Thread by @hannahsbee

NEW: NHS England has announced that new youth gender services will provide masculinising and feminising hormones to children from ‘around their 16th birthday.’ This goes further than GIDS ever did: YPs cld only access hormones at 16 if they’d been on puberty blockers for 1 year🧵

Just last week, it seemed that the new services would have no medical pathway, with NHSE ending the routine prescription of puberty blockers. Today’s announcement, which was not put out to consultation, appears to signal a move in the opposite direction.

NHSE says it’s considered whether ‘scientific research has shown the treatment to be of benefit to patients’ & if it represents best use of NHS resources. Three documents have informed the policy, dating from 2013, 2016 & 2018 – two apply to adults only.
england.nhs.uk/wp-content/upl…

But there’s no mention at all of NICE’s 2020 systematic evidence review which concluded that for use in '18 years or under' hormones were not cost effective and there was uncertainty over their safety... cass.independent-review.uk/wp-content/upl…

“Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria." Seven studies informing the review appear not to have been taken into account by NHSE

Children who are experiencing ‘psychotic episode[s], drug addiction or self-harming’ will be eligible for hormones, as long as the ‘associated difficulties… are not escalating’...

‘Ideally there will be support … from one or both parents (the family)/carers, or social support if the individual is a ‘Looked After Child’, and the Local Authority has been consulted.’ Non-binary individuals will be deemed eligible for hormones.

The decision over when hormones can be given will be up to different clinicians in a multi-disciplinary team – just as at GIDS - over an undefined "period of time". The duration of assessment is ‘determined by the clinical team as relative to the needs of the individual.’

While the policy does not appear to have taken into account the NICE evidence review, NHSE says it will ‘consider the recommendations of the independent Cass Review in so far as those recommendations relate to this policy document.’

One safeguarding measure does appear to be in place: "The CYP Gender Service National MDT, that includes clinicians not directly involved in the formation of the individual’s care plan" has to agree that the child is suitable for treatment.