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religion-is-a-mental-illness · 2 months

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By: Lucy Bannerman, James Beal, Eleanor Hayward

Published: Apr 10, 2024

The report should be the final nail in the coffin of Gids, the clinic that told thousands of children they were transgender

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

The sudden increase has gone hand in hand with the adoption of a model of “gender-affirming” care, which puts children on a life-altering path of hormone treatment. Services have been left overwhelmed, with vulnerable young people clamouring for medical interventions to help them change gender — despite a lack of evidence over the long-term effects.

It was against this backdrop that Dr Hilary Cass was commissioned in 2020 to examine the state of NHS services for children identifying as trans. Her final report, published on Wednesday, delivers a damning verdict on the medical path thousands of children have been sent down. It marks a turning point in years of bitter debate over how to help this distressed group of young people, confirming a shift towards a holistic model that takes into account the wider social and mental health problems driving the rise in demand.

Gen Z and online porn

The Cass report shines a light on the biggest unanswered question over transgender healthcare: why are so many Gen Z women suddenly wanting to change gender?

Cass paints an alarming picture of an anxious and distressed generation of digitally savvy young women and girls, who not only are more exposed to online pornography and the wider problems of the world than any previous generation but also consume more social media and have lower self-esteem and more body hang-ups than their male peers.

When Gids opened in 1989, it treated fewer than ten people each year, mostly males with a long history of gender distress. In 2009 it treated 15 adolescent girls. By 2016 that figure had shot up to 1,071.

Cass concludes that such a sudden rise in such a short time cannot be explained alone by greater acceptance of trans identities, which “does not adequately explain” the switch in patient profiles from predominantly male to female. She also says greater investigation of the “consumption of online pornography and gender dysphoria is needed”, pointing to youngsters’ increasingly early exposure to “frequently violent” online material that can have a harmful impact on their self- esteem and body image.

Gen Z is defined as those born between 1995 and 2009. Rather than focusing on the issue of gender in isolation, Cass looked at the context in which adolescents today, who have “grown up with unprecedented online access”, are experiencing such a disproportionate crisis over their gender.

“Generation Z is the generation in which the numbers seeking support from the NHS around their gender identity have increased, so it is important to have some understanding of their experiences and influences,” she writes. “In terms of broader context, Generation Z and Generation Alpha (those born since 2010) have grown up through a global recession, concerns about climate change and most recently the Covid-19 pandemic. Global connectivity has meant that as well as the advantages of international peer networks, they are much more exposed to worries about global threats.”

The report also focuses on 2014, when female referrals to Gids accelerated. Although this is not mentioned, 2014 was the year that CBBC, for example, broadcast I Am Leo, a video-diary-style documentary, to an audience of to 6 to 12-year-olds, showing the positive personal journey of a child who transitioned from female to male.

Throughout almost 400 pages, Cass argues that the gender-related issues of young patients should be treated in the same context as the wider mental health issues facing their entire generation. “The striking increase in young people presenting with gender incongruence/dysphoria needs to be considered within the context of poor mental health and emotional distress among the broader adolescent population, particularly given their high rates of co-existing mental health problems and neurodiversity.” Cass calls for more research into the “complex interplay” between these issues and a teenager’s sudden desire to change gender.

Lack of evidence for medical pathway

Rather than affirming children’s gender identity with medical treatment, the report calls for a holistic approach that examines the causes of their distress. It finds that, despite being incorporated into medical guidelines around the world, the use of “gender-affirming” medical treatment such as puberty blockers is based on “wholly inadequate” evidence. Doctors are cautious when adopting new treatments, but Cass says “quite the reverse happened in the field of gender care for children”, with thousands of children put on an unproven medical pathway.

Cass says gender care is “an area of remarkably weak evidence” and that results of studies “are exaggerated or misrepresented by people on all sides of the debate”. She adds: “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

The report finds that treatment on the NHS since 2011 has largely been informed by two sets of international guidelines, drawn up by the Endocrine Society and the World Professional Association of Transgender Healthcare (WPATH), but that these lack scientific rigour. The WPATH has been “highly influential in directing international practice, although its guidelines were found by the University of York’s appraisal to lack developmental rigour and transparency”, Cass says.

The report says the NHS must work to improve the evidence base.

Mental health

Mental health issues could be presenting as gender-related distress. Children and young people referred to specialist gender services have higher rates of mental health difficulties than the general population. This includes rates of depression, anxiety and eating disorders. Some research studies have suggested transgender people are three to six times more likely to be autistic than the general population, with age and educational attainment taken into account.

Therefore, the report says that the striking increase in young people presenting with gender dysphoria needs to be considered within the context of rising levels of poor mental health.

The increase in gender clinic patients “has to some degree paralleled” the deterioration in child and adolescent mental health, it finds. Mental distress, the report says, can present through physical manifestations, such as eating disorders or body dysmorphic disorders. Clinicians were often reluctant to explore or address co-occurring mental health issues in those presenting with gender distress, the report finds. This was because gender dysphoria was not considered to be a mental health condition.

The report finds that, compared with the general population, young people referred to gender services had higher rates of neglect; physical, sexual or emotional abuse; parental mental illness or substance abuse; exposure to domestic violence; and loss of a parent through death or abandonment.

Puberty blockers

The report says there was “no evidence” puberty blockers allowed young people “time to think” by delaying the onset of puberty — which was the original rationale for their use. It finds the vast majority of those who start puberty suppression continued on to cross-sex hormones, particularly if they started earlier in puberty.

There was insufficient and inconsistent evidence about the effects of puberty suppression on psychological or psychosocial health, it says, and some young females had a worsening of problems like depression and anxiety.

Cass says there is “some concern” that puberty blockers may actually change “the trajectory of psychosexual and gender identity development”.

Her report warns that blocking the chronological age and sex hormones released during puberty “could have a range of unintended and as yet unidentified consequences”.

It describes adolescence as a time of “identity development, sexual development, sexual fluidity and experimentation”. The report says “blocking” this meant young people had to understand identity and sexuality based only on their discomfort about puberty and an early sense of their gender. Therefore, it adds, there is “no way of knowing” whether the normal trajectory of someone’s sexual and gender identity “may be permanently altered”.

Brain maturation may also be “temporarily or permanently disrupted” by the use of puberty blockers, it says. This could have a significant impact on a young person’s ability to make “complex risk-laden decisions”, as well as possible long-term neuropsychological consequences.

The report highlights the “concern” of young people remaining on puberty blockers into adulthood — sometimes into their mid-twenties. This is partly because some “wish to continue as non-binary” and partly because of ongoing gender indecision, the report says.

Cass adds: “Puberty suppression was never intended to continue for extended periods.”

The report finds young adults who had been discharged from Gids “remained on puberty blockers into their early to mid twenties”. A review of audit data suggested 177 patients were discharged while on puberty blockers.

Cass says the review “raised this with NHS England and Gids”, citing the unknown impact of use over an extended period. “The detrimental impact to bone density alone makes this concerning”, the report adds.

A Dutch study originally suggested that puberty blockers might improve psychological wellbeing for a narrow group of children with gender issues.

Following this, the practice “spread at pace to other countries” and in 2011 the UK trialled the use of puberty blockers in an early intervention study.

The results were not formally published until 2020, at which time it showed there was a lack of any positive measurable outcomes. It also found that 98 per cent of people had proceeded to take cross-sex hormones.

Despite this, from 2014 puberty blockers moved from a research-only protocol to being available in routine clinical practice. “The rationale for this is unclear,” the report says.

Puberty blockers were then given to a wider range of adolescents, it says, including patients with no history of gender issues before puberty and those with neurodiversity and complex mental health issues. Clinical practice, Cass found, appeared to have “deviated” from the parameters originally set.

Overall, the report concludes there was a “very narrow indication” for the use of puberty blockers in males to stop irreversible pubertal changes, while other benefits remained unproven.

It says there were “clearly lessons to be learnt by everyone”.

Social transition

The report concludes it was “possible” that social transition, including the changing of a child’s name and pronouns, may change the trajectory of their gender development. It finds “no clear evidence” social transitioning in childhood has any positive or negative mental health effects, but that children who socially transitioned at an earlier age were more likely to proceed to medical treatment. A more cautious approach to social transition needs to be taken for children than for adolescents, it concludes.

The review also heard concerns from “many parents” about their child being socially transitioned and affirmed in their expressed gender without their involvement. Draft government guidance, published in December, stated that schools should not accept all requests for social transition and should involve parents in any decision that is made.

Despite this, there has been evidence of schools ignoring ministers and allowing children to change gender behind their parents’ backs.

The report makes clear that “parents should be actively involved in decision making” unless there are strong grounds to believe that it may put the child at risk.

It also finds that social debates on trans issues led to fear among doctors and parents, with some concerned about being accused of transphobia.

The interim report, from 2022, had classed social transition as “not a neutral act”. The full report explains that it is an “active intervention”, because it may have significant effects on a young person’s psychological functioning and longer-term outcomes.

In a strong warning to schools, the report describes the need for “clinical involvement” in the decision-making process on social transitioning. It adds: “This is not a role that can be taken by staff without appropriate clinical training.”

The report concludes that maintaining flexibility is key among those going down a social transition route and says a “partial transition”, rather than a full one, could help.

In decisions about whether to transition prepubescent children, families should be seen “as early as possible by a clinical professional”.

Rogue private clinics

Long waiting lists for NHS care mean distressed children are turning to private clinics or resorting to “obtaining unregulated and potentially dangerous hormone supplies over the internet”, the report says.

Some NHS GPs have then felt “pressurised to prescribe hormones after these have been initiated by private providers”, and Cass says this should not happen.

The report also urges the Department of Health to consider new legislation to “prevent inappropriate overseas prescribing”. This is intended to tackle a loophole which means that, despite the NHS banning the use of puberty blockers last month, children can still access them from online clinics such as GenderGP, which is registered in Singapore.

Detransitioning

Cass says some of those who have been through medical transitions “deeply regret their earlier decisions”. Her report says the NHS should consider a new specialist service for people who wish to “detransition” and come off hormone treatments. She says people who are detransitioning may be reluctant to return to the service they had previously used.

NHS numbers

The report recommends that the NHS and Department of Health review current practice of issuing new NHS numbers to people who change gender.

Cass suggests that handing out new NHS numbers to trans people means they risk getting lost in the system — making it harder to track their health histories and long-term outcomes.

The review says that this has had “implications for safeguarding and clinical management of these children”, — for example, the type of screening that they are offered.

Toxic debate

Cass has called for an end to the “exceptionally toxic” debates over transgender healthcare after she was vilified online while compiling her review. In a foreword to her 388-page report, the paediatrician said that navigating a culture war over trans rights has made her task over the past four years significantly harder.

She warned that the “stormy social discourse” does little to help young people, who are being let down by a lack of research and evidence. Cass added: “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.

“Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”

Cass said: “Finally, I am aware that this report will generate much discussion and that strongly held views will be expressed. While open and constructive debate is needed, I would urge everybody to remember the children and young people trying to live their lives and the families/ carers and clinicians doing their best to support them. All should be treated with compassion and respect.”

The recommendations

Data collection

Gender identity clinics should offer their data to NHS England for review, and more research should be conducted on the impact of psychosocial intervention — such as therapy — and the use of masculinising and feminising hormones, such as testosterone and oestrogen. Cass recommended that the NHS should also consider data from private clinics.

Puberty blockers and hormone treatment

Cass recommended research to establish the long-term impact of puberty blockers, which is expected to start by December.

Assessment of other conditions

Cass said that children arriving at gender identity services should be screened for conditions such as autism and other neurodevelopmental conditions.

Criteria for medical treatment

When treating children with gender dysphoria, only those who have experienced “longstanding gender incongruence” will be able to get medical treatment. Even then, this will only be available — with “extreme caution” — for over 16s.

A holistic approach

Before any medical intervention, Cass recommends that children should be offered fertility counselling and “preservation” by specialist services. This formed part of a more “holistic” approach to gender identity services. Cass suggested the creation and implementation of a national framework and infrastructure for gender-related care.

Growing into adulthood

The review advised that follow-through services for 17 to 25-year-olds should be established to ensure a continuity of care and support when children grow into adulthood.

Detransitioners

The report proposed that NHS England should “ensure there is provision for people considering detransition”, while recognising that they may not wish to attend services that assisted in their initial gender transition.

[ Via: https://archive.today/7GxDe ]

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1000sandwiches · 4 months

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Tue, Feb 6, 2024

Lately I have become extremely nostalgic for the Web 1.0 era of the internet. It started with me looking at archived Usenet posts via Google Groups, but has turned into me spending hours on the Wayback Machine looking up sites I used to haunt back in the 90s and early 2000s. Stuff like The Gaming Intelligence Agency (which is still up somehow), Elfwood, Toriyama's World, or various rabbit holes from the Anime Web Turnpike. I really miss the days everyone had their own website (I had several if you're wondering. A Flame of Recca fan site, for example). I want to be one of the cool kids and join Neocities in hopes it'll give me a similar vibe, but I haven't done HTML in years and feel a bit intimidated by it. So for now maybe a Tumblr diary will do. So that's what this is, a rambling online diary like the kind I kept as a teenager. It seemed cheaper than therapy.

Rambling about being a new parent and venting about my in-laws below. It's not particularly interesting. Next time I'll just write about video games I'm playing, probably.

I became a dad in November 2023. My emotions and mental health have been sort of all over the place since the day we checked into the hospital. I had always wanted a family of my own, and my wife and I both felt we would regret not having at least one child. I have a lot of insecurities about being a first time father at my age. I'm 38 now, and I just keep thinking about how I'll be 43 when my son is 5, and worry I won't be able to keep up with him. But here we are.

My wife was induced and spent 30 hours in labor before the doctor finally gave us the option for a C-Section. She didn't even hesitate to say yes, honestly just relieved to get it over with. The operation went fine, but apparently I am a lightweight when it comes to gore. Seeing my partner's blood and guts all over the surgeons had my anxiety screaming. Also, no one will ever believe me, but during the surgery the anesthesiologist, Bob, was playing on his phone. All of a sudden an ad for homemade marinara started playing, and the whole room stopped to stare at him. Surgeons still covered in bloody bits. Bob just mumbled "bad timing" and turned the volume down. What an absolute legend. I love you, Bob!

The experience of holding our son for the first time was just as powerful as I had always heard. So many different feelings washed over me all at once. I'd never even held a baby before then. Seeing my son being held up against my significant other's head made me cry.

Unfortunately, I am a peon at a public library, and my wife works retail, so neither of us are great breadwinners. Oops. Sorry, baby! So now we have super fun medical bills while we also figure out a budget. Currently we are living with my in-laws. Having to adjust to both our newborn and their family routine has been a challenge for us both.

Some days are great. Others are hard. Especially in the first month, where some nights the baby would just scream his head off for hours. I knew I hated loud noises, but I never realized how triggering a baby's cry could be. I'm not suicidal, but I've spent several nights imagining a scenario where I'd jump into my car and driving off a cliff. This has gotten better recently as he now does fairly good job of sleeping through the night. It's a lot easier to be patient with his crying when we are not exhausted.

My wife had a few struggles with post-partum depression. The week after giving birth, her hormones were all over the place and she had frequent panic attacks. One morning she woke up, walked into the living room and saw our son, only to then throw up. She is over this now thankfully, and has put a lot of energy into figuring out how to be a mom. I'm very proud of her.

The In-laws are a huge help, but there are pros and cons to their assistance. There are times where my wife and I really need to learn how to deal with our son's tantrums by ourselves, but the grandparents will insist on taking him. I appreciate the help, but I worry about not being able to handle him myself. In fairness, I might struggle to get him down for an hour, but Grandma can get him to sleep on five minutes. It's like dark magic for grandparents, I swear.

I am also prone to feeling like a burden on the family. I notice a lot of little corrections. Stupid things like say I take some chips from the cupboard and I know I'll put them back in a moment. I might decide to leave the door open for a moment, but Grandma walks in and immediately shuts the cupboard. Other times I might leave a light on which Grandma turns off while I'm still using. I also feel like every interaction I have with my son is being judged. If he's crying and I set him down for a few minutes, someone feels the need to swoop in and take him from me. It's like leaving him be in his bassinet while he's awake his frowned upon.

My In-Laws also have a family culture where everyone hangs out in the living room together all day. This is completely new to me, and I'd rather be alone in my room most of the time. It doesn't help that they are a family that keeps their television on all day and I get very sick of hearing the news cycle repeat over and over. This recently had consequences when Grandpa came home from work sick, and apparently keeping the baby in another room, away from the sick guy, was never even considered.

As you might expect, our baby got sick. I was pissed. I just couldn't believe that I would come home from work to find grandpa coughing just a few feet away from him, and no one thought to keep them separated. Our son then passed his cold onto the rest of the household (not covid or flu, as several of us have tested negative).

So that brings us to now. A week after getting sick, I am still having issues with sinus drainage along with aches and pains. Our son is doing better, and you can't even tell my wife was ever sick. I'm very jealous. I should probably take a few moments to proof read all this, but I've already been typing on my phone for an hour and feel silly about posting this at all.

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