Abstract

Referrals (particularly natal female) to gender identity clinics have increased significantly in recent years. Understanding the reasons for this increase, and how to respond, is hampered by a politically charged debate regarding gender identity. This article starts with a discussion of the so-called 'affirmative approach' to gender dysphoria and considers the implications of the Memorandum of Understanding on conversion therapy. I then say something about the relationship between gender dysphoria and the developmental problems that are characteristic of adolescence. Finally, I outline what changes to the current approach are needed to do our best to ensure these patients receive the appropriate treatment.

Highlights

  • There has been a 3264% rise in referrals to the national gender identity service at the Tavistock and Portman National Health Service (NHS) Trust in London over the past 10 years.[1]

  • Bernadette Wren, the associate director of the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS), gave evidence to a House of Commons select committee in which she summarised the GIDS intake in the following terms: ‘many of the young people, and increasing numbers of them, have had a gender-uncontentious childhood, if you like, and it is only when they come into puberty and post-puberty that they begin to question

  • A group of parents whose children were treated at the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS) in London wrote to the trust’s board

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Summary

SPECIAL ARTICLE

Freedom to think: the need for thorough assessment and treatment of gender dysphoric children*. Commenting on the decision of the American Academy of Paediatrics (AAP), Cantor says ‘ almost all clinics and professional associations in the world use what’s called the “watchful waiting approach” to helping gender diverse children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach’.6 This is despite research findings which strongly suggest that most of these cases would eventually desist if left untreated.[7,8] The ‘affirmative approach’ risks sending children down a path towards concrete and sometimes irreversible medical interventions for what is in very many cases a psychological problem. SPECIAL ARTICLE Evans Freedom to think trauma, social anxieties and even the relatively normal turbulence of adolescence

The Memorandum of Understanding on Conversion
Children with complex problems
Patients that regret treatment
Informed consent
Comprehensive assessment
Gender conflicts are a normal part of development
Political pressure on institutions and research
Conclusions
Findings
Declaration of interest
Full Text
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