Private trans clinics do not assess children to high enough standard, fears Dr Hilary Cass

Hilary Cass

Dr Hilary Cass has expressed concern that private transgender clinics’ assessment of children is not to a high enough standard in the wake of her landmark review.

The paediatrician has made a series of recommendations to the NHS about how it treats children who believe they are transgender and warned that extreme care should be taken in the treatment of those aged under 25.

The remit of her review does not extend to private clinics, but the report did find that GPs felt “pressured to prescribe hormones” by patients who had seen a private doctor.

Dr Cass said “everybody should be getting the same standard of care”, while campaigners have called for an end to the “cowboy clinics” that are not bound by the NHS ban on puberty blockers.

“I do have concerns about private provision which is not providing the level of assessment that I’m recommending in the NHS,” she told BBC’s Today programme.

“I fully understand why parents have felt that going down that path is the best way to serve their children,” she said. “We have asked NHS England to provide advice to families about what it means if they go down a private route in terms of coming back into the NHS later.”

Ministers have pledged to “look carefully” at whether the review could be used to inform new legislation that would apply to private and online clinics as well as the NHS.

Dr Hilary Cass, a retired consultant paediatrician, spent four years drawing up the report – YUI MOK/PA

Liz Truss has called for a ban on puberty blockers that would stop them being prescribed privately as well as on the NHS and her Bill with those proposals is due to return to Parliament on April 19 with the support of a dozen colleagues.

The report warned against “the use of unregulated medications and of providers that are not regulated within the UK”.

It said GPs should resist attempts by private providers to prescribe puberty blockers or cross-sex hormones, “particularly if that private provider is acting outside NHS guidance”.

Fiona McAnena, director of campaigns at charity Sex Matters, said: “It’s scandalous that rogue private gender clinics in the UK and abroad are still free to supply British children with off-label puberty blockers.

“Dr Hilary Cass has done everything she can to close this dangerous loophole, including by warning GPs not to get involved in shared care with private providers,” she said.

“Dr Cass has done her best, but shutting down cowboy clinics is beyond the scope of her review. Ministers must now act urgently, and prevent overseas and private clinics from prescribing these dangerous drugs to gender-distressed children.”

‘Gender medicine built on shaky foundations’

Dr Cass declared that “gender medicine for children and young people is built on shaky foundations” as research commissioned by the review found there was “no evidence” that puberty blockers or cross-sex hormones work.

The research found that the powerful drugs did not ease symptoms of gender dysphoria, where a person feels their gender does not match their sex, improve body image, or reduce suicide risk in children and young people, and called for an end to the prescribing of them to under 18s.

Dr Cass said not enough was known about how the drugs, which were still being prescribed on the NHS to children of all ages until last month, affect the development of the brain.

The report found that people had been let down by local services who had allowed referrals to the controversial Tavistock gender clinic without proper assessment because of “the toxicity of the debate”.

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Laura Farris, the Home Office’s victims and safeguarding minister, said the government was “looking carefully” at the review and whether wider legislation was required.

She said the public could “expect to see a fundamental change of direction” as a result of the landmark report.

“In her interim report that she published two years ago, she said that there were doctors who felt under significant pressure to adopt an unquestioning affirmative approach to that,” she told Sky News.

“That was one of the reasons why she said that has to change fundamentally and that is why, I have to say, the Tavistock clinic is no longer.”

She added: “I think this is the first, the most important and comprehensive report that’s been written on all of that.

“We began the work on changing it after her interim report was published, but I think you can expect to see a fundamental change of direction that comes out of this.”

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