the belfry is another, smaller, refectory which is attached to the Trinity Gate-Church, which was also constructed in the 1650s on the orders of Tsar Alexis who made it his own family church. The church is elaborately decorated with colourful trims and underneath the archway is a beautiful 19th century fresco.

Nativity of Virgin Mary Cathedral

The Nativity of Virgin Mary Cathedral is the oldest building in the monastery and among the oldest buildings in the Moscow Region. It was built between 1404 and 1405 during the lifetime of St Sabbas and using the funds of Prince Yury of Zvenigorod. The white-stone cathedral is a standard four-pillar design with a single golden dome. After the death of St Sabbas he was interred in the cathedral and a new altar dedicated to him was added.

Under the reign of Tsar Alexis the cathedral was decorated with frescoes by Stepan Ryazanets, some of which remain today. Tsar Alexis also presented the cathedral with a five-tier iconostasis, the top row of icons have been preserved.

Tsaritsa's Chambers

The Nativity of Virgin Mary Cathedral is located between the Tsaritsa's Chambers of the left and the Palace of Tsar Alexis on the right. The Tsaritsa's Chambers were built in the mid-17th century for the wife of Tsar Alexey - Tsaritsa Maria Ilinichna Miloskavskaya. The design of the building is influenced by the ancient Russian architectural style. Is prettier than the Tsar's chambers opposite, being red in colour with elaborately decorated window frames and entrance.

At present the Tsaritsa's Chambers houses the Zvenigorod Historical, Architectural and Art Museum. Among its displays is an accurate recreation of the interior of a noble lady's chambers including furniture, decorations and a decorated tiled oven, and an exhibition on the history of Zvenigorod and the monastery.

Palace of Tsar Alexis

The Palace of Tsar Alexis was built in the 1650s and is now one of the best surviving examples of non-religious architecture of that era. It was built especially for Tsar Alexis who often visited the monastery on religious pilgrimages. Its most striking feature is its pretty row of nine chimney spouts which resemble towers.

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