Irish doctors warn of 'lack of clarity' on clinical care for transgender youths after service closure
Doctors Services For Youths Transgender Clinical Picture: For Report Challenges' 'many Irish Istock
Irish doctors have warned of the challenges faced by young transgender people here due to a "lack of clarity" around alternatives to a now-closed UK service.
Six consultants working mainly in paediatrics, psychiatry, and endocrinology raised nine urgent questions about the direction of care for these patients almost five months after the Tavistock GIDS (gender identify development service) was closed following concerns raised by the Cass Review about use of puberty blockers.
There were strong links between Ireland and Tavistock, with 233 referrals between 2012 and 2023. By 2022, there 72 Irish patients on its waiting lists among 5,000 altogether.
The concerned clinicians include Professor Donal O’Shea, Dr Paul Moran, Dr Susan O’Connell, and Professor Fiona McNicholas.
They say “many challenges” remain for these clinical services in Ireland.
“The substantial body of evidence showing little or no evidence of benefit and possibility of harm is of grave concern,” they said in an article in the
.“Access to GIDS UK has now been removed and there is a lack of clarity regarding alternative care pathways.”
They ask what doctors should tell parents “when they ask for advice about referral or treatment”, due to the lack of information about future transgender services here.
“Are we knowledgeable or confident to advise regarding social transition?” they ask.
It is also unclear how clinicians should treat young people who were previously placed on puberty suppressing hormones or cross-sex hormones through Tavistock.
They query how young people prescribed privately or by doctors from other countries can be treated and why treatment is diverted through Camhs.
They warn of uncertainty for young people who waited months or years only now to realise there appears to be a blanket ban on puberty blockers in NHS clinics.
“What can we say when asked by a carer or youth why must they travel to UK for gender-specific healthcare services?” they ask.
Most of all, they warn: “How can we safeguard youth and ensure that whatever stance we take follows our Hippocratic oath, and our promise to ‘primum non nocere’,” referring to the adage ‘first do no harm’.
They highlight significant challenges in recruiting expert staff, which have contributed to the lack of a specialised Camhs for transgender young people.
Development of a new national model of care is eagerly awaited, they say, and they welcome the appointment of a clinical lead for this.
In the meantime, they say Irish services may need to return to the watchful waiting therapy model originally used by Tavistock before hormone use became so prevalent.
The closure of Tavistock followed two critical reports, known together as the Cass Review.
It recommended “extreme caution” be used when prescribing hormones to under-18s, saying a “clear clinical rationale” is needed to do this, rather than waiting until the person turns 18.
NHS England said, in March, that there was not enough evidence to support the safety or clinical effectiveness of puberty-suppressing hormones to make the treatment routinely available for children and young people.
The Irish paper “Cass Report and Implications for Transgender Youth and Services in ROI” can be read in the
.