Opinion: For anyone interested in evolving health issues and in particular care and treatment being provided for children and teenagers identifying as transgender or non-binary, there have been some pretty extraordinary developments in recent weeks. But you wouldn’t know it from reading the papers here.

In recent days the UK media has reported that up to 1000 families are expected to file a medical negligence lawsuit against the Tavistock Gender Identity Development Service, the National Health Service’s gender clinic for children, young people and their families. Key grievances relate to claims about harmful side effects from puberty blockers, and the view that children and young people were rushed into drug treatment without adequate assessment and counselling.  

News of this impending legal action follows the sudden announcement by the NHS several weeks ago of the imminent closure of the Tavistock clinic, over safety concerns. Gender identity services for children and teenagers in England will now operate out of two children’s hospitals, and will take a more holistic approach (including mental health assessment and support), with more thorough assessments on the value of hormonal treatment in each case.

These very recent developments in the UK come off the back of the release in March of an independent review of Gender Identity Services for Children and Young People, led by senior paediatrician Dr Hilary Cass OBE.

The findings of this report led to (then) UK Health Secretary Sajid Javid launching an urgent investigation into the NHS’s Gender Identity Services for children in April:

The Cass report makes for unsettling reading, finding the Tavistock and the current NHS service model unable to provide safe care for this age group. A key concern relates to significant gaps in the evidence base on the safe use of puberty blockers for children and teenagers.

Specific recommendations from Dr Cass to the NHS outline – with some urgency –  the need for a new multi-disciplinary model of care, and spell out the steps needed to provide best practice care for this age group.

So why the media silence on this in New Zealand? As a story with obvious child and teen health implications, there has been extensive international media coverage (including in Australia) around the reasons for the closure of the Tavistock clinic. A quick google of international media sites also reveals a flurry of thoughtful commentary and op-eds.

But there has been no coverage locally in mainstream media. Should New Zealand families have to fish around to learn about these newsworthy international developments by chance?

If I were a parent with a child who felt they had been born in the wrong body, experiencing acute discomfort and unhappiness as a result, I would hope any decision I made to support the wishes of this child to modify their body could be made in full awareness of any treatment-related health risks.

And in awareness of the completeness, or incompleteness, of the available evidence base for this age group. Certainly my ears would prick up if I heard that 1000 families in the UK unhappy with their children’s gender identity treatment were now expected to take a group civil action against the NHS.  

I would expect to be able to read about this and related stories in New Zealand media coverage, and to see commentary by health and social issues journalists and by science communicators.

I have faced such questions myself as a parent, having in the past supported a teenager through a period of gender questioning. And what I am sensing currently as the parent of a subsequent child is that increasing numbers of New Zealand families are now facing these kinds of decisions about how to support the wellbeing of their gender questioning children and teens – and they are going to want to do this confidently and from a fully informed position.

At present, it’s not clear that we are best supporting such families to make these kinds of decisions, which of course are intended to be life-changing in a positive way. Here in New Zealand, the Ministry of Health’s webpage on transgender children and young people currently states about Puberty Blockers:

Blockers are a safe and fully reversible medicine that may be used from early puberty through to later adolescence to help ease distress and allow time to fully explore gender health options.

This reassuring statement now seems oddly out of step with the hesitancy being expressed internationally. Hesitancy which has seen a number of internationally renowned gender medicine clinics end the use of these drugs for under 18s within the last few years.

The UK’s Cass report also found that almost all children and young people prescribed puberty blockers then subsequently go on to cross-sex hormones (96.5 percent and 98 percent respectively). Again, this would appear rather at odds with our Health Ministry’s presentation of puberty blockers as an uncomplicated and totally reversible ‘pause button’. 

UK families tentatively searching online about treatment options for their children will however find more cautious wording in the current NHS guidance:

Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although the Gender Identity Development Service advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be. It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones.

As a public health researcher and as a parent, the level of ‘unknowns’ declared in this health guidance for the public raises some alarming questions. But the thing about ‘known unknowns’ is that they at least enable us to weigh up any apparent risks on our own terms. And parents of gender questioning children certainly deserve the chance to do just that. That’s the foundation of informed consent for all involved.

How does the New Zealand model of child and teen gender services compare with the NHS model now being urgently overhauled? What a great piece of local investigative journalism that would make.

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