The podcast discusses the mismanagement and scandal surrounding the closure of the Gender Identity Development Service (Gids) in Britain. Kathleen Stock investigates whether the new gender services for children will be an improvement and finds that they are still unsafe, with senior figures pushing an activist ideology. The chapter explores controversies in gender medicine, concerns about repeating mistakes in trans clinics, the emergence of private providers, and the lack of skepticism. There are also discussions on procurement of puberty blockers from unregulated sources, the involvement of hospitals in trans activist schemes, and concerns about the rushed process of transitioning.
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Quick takeaways
The new gender service hubs in the UK are still struggling to provide a clinically safe space for children and teens, with senior figures pushing an activist ideology.
There is ongoing tension between the affirmatory and exploratory approaches to treating gender dysphoria in children, as some worry that affirmation may restrict genuine exploration of a child's gender identity.
Deep dives
Overview of JIDS and its Issues
Until a year ago, most young people experiencing gender dysphoria were referred to JIDS, the Gender Identity Development Service. However, the service faced challenges and came under scrutiny due to record-keeping issues, insufficient assessments, and poor communication. A review by Hillary Cass recommended closing down JIDS and replacing it with two new services in the South and North of England. Despite this, JIDS is still operational, managing a cohort of around a thousand patients, while the waiting list for the new services continues to grow.
Concerns about Affirmation and Exploration
There is ongoing debate about the affirmatory and exploratory approaches to treating gender dysphoria in children. Advocates of affirmation argue for accepting a child's gender identity without challenge, while critics emphasize the need for exploring alternatives and considering factors like mental health and social context. The involvement of clinicians with different perspectives in the new gender service hubs has led to tensions. Some worry that affirmation may restrict genuine exploration of a child's gender identity.
The Complexities of Puberty Blockers
Puberty blockers have become a key aspect of treatment for gender incongruity in young people. However, their use has sparked controversy and concerns. While some studies suggest they can alleviate psychological distress, others raise questions about potential long-term effects on physical and cognitive development. Hillary Cass recommends that the prescription of puberty blockers should be limited to clinical trials. However, implementing such trials presents challenges, and there are debates about whether alternatives like animal studies or a review of existing literature could provide sufficient evidence.
Challenges and Concerns in the Transition to Adult Services
The transition from child to adult gender services poses its own set of challenges and concerns. The adult services currently lack the cautious and exploratory approach recommended for children, with no mandatory psychological assessments and minimal consultations required before prescribing hormones or approving surgeries. The experiences and needs of vulnerable individuals between the ages of 17 and 25 can be easily overlooked. Moreover, the involvement of clinicians associated with the previous approaches and criticized practices raises questions about the future of adult services.
Since its closure was announced last July, Gids — the Gender Identity Development Service at the world-renowned Tavistock and Portman Trust — has become synonymous with mismanagement and medical scandal.It was supposed to be a haven for young people experiencing gender-related distress. Instead, following a string of complaints by whistle-blowers, an “inadequate” rating by the Care Quality Commission, a high-profile judicial review and, finally, a damning independent review, it was deemed unsafe.In its place, two new regional hubs were set to open, with several more centres to follow. For Gids’s long-standing critics, concerned about the distress its tumult was having on children, this came as a huge relief.The story, however, does not end here.Kathleen Stock has spent the past month speaking to a range of clinicians, NHS professionals and parents of dysphoric children — to find out whether Gids’s new service will be an improvement.The portrait she paints is stark: her findings suggest that the NHS gender services are yet to become a clinically safe space for children and teens, with senior figures still pushing an activist ideology. Only last week, NHS bosses internally announced that they are significantly delaying the launch of one of the hubs. And as she reveals in her investigation, it is unlikely to be the final twist in Gids’s new chapter…