Detrans clinic, soon

Planned Parenthood's gender boom; big hit on Chilean TV; Cass in South Africa; UK adult clinics under review; a nudge for Canada's medical elite; more secret transitions in the US; blockers on trial

Photo by The Australian War Memorial on Unsplash

GCN in brief

Finally

United Kingdom | England is to establish its first service for detransitioners. In an August 7 update, England’s National Health Service (NHS) said it would set up a project “to explore the issues around a detransition pathway” by next month. “This would include examining the rate at which patients detransition and their reasons for doing so, as these are currently unknown,” The Daily Telegraph reported. In her final report, Dr Cass noted that young people who decide to detransition may not want to return to the same clinic that transitioned them. British detransitioner Ritchie Herron welcomed the news of a detrans-specific service, saying, “Getting care is very difficult, no one wants to go back to the place that caused harm.”

Gender-conforming care

Chile | The high-profile TV investigations program Informe Especial has devoted a one-hour episode “Our trans children” to the Chilean debate over paediatric gender change. Presented by Santiago Pavlovic, a well-known war correspondent, the episode cited the “worldwide repercussions” of England’s Cass report and featured a range of views critical and supportive of the “gender-affirming” treatment approach.

“It is not a model in which children are allowed to freely explore their identity without any kind of label,” said one critic, Nael Condell, a female who transitioned at age 18 and has taken testosterone as a transsexual man over the last two decades. “In other words, a girl who plays ball does not become a boy,” Mr Condell said. “A boy who does ballet, that doesn’t make him a woman either. But nowadays they are labelling you—and that is what is delicate and complicated, because this has already been taken to the state level, to the level that the child who has some kind of confusion or who has doubts or whatever, arrives at the public hospital and [is put down for] gender affirmation.”

As a health professional Mr Condell said there was a fear of criticising the gender-affirming model. “There is an issue of the culture of cancellation at the medical, media, psychological level, everything.” He gave the example of a doctor who might express legitimate doubt that hormone treatment would serve a patient’s well-being—“and all the activists throw him to the lions.” Mr Condell also criticised clinicians who play down the significance of testosterone as a cross-sex hormone, those who say, “‘You just grow a beard, change your voice or give you some physical attributes, that’s it’. No, it has a lot more implications, especially at the level of the organism and at the level of the brain.”

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Video: “I realised I liked girls when I was 12. I was worried that being gay was wrong”

Wrong plan

America | Planned Parenthood, the US birth control agency turned fast-track gender clinic, faces its first lawsuit brought by a detransitioner, The Free Press has reported. At age 18, Cristina Hineman says, she was given a testosterone prescription after a 30-minute appointment. A little more than a year later, she realised her mistake. “A lot of people say that adults should be able to do whatever they want,” Ms Hineman said. “But if you have mental illness that’s clouding your view, or you’re so misinformed about what gender dysphoria even means, then you cannot consent to such invasive treatments.” She was suffering from depression and anxiety; she was autistic and exposed to trans influencers on YouTube.

In her Free Press article, journalist Jennifer Block recounts how Planned Parenthood became America’s “leading provider of gender transition hormones for young adults, according to insurance claim data. In 2015, around two dozen of their clinics began offering this service. Now it’s available at nearly 450 locations. Insurance claim information provided to The Free Press by the Manhattan Institute shows that at least 40,000 patients went to Planned Parenthood for this purpose last year alone, a number that has risen tenfold since 2017. The largest proportion, about 40 percent, were 18- to 22-year-olds.”

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Not so affirming

South Africa | England’s Cass report has been misrepresented in South Africa as a charter for more “gender-affirming care,” according to representatives from the watchdog group First Do No Harm Southern Africa (FDNHSA), Dr Allan Donkin, Professor Reitze Rodseth and Dr Janet Giddy. In a June article for the Spotlight health magazine, two clinical psychologists from the Professional Association for Transgender Health South Africa had seized on Dr Cass’s theme of improved access to care, and stated that, “In South Africa, similar steps are needed to both expand gender-affirming care for youth and prevent the collapse of the existing, limited services.” Last month, in The Mail & Guardian newspaper, FDNHSA said this was misleading. “The Cass review does not recommend expanding gender-affirming care, medical or social transition, but rather recommends expanding support for children with psychological distress, of which gender confusion may be a component,” the watchdog group said.

It also took aim at the gender-affirming treatment guideline issued by the South African HIV Clinicians Society, pointing out that this document was among the international guidelines evaluated in peer-reviewed research commissioned by Dr Cass. The 2021 South African guideline scored 21/100 for the rigour of its development, compared with 71/100 for Sweden’s new, more cautious guideline. Like other poorly rated guidelines, the South African document relied heavily on the low-quality recommendations of the World Professional Association for Transgender Health.

“A glaring oversight in the development of the [South African guideline] is that detransitioners and their lived experience were not included in the development of the guide,” the FDNHSA article said. “Clinicians who have been providing (and continue to provide) medicalising treatments to children and adolescents for gender dysphoria in South Africa may find it difficult to hear the news of the shifting evidence base, and to seriously engage with what the implications are. It will take courage to reconsider a position that has been rationalised and defended.”

Knock, knock

United Kingdom | The first on-site visits for an official review of England’s adult gender clinics are expected next month. “The key lines of enquiry will be designed in collaboration with current and former patients, clinicians and other key stakeholders,” according to NHS England, which said it recognised the “courage” of clinicians who had privately put their concerns about adult clinics to paediatrician Hilary Cass.

In a May 2024 letter to the NHS, made public on August 7, Dr Cass said she had been told of patients put on hormones at their second appointment with little time for assessment, of clinicians facing complaints if they delayed the prescription of hormones, of doubt about consent and “limited explanation of risks such as vaginal atrophy, osteoporosis, etc”, and of there being no formal process to learn from the suicide of patients receiving treatment.

Meanwhile, Dr Cass has contradicted a claim that she had recommended Abigail Shrier’s book Irreversible Damage to a clinician critical of her review who had worked at the London-based Tavistock gender clinic. “This is a baseless and wholly untrue comment and should be seen for what it is, which is a cynical attempt to undermine the [Cass] review,” Dr Cass told journalist Benjamin Ryan. “Anyone who has actually read my report will see that it advocates to provide appropriate support for all gender-questioning young people, regardless of whether they choose a medical pathway or not.”

Wake-up call

Canada | Canadian opposition leader Pierre Poilievre, whose Conservative Party is well ahead in opinion polls, has nudged the country’s medical societies to address concerns about paediatric gender medicine highlighted by England’s Cass report. On August 3, Mr Poilievre quote tweeted the headline of a National Post opinion article, “It’s time Canadian medical leaders stood up to gender medicine”. The article drew a contrast between the caution of Dr Cass’s approach and the liberal access to gender medicalisation for minors in Canada. The country’s next election is on or before 20 October 2025.

Deceptive

America | A school counsellor in the US state of Colorado set up for transition a teenage girl suffering depression and anxiety without any reference to her parents, according to a lawsuit Doe v Weiser filed by the Center for American Liberty. The counsellor allegedly affirmed the girl as a boy and arranged a telemedicine appointment. “Unfortunately, this deliberate deception on the part of schools is becoming more common across the [the US],” the center said. “School districts and states are implementing policies and laws that aim to remove parents from critical decisions in their kids’ lives.”

Trial by ethics

United Kingdom | A clinical trial of puberty blockers potentially involving hundreds of children is expected to begin early next year, The Times has reported. The chief investigator for the study will be Dr Emily Simonoff, Professor of Child and Adolescent Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. “The study will measure a range of potential treatment benefits and harms (for example, whether puberty suppressing hormones impact in a meaningful way on levels of anxiety or depression, on body image, or brain development) using a range of validated tools, questionnaires and user feedback,” England’s NHS said.

However, the trial does not yet have ethics committee approval. The watchdog group Transgender Trend tweeted: “We do not see how a clinical trial on a drug that may damage a healthy child’s brain, with no clear rationale or benefit, can possibly gain ethical approval—especially when animal trials (which showed some permanent harms) were not even completed.”

Class act

America | California’s Attorney-General Rob Bonta has been added as a defendant in a proposed class action against “parental exclusion policies” under which teachers hide a child’s social transition from parents. On August 8, US District Court Judge Roger T. Benitez also allowed Thomas More Society lawyers to add parents and additional teachers to the action brought by two teachers, Elizabeth Mirabelli and Lori Ann West, who had refused to follow a school district policy in Escondido, California, which they said would require them to lie to parents. Last month, California governor Gavin Newsom signed a law that stops schools from adopting any policy mandating that parents be informed about a change in their child’s declared “gender identity” at school.

Captured

United Kingdom | Fewer than half of the 69 voting members of the UK council of the British Medical Association (BMA) supported a contentious decision to oppose England’s Cass review and make puberty blockers available again, according to journalist Hannah Barnes. Meanwhile, more than 900 UK doctors have put their names to an open letter deploring the BMA council’s “opaque and secretive” decision and defending the Cass review as “the most comprehensive review into healthcare for children with gender related distress ever conducted”. “By lobbying against the best evidence we have, the BMA is going against the principles of evidence-based medicine and against ethical practice,” the open letter says.

The Association of Clinical Psychologists UK has also stood by the Cass review, noting that, “In the absence of a robust evidence base, caution must be taken to ensure that any medical intervention for children is safe and that any interventions are based on a synthesis of the best available evidence.” In a letter to The Observer, Dr Jim Boddington highlighted paediatric gender medicine’s “many red flags: the administration of experimental treatments with potential lifelong adverse consequences to vulnerable children; the influence of campaigning organisations on clinical decision-making; the exceptionalism used to justify overriding accepted standards of evidence and ethics.”