The closure follows an external review of the Tavistock Clinic in London, which has served thousands of transgender patients since the 1990s. The review, which is ongoing, has raised many concerns, including long waiting times, inadequate mental health support and the growing number of young people seeking gender-based treatments. The review of services for transgender young people in England is part of a marked change in medical practice in some European countries with nationalized healthcare systems. Some doctors there are concerned about the rising numbers as well as the lack of data on the long-term safety and outcomes of medical transitions. In the United States, doctors who specialize in adolescent gender care have mixed feelings about the reforms in Europe. While many agree that more comprehensive health care for transgender youth is needed, as well as more studies on treatments, they worry that the changes will fuel a growing political movement in some states to ban such care altogether. “How do we draw the line to keep care personalized while maintaining safety standards for everyone? That’s what we’re trying to sort out,” said Dr. Marci Bowers, a gynecologist and reconstructive surgeon and the new president of the World Professional Association for Transgender Health, who is transgender. “It’s the people on the ground who have to make those decisions, not the people in Washington or the state legislatures.” The NHS said current patients at the Tavistock clinic could continue to receive care there before being transferred to two new hubs at children’s hospitals in London and Manchester. The new clinics will expand gender services in the country while ensuring children are adequately treated for autism, trauma and mental health issues. Experts will also conduct clinical research on gender-specific drugs. There are “critical unanswered questions” about the use of puberty blockers, Dr Hilary Cash, head of the external review of the country’s youth gender identity services, wrote in a letter to the head of NHS England last week. Puberty blockers, which are largely reversible, are intended to give younger patients time to make important decisions about permanent medical changes. But Dr. Kass questioned whether most teenagers prescribed these drugs had the support to reverse their course if they chose to. Tavistock received more than 5,000 patient referrals in 2021, up from just 250 in 2011. The types of patients seeking referrals have also changed over the past decade. When the clinic opened, it primarily served children assigned male at birth. Last year, two-thirds of her patients were female at birth. It is not clear why the number of patients has increased so drastically, or why transgender boys are driving the increase. Transgender advocates in Britain welcomed the changes but stressed that many questions remained about how they would affect care for young people. “We are optimistic, cautiously optimistic about the news,” said Susie Green, chief executive of Mermaids, an advocacy group for transgender and gender-diverse youth. “There is a two and a half year waiting list for your first appointment. We have seen the distress caused to young people because of this.” But Ms Green, who has a transgender adult daughter, said the group was concerned whether mental health services would be prioritized over medical care. Gender diversity, he said, should not be treated as a mental disorder. “We don’t want any more barriers to be put in place in terms of access to medical intervention,” Ms Green said. In 2020, a former Tavistock patient, Keira Bell, took part in a highly publicized lawsuit against the clinic. She claimed she was put on puberty blockers at 16 “after a series of superficial discussions with social workers” and had her breasts removed in her 20s, decisions she later regretted. A high court initially ruled that children under 16 were unlikely to be mature enough to consent to such medical interventions. But that decision was overturned in September last year, with judges ruling that “clinicians, not the court, decide” whether a young patient could provide informed consent. In 2020, Tavistock workers raised concerns about medical care at the clinic, prompting the NHS to commission Dr Cass, a London pediatrician unaffiliated with the clinic, for an external review. Its interim report was released in February this year. Sweden’s national health service ruled this year that gender-related medical care for young people should only be provided in exceptional cases when children have a clear concern about their gender, known as dysphoria. All adolescents receiving treatment should be enrolled in clinical trials in order to collect more data on side effects and long-term outcomes. Finland took a similar stance last year. “Our position is that we can’t just look at this as a rights issue,” Dr. Thomas Linden, director of the country’s National Board of Health and Welfare, said in an interview in February. “We have to look at patient safety and accuracy in the crisis. We have to really be to some degree sure that we are giving the right treatments to the right person.” While these European countries have placed some limits on transgender care, their approaches are far more permissive than those in some conservative US states. A recent Alabama law made it a felony for doctors to prescribe puberty blockers and hormones to minors. In Texas, parents who allow their children to receive sex therapy have been investigated for child abuse. Both states are locked in legal battles with civil rights groups. Some American doctors worried that changing standards in Europe would reinforce the perception that gender-changing treatments are dangerous for young people. “My fear is that this is going to be interpreted as another tier against providing gender-affirming care to children,” said Dr. Angela Goepferd, medical director of the Gender Health Program at Children’s Minnesota Hospital. More services are needed, they said, not less. “That’s our challenge here.”
