Clinicians, former patients and parents have for years been raising concern about the Tavistock’s gender identity clinic for under-18s. The only clinic for children and young people with gender dysphoria in England, it stands accused of putting young people on the path to irreversible medical treatment without first exploring the causes of their condition. Last month an independent review led by an experienced paediatrician, Dr Hilary Cass, instructed NHS England to shut the clinic down and replace it with a network of regional clinics that she says should take a more holistic and evidence-based approach to treating children and young people.

This is a highly-contested area of children’s healthcare. Campaigners and charities such as Mermaids argue for the “affirmative model”, which takes a child’s expression of gender dysphoria as a sign they have a fixed trans identity, and the starting point of any treatment. Other experts – including clinical whistle-blowers from the Tavistock clinic – say underlying causes must be looked at before a child goes down the road of medical transition, which involves taking puberty blockers and then, after the age of sixteen, cross-sex hormones, before, potentially, sex-change surgery.

Those challenging the lack of evidence for the affirmative model have been labelled transphobes. Yet it’s been shown that Mermaids misrepresented suicide statistics to argue that children and young people will die if they aren’t given puberty blockers – a deplorable way to emotionally blackmail parents. (Even the Tavistock clinic is clear that suicide is extremely rare in children with gender dysphoria.) An employment tribunal found that the safeguarding lead at the Tavistock was vilified by the trust simply for reporting concerns raised by whistle-blowers, and awarded her damages.

Those diagnosed with gender dysphoria deserve evidence-based care in their best interests, not in the perceived interests of an adult ideology

The terms in which this debate has been conducted do a dreadful disservice to children; those diagnosed with gender dysphoria deserve evidence-based care in their best interests, not in the perceived interests of an adult ideology. It has taken numerous whistle-blowers, years of reporting that campaigners tried to tarnish as transphobic, a CQC inspection and several court cases – including a judicial review of the NHS by Keira Bell, a young woman who received appallingly inadequate care at the Tavistock – to get the government to take action.

That came in the form of the Cass review. It has yet to produce a final report but has already established some key findings. Primary among these is that while gender dysphoria might be indicative of a child moving towards a settled trans identity in adulthood, it can also be associated with other adolescent experiences such as puberty discomfort and confusion around same-sex attraction (many gay people say they experienced gender dysphoria in childhood), as well as childhood trauma and neurodiversity.

Cass is clear that a young person’s gender identity can be in flux until their early twenties, and that for many children (we don’t know exactly how many), gender dysphoria will naturally resolve through puberty. We do not know enough about the long-term risks of puberty blockers, except that they can have potentially significant impacts on a child’s physical development, including the development of the brain and healthy bone density.

While the Tavistock says prescribing puberty blockers provides a “pause” for young people to consider their identity, the evidence so far shows that almost all young people who started on puberty blockers progressed onto cross-sex hormones; Cass says that by blocking a child’s normal development they may bake in permanently what would otherwise be a transitory experience.

The report adds that the majority of young people referred to the Tavistock clinic often have additional mental health or neurodiversity issues, but that it has failed to assess the complexity of their needs. The Cass review also lambasts the Tavistock for failing to capture even the most basic data on patient outcomes, given the evidence gaps around puberty blockers and the affirmative model in general.

Cass’s recommendation for a more holistic model of care grounded in children’s broader mental health needs, and for proper collection of data, is extremely welcome. But there are serious questions about why ideology was for so long allowed to prevail over an honest assessment of the evidence.

She shoots, she scores!
It was my first-ever time at a football match – and what a game! The atmosphere in the stadium was electric as the Lionesses defeated Germany at the Euro final at Wembley, to the biggest crowds ever seen. And it was the England women’s team who brought football home for the first time since 1966. I watched it sitting next to my friend’s ten-year-old daughter, who plays with Fulham’s football academy. Thanks to the sustained hard work of women players, coaches and supporters over the years, determined to get women’s football recognised in the face of an FA ban that wasn’t lifted until 1971, many more girls like her now have the chance to play the national game.

But there’s a long way to go. More than a third of schools don’t offer girls’ football, and over half don’t offer the same sports to girls as to boys. Men’s games still attract hugely more financial investment than women’s. The momentum created by the Lionesses’ victory needs to be channelled into raising the women’s game across all sports – and booting into touch the delusion that football is a man’s game.

Sonia Sodha is chief leader writer at the Observer and a Guardian/Observer columnist. She also presents Analysis documentaries for Radio 4

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