VK stopt na kritisch rapport met puberteitsremmers bij tienertransgend

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Na een rapport over de behandeling van jongeren met genderdysforie (onvrede met het geboortegeslacht) is in het Verenigd Koninkrijk per direct een streep gezet door de gangbare praktijk van genderverandering.

Tieners zijn met "te weinig medisch bewijs" behandeld, zo concludeert de prominente kinderarts Hillary Cass na een langdurig onderzoek.

"Er zijn jarenlang puberteitsremmers verstrekt aan tieners, terwijl er onvoldoende medisch bewijs is dat deze medicatie echt veilig is", concludeert het onderzoek van Cass.

Gebaseerd op deze bevindingen heeft het Britse zorgsysteem NHS al in maart aangekondigd puberteitsremmers niet meer routinematig te verstrekken. Ze worden nu enkel nog in klinische onderzoeken voorgeschreven.

Britse klinieken zoals Tavistock and Portman, die eerder puberteitsremmers verstrekten, zijn gesloten nadat de eerste resultaten van het onderzoek van Cass naar buiten waren gekomen. Volgens Cass zijn er potentieel "levensveranderende behandelingen" gegeven aan tieners, zonder dat bekend is wat er met hen gebeurt in volwassenheid'.

Cass stelt verder dat het "verhitte en felle debat" rondom gender in de maatschappij ook medische professionals ervan heeft weerhouden om eerder hun twijfels te uiten.
Pauzeknop

In andere landen, waaronder Nederland, worden ook puberteitsremmers gebruikt, hoewel de medische discussie over hun gebruik wel beginnend is.

In veel westerse landen worden puberteitsremmers beschouwd als een soort tijdelijke 'pauzeknop' voor transgenderjongeren: eerst worden op jonge leeftijd puberteitsremmers voorgeschreven, daarna kunnen ze vanaf 15- of 16-jarige leeftijd mogelijk hormonen krijgen en pas na de leeftijd van 18 komt een mogelijke geslachtsaanpassende operatie in beeld.

Nederland staat internationaal bekend als gidsland op het gebied van de behandeling van transgenderjongeren, waarbij de "Dutch approach" andere landen heeft beïnvloed wat betreft de behandeling van transgenderjongeren.

De puberteitsremmers onderdrukken de productie van geslachtshormonen, waardoor de ontwikkeling van uiterlijke kenmerken van het geslacht waar de persoon mee worstelt - zoals borstgroei, brede schouders, een diepere stem of baardgroei - wordt gepauzeerd. Dit geeft jongeren met genderdysforie meer tijd om na te denken over hun geslacht.
Betere resultaten

Het pauzeren van deze ontwikkelingen kan op latere leeftijd, wanneer patiënten mogelijk een geslachtsaanpassende operatie ondergaan, ook leiden tot betere resultaten. Maar in het Verenigd Koninkrijk klinkt nu kritiek: er was onvoldoende bewijs om dit op grote schaal toe te passen. Bovendien is het aantal jongeren onder de 18 jaar dat zich aanmeldt met genderproblematiek aanzienlijk gestegen.

Terwijl de NHS in 2009 nog te maken had met 50 jongeren per jaar, is dat aantal vorig jaar gestegen naar 5000 aanmeldingen. Een verklaring voor deze sterke groei, die ook in meerdere landen te zien is, ontbreekt nog.

Naast de stijging van het aantal aanmeldingen was er ook een opmerkelijke rechtszaak in Engeland die vragen opriep over het gebruik van puberteitsremmers en de klinieken die ze voorschrijven. De zaak van Keira Bell, die op 16-jarige leeftijd puberteitsremmers nam maar later spijt kreeg, bracht aan het licht hoe weinig medische gegevens eigenlijk beschikbaar waren bij de kliniek die haar behandelde.
Vervolgstappen

De kliniek, genaamd Tavistock, hield geen gegevens bij over de vervolgstappen van de patiënten en documenteerde nauwelijks langetermijnresultaten. Daarnaast rezen er steeds meer vragen over de mate waarin er voorafgaand aan het voorschrijven van puberteitsremmers voldoende onderzoek werd gedaan naar de onderliggende psychische oorzaken van genderdysforie bij tienerpatiënten.

Het rapport van Cass uit zorgen over de onbekende effecten die puberteitsremmers kunnen hebben op de psychologische of psychosociale gezondheid, evenals op neuropsychologische gevolgen en de rijping van het brein.

Kinderarts Cass adviseert om de zorg voor transgender jongeren minder medisch en meer "holistisch" aan te pakken, waarbij er meer nadruk moet liggen op het screenen van de mentale gezondheid en andere mogelijke problemen die een rol kunnen spelen in het leven van tieners.

De vraag rijst echter of deze holistische aanpak ook realistisch en haalbaar is in het Verenigd Koninkrijk, waar de NHS piept en kraakt onder personeelstekorten en financiële problemen. De wachtlijst voor geestelijke gezondheidszorg is opgelopen tot 1,2 miljoen.

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In 2009 the NHS’s gender identity development service (Gids) saw fewer than 50 children a year. Since then, demand increased a hundredfold, with more than 5,000 seeking help in 2021-22.

In her review of gender services, Dr Hilary Cass said there had been a “dramatic increase” in presentations to gender clinics in the last decade, in particular by birth-registered females. In 2009, Gids treated 15 girls. By 2016, that figure had risen to 1,071.

“There has been a significant change in the population of young people over the last 10 to 15 years,” Cass told BBC Radio 4’s Today programme on Wednesday.

“So about 15 years ago, the service was seeing perhaps 50 predominantly birth registered boys in childhood. And over the last 10 years or so it’s switched to over 3,000 young people, and it’s mainly birth-registered girls presenting in early teens … often with quite complex additional problems.”

There is no single explanation for the increase in prevalence of gender incongruence or the specific rise in birth-registered females referred to Gids, her review concluded.

But it says various factors may explain the increase in predominantly birth-registered females presenting to gender services in early adolescence:
Social media and the internet

Generation Z and Generation Alpha (those born since 2010) have grown up with “unprecedented” online lives, the report says. This has huge advantages, but also brings risks and challenges.

Greater access to the internet has given children and young people learning resources “but it has also made them vulnerable to new dangers”, according to the review.

“Biology hasn’t changed and adult biology hasn’t changed in the last few years,” Cass said this week. “So it’s not that that’s changed things.

“I don’t think that young people today are being exposed to more abuse, or trauma or so on, than previous generations. We do have to think very seriously about the impact of social media.”

The report says girls spend more hours using social media than boys. A study cited by Cass found 43% of girls used social media for three or more hours a day, compared with 22% of boys.

A systematic review highlighted by the Cass report found that use of social media was associated with body image concerns. Numerous other studies cited by the report implicate smartphone and social media use in mental distress and suicidality among young people, particularly girls.

All showed a clear dose-response relationship: the more hours spent online, the greater the effect.
Peer and socio-cultural influence

The report suggests that although the impact of societal influences on a child’s gender expression remains unclear, it’s clear that the influences of a child’s peers are “very powerful during adolescence”.

Although the report does not specifically state that girls are affected by social and cultural influences, such as peer pressure, more than boys, and so too their gender expression, other evidence has suggested this is the case.

Several studies have implied that girls are more affected by peer pressure than boys, and are more likely to develop a negative body image during adolescence.

Another societal influence that the report references as possibly having an impact on a young person’s gender expression includes information on gender dysmorphia and gender expression found online.

More specifically, a focus group of gender-questioning young people and their parents who spoke to the review said that they often found online information “that describes normal adolescent discomfort as a possible sign of being trans and that particular influencers have had a substantial impact on their child’s beliefs and understanding of their gender”.

One gender-questioning young person is quoted in the report affirming this view, saying a “lot of trans people make YouTube videos, which I think is a major informational source for a lot of people, and that’s mainly where I get my information from, not so much professional services”.

The report also stated that according to another focus group of gender-questioning young people, they often found it difficult to find “trusted sources of information, favouring lived experience social media accounts over mainstream news outlets”.

Greater societal acceptance of transgender identities has allowed young people to come out easily, the review found. It suggests that the increased numbers now reflect the true prevalence of gender incongruence in society.
Dangerous online influencers

Cass said her review team received reports of gender-questioning children being urged to hide things from their parents. “We haven’t done a comprehensive search but certainly when we were told about particular influencers, I followed some of those up,” Cass said. “Some of them give them very unbalanced information.

“And some [young people] were told that parents would not understand, so that they had to actively separate from their parents or distance their parents. All the evidence shows that that family support is really key to people’s wellbeing. So there was really some dangerous influencing going on.”

Cass says the influencers “are legion” but declined to identify any specially.
Mental health

The striking increase in young people presenting with gender dysphoria should be seen within the context of increasing rates of poor mental health and emotional distress among the broader adolescent population, particularly among girls, the Cass report found.

There has been a substantial increase in rates of mental health problems in children and young people, with increased anxiety and depression being most evident in teenage girls, UK national surveys between 1999 and 2017 show.

The Cass review found that there was a “marked increase” in young women aged between 16 and 24 presenting with anxiety, depression and self-harm. Some conditions – for example, eating disorders – have increased more than others, particularly in girls and young women.

Studies of rates of self-harm have shown similar increases. For example, the report says there was an almost 70% increase in girls aged between 13 and 16 presenting with self-harm. This was not seen in boys, the review noted.

“The increase in presentations to gender clinics has to some degree paralleled this deterioration in child and adolescent mental health,” the report says. “Mental health problems have risen in both boys and girls, but have been most striking in girls and young women.”

Girls were also more likely to have low self-esteem (12.8% versus 8.9% of boys), according to a study cited by the Cass review. They were also more likely to be unhappy with their appearance (15.4% versus 11.8% of boys).
Changes in concepts of gender and sexuality

The report states that the relationship between sexuality and gender identity is “complex and contested”, and that although a trans identity does not necessarily determine a person’s sexuality, it was “important to consider the relationship between sexual identity and gender identity given that sexuality contributes to a person’s sense of identity, and both may be fluid during adolescence”.

The report cites a 2016 research paper from Gids that looked at sexual orientation in 57% (97) of a clinic sample of patients over 12 years of age for whom this information was available.

Of the birth-registered females, 68% were attracted to females, 21% were bisexual, 9% were attracted to males and 2% were asexual. Of the birth-registered males, 42% were attracted to males, 39% were bisexual and 19% were attracted to females.

The report goes on to say that it is “common in adolescence to experience same-sex attraction and not to conform to gender stereotypes. In making sense of these feelings young people are now having to navigate an increasingly complex interplay between sex and gender.”

On the relationship between sexual orientation and gender identity, the review concludes that it “is an area that warrants better exploration and understanding”.

The report also stated that it had received several reports from parents of birth-registered females “that their child had been through a period of trans identification before recognising that they were cisgender same-sex attracted”.

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In the autumn of 2019, leading consultant paediatrician Hilary Cass agreed to conduct a review of international research into puberty blockers for NHS England. She expected it to be a short, straightforward task.

“I thought it would be couple of afternoons a month for six months and then I could go home and get on with my retirement,” she said, laughing wryly, on the morning before the publication of her review into gender identity services, a project that has become one of the most controversial evidence review projects in recent medical history.

The work has developed into “a 24-hour a day obsession to try to help improve things” and has placed her at the vortex of a debate she describes as toxic, politicised and ideological.

Cass’s review is written in a calmly clinical tone but there are moments when her anger about how NHS England has cared for a generation of vulnerable children is barely disguised.

Clinicians have become “fearful”. The available evidence is “poor”. Her efforts to conduct a vital and comprehensive study into the outcomes of all 9,000 children and adolescents treated at the Tavistock and Portman gender identity development service (Gids) clinic between 2009 and 2020 were “thwarted”.

Cass knows her recommendations will be hugely controversial and that some children waiting for treatment will be dismayed by her conclusions but she is adamant that she has young people’s best interests at heart.

“We’ve let them down because the research isn’t good enough and we haven’t got good data,” she said.
Review of gender services has major implications for mental health services
Read more

“The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it. The children are being used as a football and this is a group that we should be showing more compassion to.”

The scope of her review is huge; she has set out to review all the available evidence on which gender medicine has been based globally, as well as trying to answer the puzzling question of why the numbers of children seeking referrals to gender clinics in the UK and in other developed countries began an exponential rise in around 2014, and why so many more girls began seeking treatment. (In 2011-12 there were just under 250 referrals to the service; in 2021-22 this had risen to more than 5,000 referrals.)

She has also been charged with making clear recommendations about how services can be improved, in the wake of the closure of the Tavistock clinic’s Gids clinic last month, a closure which came about as a result of her interim research. In the future she wants services to offer a broad range of interventions, rather that having “tunnel vision” on gender.

She is not even sure that future clinics should have gender in the name, noting that we should “move away from just calling these gender services because young people are not just defined by their gender”.

Cass says it is not her job to comment on whether some professionals should face disciplinary proceedings for their role in what has gone wrong.

“I don’t think you can point a finger at anyone in particular; it’s been a system failure,” she said.

“The toxicity of the debate has been so great that people have become afraid to work in this area.”

Medical professionals experienced a sense of fear “of being called transphobic if you take a more cautious approach”, she said.

Others were worried that they might be accused of conducting “conversion therapy if, again, they take a cautious or exploratory approach” and some clinicians expressed “fearfulness about what colleagues might say if they speak up and express an opinion that is not consistent with theirs”.
A person standing on asphalt road with gender symbols of male, female, bigender and transgender. Concept of choice or gender confusion or dysphoria.
Gender medicine ‘built on shaky foundations’, Cass review finds
Read more

The consequence of this rising nervousness among clinicians over the past 15 years has been that many children exploring their gender (which Cass describes as “a normal process” in adolescence, not necessarily requiring any NHS input) have been prematurely diverted towards chronically oversubscribed specialist clinics, and left sitting on waiting lists for years, without any support.

“There are many more young people now who question their gender; what’s really important is they have a space to be able to talk to somebody about that and to work that through.

“The problem has been that whilst they’ve sat on a waiting list, they just haven’t had that help. They’ve just had the internet to help them and that’s not always helpful.

“Sometimes they’ve come to a premature conclusion and foreclosed options, when there might have been many different ways of resolving their distress. The aspiration – and I’m under no illusions this is going to happen quickly – is that they should have someone to talk to much earlier on before they narrow their options.”

Cass believes that for a minority of young people medical transition will be the right option, but she is clear that there is no solid evidence basis justifying the use of hormones for children and adolescents.

Her earlier research has led to a decision by NHS England to stop prescribing puberty blockers to children and the new research recommends “extreme caution” before prescribing masculinising and feminising hormones to under-18s.

“We’ve got it locked into this focus on medical interventions. And certainly some of the young adults said to us, they wish they’d known when they were younger, that there were more ways of being trans than just a binary medical transition,” she said.

A long section of her report looks at whether nature, nurture or other factors best help explain the soaring numbers of referrals to gender clinics. Cass’s conclusions are nuanced, but she acknowledges that Generation Z are facing unprecedented exposure to social media and the internet.

“It’s a social experiment – we don’t know what that’s done for the generation that’s coming through – what has been good and what is bad,” she said.

“Biology hasn’t changed in the last few years so it’s not that that’s changed things … we do have to think very seriously about the impact of social media, not just in terms of influencers, but about the effect of long hours on social media.”

She added: “There was some very dangerous influencing going on. Some of them give them very unbalanced information. Some were told parents would not understand so that they had to actively separate from their parents or distance their parents; all the evidence shows that that family support is really key to people’s wellbeing,” she said.

She acknowledged that some children may have been harmed by being misprescribed hormone treatments, but she said it was impossible to say how many. “We really don’t know how many children have benefited versus how many children and young people have been harmed because we haven’t got the adequate follow-through data. We urgently need to get that information.”

It was “unbelievably disappointing” that the research study she had hoped to conduct to look at the outcomes of 9,000 former Tavistock patients had been blocked by the adult gender clinics, who refused to contact former patients for permission on her behalf.

The former health secretary Sajid Javid had changed legislation to allow researchers to link pre- and post-transition NHS numbers, but the research had to be abandoned when all but one of the adult clinics refused to cooperate, Cass said.

“I do think it was coordinated. It seemed to me to be ideologically driven,” she said. “There was no substantive reason for it. So I can only really conclude that it was because they didn’t feel that it was the right thing to do to try and nail down this data.”

Cass said she had a distant relative who had had a trans identity, but that her outlook had not been influenced by this connection.

“They were of a different generation and transitioned very late in life; I don’t think there were any transferrable messages really, to sort of this group of young people,” she said.

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Op donderdag 11 april 2024 10:42 schreef Straatcommando. het volgende:
Zonder het bericht plat te willen slaan..maar het lijkt er dan meer op dat er een verkeerde diagnose word gesteld.

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The NHS must reveal the fate of 9,000 transgender young people treated by the controversial Tavistock clinic, the Health Secretary has said in the wake of the Cass review.

The landmark report published on Wednesday found adult gender clinics had refused to disclose whether transgender people who started their treatment as children later changed their minds about transitioning, or went on to suffer serious mental health problems.

Victoria Atkins, the Health Secretary, met Amanda Pritchard, the chief executive of NHS England, on Wednesday to tell her “nothing less than full co-operation by those clinics in the research is acceptable”.

Writing in The Telegraph, Ms Atkins says she has had enough of “a culture of secrecy and ideology over evidence and safety”.

She goes on: “We simply do not know the lifelong impact of these medical interventions on young minds and bodies to be clear that they are safe.”

The Cass review called for an end to the prescribing of powerful hormone drugs to under-18s and warned that under-25s should be cared for with “extreme caution” and not hurried down a medical pathway.

Ms Atkins says that she expects private clinics to also follow these recommendations, and is looking into ways the Department for Health and Social Care can block doctors abroad from prescribing puberty blockers to children in Britain.

She also praises those who spoke out to “raise the alarm about how treatment was diverging so far from guidance” and says that she is “greatly troubled” by the rapid rise in the referral of teenage girls to transgender clinics.

The Telegraph understands that NHS England has now written to the chief executives of the hospital trusts that operate the adult clinics demanding that the data is handed over as well as instructing an end to appointments for under-18s. The health service will also undertake an external review of all its transgender services.

Lack of data ‘unacceptable’

The review, led by Dr Hilary Cass, a paediatrician, said that the lack of “robust data” on what had happened to the 9,000 children who were treated by the gender clinic at the Tavistock between 2009 and 2020 was “unacceptable”.

Those children then went on to continue their treatment at adult clinics.

Research led by the University of York had been due to look at the long-term outcomes of children treated by the Tavistock.

It was expected to provide insights into the clinic’s work, including the number of patients treated with puberty blockers and cross-sex hormones, how many people detransitioned and how many had a “co-occurring mental health diagnosis” or a “diagnosis of autistic spectrum disorder”. The review had been given the power to access medical records.

Ms Atkins says: “It is disgraceful that adult gender clinics have not co-operated with the vital University of York research to link data on children at the Tavistock so that we can understand their journey into adulthood.

“This Government took the unprecedented step of changing the law to make this possible. There can be no further delay on their full participation. I know that NHS England will use all the powers at their disposal to compel this if they have to.

“Nothing less than full cooperation by those clinics in the research is acceptable.”

It is understood health leaders are prepared to use legal powers to mandate the main seven adult gender clinics to hand over the data they hold on trans patients, with only one being willing to comply with requests by researchers to date. There are a further five pilot adult clinics that have been set up since 2020.


Dr Cass told the NHS it was “hugely disappointing” that the clinics would not engage in research that would help to inform the future treatment of children who believe they are transgender.

The Tavistock, which also runs an adult service, refused to give data on either of its services, the report said.

The other adult clinics are the Leeds Gender Identity Clinic, the Northampton Gender Identity Clinic in Daventry, the Northern Region Gender Dysphoria Service in Newcastle, the Nottingham Centre for Transgender Health, the Porterbrook Clinic Gender Identity Service in Sheffield, and the Laurels Gender Identity Clinic in Exeter.