Dr. Hilary Cass made 32 recommendations in total on multiple aspects of gender child care. Here you have the summary of what they are…
Investigation
The NHS should implement a “comprehensive research programme” that analyzes the characteristics, interventions and outcomes of every young person who presents to NHS gender services, and routinely seek consent for their enrollment in a research study that follows them to adulthood.
Gender attention is “a notably weak area of evidence,” the review stated, but study results have been “exaggerated or misrepresented by people on all sides of the debate to support their point of view.”
Dr Cass said there is currently “no strong evidence on the long-term outcomes of interventions to manage gender-related distress”.
In addition to a trial on puberty blockers, which is expected to be ready in December, there should be research on psychosocial (therapeutic) interventions and the use of the masculinizing and feminizing hormones, testosterone and estrogen.
On the latter, the review warned that administering these types of hormones to 16-year-olds should be an approach taken with “extreme caution.”
Care must be holistic.
The care of children and young people who question their gender identity or experience gender dysphoria “must be holistic and personal.”
Services “must operate to the same standards as other services caring for children and young people with complex presentations and/or additional risk factors”.
The review says needs assessments with a view to informing “an individualized care plan” should include screening for neurodevelopmental conditions, including autism, as well as a mental health assessment.
Age
The approach to care for younger children should be different from that for adolescents.
There should be no lower age limit for accessing help and support, and parents and families should be helped to ensure that options “remain open and flexible for the child”.
For those who have not yet reached puberty, there should be a “separate pathway” of care within each regional service network, and young children and their parents should be prioritized for “early discussion with an experienced professional.” relevant”.
There should be ‘follow-up services’ for 17-25 year olds, rather than transferring them directly to adult services, with regional centers expanding the age range of their patients or through ‘linked services, to ensure continuity of care and support at a potentially vulnerable stage of their journey.
The review said all children should be offered “counseling and fertility preservation” before going down the path of medical intervention.
References approach
Referrals to the now-closed Gender Identity Development Service (GIDS) at Tavistock and Portman NHS Foundation Trust were “unusual” in that they were accepted directly from GPs and non-health professionals, including teachers and youth workers.
Dr Cass said she supports NHS England’s proposal for all referrals to be made through secondary care.
Social transition
There was “no clear evidence” that social transition in childhood has positive or negative mental health outcomes and “relatively weak” evidence of effects in adolescence.
But children who socially transitioned (changed names, pronouns) at a younger age or before being seen at the clinic “were more likely to follow a medical path.”
Partial transition “may be a way to ensure flexibility”, the review said, adding that appropriately trained clinical staff should advise on the risks and benefits of social transition “with reference to the best available evidence”.
It warns parents to be careful not to unconsciously influence a child’s gender expression.
Staff
Professionals have been reluctant to engage in the clinical care of gender-questioning children and young people due to weak evidence in the area, lack of consistent professional guidance and support, and the long-term implications of making the wrong judgment about gender. treatment options. the review said.
There is a need for an “appropriate skill mix to support both people who require medical intervention and those who do not” as work continues to increase the available workforce.
The workforce should include a wide range of specialists, including paediatricians, psychiatrists, clinical nurse specialists, social workers, neurodiversity specialists, speech and language therapists, and occupational health specialists.
Endocrinologists and fertility specialists should also be included “for the subgroup for whom medical treatment may be considered appropriate.”
The review said NHS England should identify gaps in vocational training programs and develop training materials “to complement vocational skills, appropriate to their field and clinical level”.
Of Transition
NHS England should consider whether a separately commissioned service is needed for people who wish to detransition (where someone stops or reverses a medical gender transition), as people who regret going through this process may be hesitant to return. to the same service they had previously used. .
The review states that “better services and pathways” are needed for a group of whom many “live with the irreversible effects of transition and without a clear way to access services”.
The percentage of people treated with hormones who later detransition is unknown due to a lack of long-term follow-up studies, but the review indicated that there is a suggestion that the numbers are increasing.
Anyone detransitioning should be carefully monitored in a supportive environment, especially when completing hormone treatment.
Private medical assistance
Since puberty blockers are no longer prescribed to children on the NHS, the review stated that no GP should be expected to “enter into a shared care arrangement with a private provider” if a young person has been given access them through that route.
The review said GPs had “expressed concern about being pressured to prescribe hormones after they have been initiated by private providers and that there is a lack of clarity about their responsibilities in relation to monitoring”.
Dr Cass said the Department of Health and Social Care and NHS England must “consider the implications of private healthcare in any future requests to the NHS for treatment, monitoring and/or participation in research”, noting that A young person’s eligibility to take part in the NHS study of puberty blockers could be affected if they were taken outside the study.