July 29, 2022

World's Largest Pediatric Gender Clinic Shut Down Due To Poor Evidence, Risk of Harm and Operational Failures

Treatment for gender dysphoria will be provided by established children's hospitals and will no longer be siloed under the "affirmative care" model

The UK’s National Health Service will close the world’s largest pediatric gender clinic, the Gender Identity Development Service in London (GIDS) often known as the Tavistock, after the NHS Trust which houses it.  An independent review condemned the clinic as “not a safe or viable long-term option” because its interventions are based on poor evidence and its model of care leaves young people “at considerable risk” of poor mental health. The clinic must close by Spring 2023. It will be replaced by a new regional hospital-based service. Regional centers will typically be children’s hospitals that also provide related services for mental health and autism, and have expertise in safeguarding, supporting looked-after children and children who have experienced trauma. Staff will therefore work across these related services “in order to embed the care of children and young people with gender-related distress within a broader child and adolescent health context.” Regional centers will partner with more local services based in community mental health services, to ensure that children can be seen close to where they live.

This reorganization is clearly intended to break the silo within which transgender medicine has operated for decades, in the UK as in other countries. Along with this reorganization comes a belated recognition of the poor state of knowledge around endocrinological interventions for gender distress, especially the off-label use of Gonadotropin-Releasing Hormone agonist (GnRHa), often called “puberty blockers.” Dr. Hilary Cass, former President of the Royal College of Paediatrics and Child Health, who is chairing the independent review, wrote to the National Health Service asking it to conduct systematic research. She emphasizes that there is “no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process” and disrupt brain development “which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences.” 

Advisers to SEGM have been raising alarm about the unfolding scandal at the Gender Identity Development Service for some years. Marcus Evans served on the governing board of the Tavistock Trust, and in 2019 he resigned over the Trust’s failure to heed warnings raised by staff within the clinic. Also in 2019, Michael Biggs uncovered the Gender Identity Development Service’s experiment with puberty blockers which the clinic had suppressed because the outcomes were not positive. He published the first analysis of the psychological functioning of adolescents in the experiment, and subsequently used the experiment’s data to measure the negative effects on bone density. More generally, advisers to SEGM have published several articles drawing attention to the paucity of evidence for puberty suppression and to the ethical problems of informed consent.

Other countries should learn the lessons from the UK (and from Sweden and Finland). First, there is insufficient evidence to justify the general clinical use of puberty suppression or cross-sex hormone use in youth experiencing gender dysphoria. Second, a treatment regimen that focuses exclusively on gender dysphoria, ignoring co-occurring mental health conditions, will not provide optimal care for young people. The shut-down of GIDS is not merely a restructuring move in response to the clinic’s failed operations—it ’s a move away from the “gender-affirming” intervention care model, and toward whole-person-affirming care that is rooted in developmental psychology.