I estimate only ~10% of children & young people who we might expect to see accessing transgender health care & support are doing so. This is due to the significant systemic barriers in accessing services. societal stigma, lack of GP support, Geographically distant locations, ££.
Today it is practically near impossible to access medical treatment for a 13 year old or older, simply due to the 4 year wait for medication & then aging out into adult services with further lengthy wait lists. This undoubtedly has an impact on the known demand for services.
Private care is filling this gap to some extent, though this introduces a cost barrier, difficult for those adolescents who are supported by family & impossible for those who are not. This relies upon supportive GPs willing to share care with a GMC suspended private provider.
Others are looking outside the UK altogether and seeking healthcare in Europe or USA. Based upon figures I've received from private providers I estimate another 500-1000 adolescents from England & Wales are accessing private treatment.
Then there is an unknown group of adolescents who are 'self-medding' that is purchasing drugs online with or without parental/family support, & without supporting baseline and monitoring blood tests. I estimate this group to be small - due to costs & perceived safety risks.
Even at the highest estimate I doubt whether self-medding is more than a few hundred individuals. Taking lowest prevalence est of 0.4% of population this still leaves a shortfall of ~23,000 trans youth who we would expect to be seeking treatment who are not. #nhsfailingtranskids
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In 1981 Stephen, a 14 yr old Trans boy in Pittsburg found a psychiatrist who would listen & asked for a 'sex change'. The psychiatrist spent 5 months analysing Stephen, & decided rather than provide hormone treatment he would prescribe anti depressents.. CW next tweet suicide 1/
Therapy' & antidepressents made things worse. Stephen had a number of suicide attempts immediately before or during menstruation. The psych to his credit, realised his treatment wasn't working & contacted an endocrinologist with experience working with 'Transsexuals' 2/
The Paediatric Endocrinologist, Dr Peter A Lee, prescribed medroxyprogesterone acetate, as a puberty blocker (now not used as less effective than GNrH agonists with a lot of side effects). Stephen had another period & took an overdose of amphetemines requiring intensive care 3/
Trans people have been using hormones for healthcare for around 100 years. There is 100 years of experience of Trans people helping each other source medication & use it as safely as possible working with health providers where possible in a 'least harm' approach. 1/
Under the current UK Government & NHS there is no access to adolescent healthcare. I believe there is a moral duty to help Trans youth who are accessing medication to do so as easily & as safely as possible. To highlight & mitigate the risks, & provide trusted information 2/
Further,, to enable Trans adolescents who may want access to Trans healthcare, to do so in line with International best practice & long established harm reduction guidelines. I will work with anyone with these aims & can provide resources, knowledge, platform & networks 3/
The question whether the Cass review team carried out engagement with Trans communities is immaterial. The engagement was not genuine, views shared in good faith by children & young people, families & support services were absent from synthesis & final recommendations. #CassFlaws
The methodology of the Cass Review qualitiative research stated they would conduct 40 interviews, 20 with 12-18s and 20 with adults up to age 30. They managed only 14 and 12 respectively. 26 interviews which were jumped on by gender critcal parents & anti Trans 'ex trans' groups
I'll repeat, in terms of the research output, the Cass York team conducted only 14 interviews with Trans children. 14 not even meeting the miniscule target set out in their research methodology.
I'm working my way through the Cass Sytemic review on Clinical guidelines for children & adolescents experiencing gender dysphoria or incongruence: it is very difficult to lack of access to the standards they review. There are also methodological issues 1/adc.bmj.com/content/early/…
I'm going to talk about the two standards the Cass research team rated highest & which the Cass Final report is most closely matched to in terms of recommendations - namely The Swedish and Finland protocols 2/
It's important to note neither of these guidelines is published in English. Originally Cass research team had stated they would exclude non English language guidelines, this is repeated in the overarching criteria of the Cass Report (screenshot 1). However they made exceptions 3/
I've been looking at a paper cited in Cass (recreating a graph introducing new spelling errors). I have thoughts. It is an undergraduate author. No full is data provided - only 3 sets of extracts, which have 9 or 10 respondents 1 of which repeats in error. tandfonline.com/doi/full/10.10…
The methodology section doesn't state the survey was originally a questionnaire to understand current needs of detransitioners and to produce an information booklet about detransition. I wonder if ethics approval was given for this - any German Trans academics can help check?
The survey was shared on Twitter, Reddit (R/Detrans), Facebook & Instagram. I've looked at these posts. There was minimal interaction which makes me suspicious of the claimed 237 respondents - much higher than more publicised surveys ie Littman (2021) 101 responents in 4.5 months
I've been reading of the Finland youth gender centre in Tampere which the Cass review lauds. It was recently revealed the head of the centre is on the Cass advisory group. CW In following tweets I relate extremely disturbing accounts from parents & youth of what they endured 1/
This is by 'Spinner' for Kehraaja (Nightjar in Finnish) 19.3.2021 "Describe to me how you masturbate?" - the position of trans youth in the treatment system is bleak" 2/kehraaja.com/kuvaile-minull…
Content Warning in the article is as follows "we recommend using discretion when reading, as the text may shock readers. The text discusses, among other things, medical power and its use, possible violations of a child's sexual integrity, and measures aimed at trans youth." 3/