Letter to the editor at The Times
In the recent article NHS swaps gender drugs for ‘holistic’ care published in The Times (05/04/2025) NHSE’s James Palmer is quoted as saying that in the year since the Tavistock GIDS closed, the new services have not identified a single patient likely to benefit from gender affirming treatment. This is despite thousands being on the waiting lists at the replacement Children and Young People’s gender services.
No matter how conservative or cautious an individual’s approach to medical prescribing for trans youth may be, this news should ring alarm bells for everyone who has the best interests of young trans people at heart, as it points towards the new services prioritising a non-medical pathway at all costs.
How have we gone from a service that would cautiously refer patients for hormone treatments (the Cass report found that less than one third of GIDS cases were ever referred) to one where no one is deemed a suitable candidate for medical treatment? How is it that specialists, who once felt prescribing was the right approach, have now decided that no one is a suitable candidate? They haven’t. Did the Cass Review in fact find that no patients were benefitting from accessing this care? It didn’t.
Instead of convincing experts who have seen first hand the benefits of gender affirming hormones, to unlearn what they know to be true i.e that some individuals benefit from this course of treatment - the NHS has conducted an effective lobotomy on trans healthcare services by strategically excluding any clinicians with experience of the benefits of this kind of treatment from the early adopter services.
Furthermore they have found ways of including a small group of former GIDS clinicians that have advocated for a non-evidence based psychotherapy approach to treating gender dysphoria in teens, to train incoming staff. Staff who in turn, have no expertise in treating gender incongruence.
To the untrained eye this may appear to be a ‘holistic’ and ‘careful’ approach, to those that understand the field, it is clear that the NHS services have thrown their weight behind psychotherapeutic approaches for transgender health that have zero evidence to support their effectiveness, and which are in reality more akin to the conversion therapy practice that the community and its allies has long been campaigning against.
The Cass Review did not recommend that we stop delivering a medical treatment pathway. Instead it called for more research to add to existing evidence that supports these treatments. Notably, countries like Germany, Austria, and Switzerland recently found this same research to be sufficient in supporting the use of medical interventions, where appropriate, in this patient cohort, see Central Institute of Mental Health.
At Gender Plus we have had a number of patients offered their first NHS appointments but they have either declined to attend or have attended but decided to continue on the pathway with our service. So, with the very slow pace at which the new NHS gender services are seeing patients, perhaps the reduced waiting times are in fact down to patients opting out of that pathway altogether, due to a lack of trust in the care they are likely to receive via these white elephant services.
Dr Aidan Kelly
Consultant Clinical Psychologist & Director of Gender Plus
