Trans children are being 'let down by NHS' amid gender identity debate, major review finds

'Remarkably weak' research and a polarising debate around trans issues could be putting children at risk

A child pictured from behind looking out a bedroom window
(Image credit: Getty Images)

A new review has found that the 'toxicity of the debate' around trans rights has led to children unsure of their gender identity being 'let down' by the NHS.

As children reach puberty, many will begin to figure out their sexual identity and gender orientation. For those who are gay, transgender or non-binary, this can be a particularly difficult time - which is just one of the reasons why it's crucial to talk to kids about coming out.

And supporting children through this difficult time is more important than ever, after a new report published on Wednesday 10 April concluded that young people with gender dysphoria (defined by the NHS as a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity) are being "let down" by "remarkably weak" research, gaps in mental health care and "unusual" clinical practice.

The report, led by paediatrician and former President of the Royal College of Paediatrics and Child Health Dr Hilary Cass, was commissioned after a steep rise in the numbers of children and young people using the NHS for help around their gender. It highlights problems spanning the whole care of children - from when they first question their gender to receiving medical treatment - but Dr Cass has stressed that the findings were not intended to challenge young people's right to transition, but to improve the care for those with gender-related distress.

Among the conclusions set out in the review - which has taken nearly four years to complete - it was revealed that puberty blockers and hormone treatment had been given to young patients despite a lack of research into their impact, while knowledge of experienced clinicians has been "dismissed and invalidated" due to the polarising nature of trans issues.

Elsewhere, Dr Cass said: "There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop." She added that the debate is shut down at the expense of patients, because of professionals' fear of expressing their views.

"We’ve got to find a way to put the animosity find the best possible way forward for children and young people and their families."

The review also highlighted increasing concern around "the numbers of young people in distress, on a waiting list, not getting the appropriate services, at risk".

Dr Cass laid out 32 recommendations for ensuring young people struggling with gender dysphoria receive safe and efficient care going forward. These include screening for neurodevelopmental conditions and a mental health assessment, a review of the NHS policy to give masculinising or feminising hormones from the age of 16, and a "full programme of research" to analyse the characteristics and outcomes of every young person who uses gender services.

The report has already led to the banning of puberty blockers for children outside research trials.

The inquiry was commissioned following concerns about the Tavistock and Portman NHS mental health trust’s gender identity development services (GIDS). In 2019, the Trust faced a lawsuit over fears children were being given puberty-blocking drugs without robust data or evidence, while it also saw a rise in referrals from just under 250 in 2011/12 to more than 5,000 in 2021/22.

Dr Cass also noted that "The surrounding noise and increasingly toxic, ideological and polarised public debate has made the work of the review significantly harder and does nothing to serve the children and young people who may already be subject to significant minority stress.

"Ultimately, we’ve got to find a way to put the animosity aside to come to a shared consensus and to find the best possible way forward for children and young people and their families."

Meanwhile, Prime Minister Rishi Sunak has said: "I welcome Dr Cass' expert review which urges treating these children, who often have complex needs, with great care and compassion.

"We simply do not know the long-term impacts of medical treatment or social transitioning on them, and we should therefore exercise extreme caution.

"We acted swiftly on Dr Cass' interim report to make changes in schools and our NHS, providing comprehensive guidance for schools and stopping the routine use of puberty blockers, and we will continue to ensure we take the right steps to protect young people. The wellbeing and health of children must come first."

In other news, an LGBTQ+ education expert has revealed three easy ways to help parents stop gender stereotyping their kids, and we've asked an expert how to educate kids on gender equality.

Ellie Hutchings
Family News Editor

Ellie is GoodtoKnow’s Family News Editor and covers all the latest trends in the parenting world - from relationship advice and baby names to wellbeing and self-care ideas for busy mums. Ellie is also an NCTJ-qualified journalist and has a distinction in MA Magazine Journalism from Nottingham Trent University and a first-class degree in Journalism from Cardiff University. Previously, Ellie has worked with BBC Good Food, The Big Issue, and the Nottingham Post, as well as freelancing as an arts and entertainment writer alongside her studies. When she’s not got her nose in a book, you’ll probably find Ellie jogging around her local park, indulging in an insta-worthy restaurant, or watching Netflix’s newest true crime documentary.