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1/šŸ§µ Some horrid passages from the Service specification: NHS Children and Young Peoples Gender Service.

EmiB71
EmiB7104/04/26

#NHS #Transrights As expected, NHS published new guidelines for treating Children and Young Persons (CYP) experiencing gender incongruence. Whilst they may receive care, none of their care is aimed at treating gender incongruence. And somehow the NHS thinks that when a person turns 18,

https://www.england.nhs.uk/wp-content/uploads/2026/04/nhs-cyp-gender-service-specification-april-2026.pdf#page=23.09

www.england.nhs.uk

2/ It literally says if you seek proper gender affirming care from the EU, then ā€œpsychosocial supportā€ may be CLINICALLY APPROPRIATE. And it makes safeguarding interventions if you refuse ā€œsupportā€. In other words, this ā€œserviceā€ will prioritise you for conversion therapy if you dare to have GAHT. 3/ And they put the Hilary Cassā€™s transphobic hate network in charge of training.

4/ In a 27 pages document, less than one page is about diagnosis. And it sets out nothing of value, but merely undermines the ICD 11 diagnosis of gender incongruence.

5/ A genuine service specification must provide operational clarity, yet this document leaves the most basic logistical questions unanswered. When is the diagnosis offered? What resources are allocated? Perhaps, I say perhaps but we know the answer, diagnosis is simply not a priority.

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Social Transition Changes in gender expression whereby the child or young person presents to others in line with societally expected indications of gender identity different to that of their natal sex is known as ā€˜social transitionā€™. This can be partial or in all forms and aspects of daily life. Appearance and behaviours (interests/activities or presentations socially defined and typically associated with another gender) are usually initiated by children or young people and often supported and facilitated by adults. The ability to express individuality and autonomy to change and adapt self-expression over time can be important to a child or young personā€™s development and wellbeing. However, the social and psychological impact that social transition may have, means that advice may be sought of clinicians within The Service. Social transition should be recognised as a significant decision and therefore, while it is not a clinical intervention, it will often be become a significant and valid subject within an individualā€™s care. While there are different views on the benefits versus the harms of childhood social transition, it is important to acknowledge that it is not a neutral act and that information is needed about long-term outcomes to support decision making. Information and discussion about this with the MDT are important within care for a child or young person in The Service. At the point of presentation to The Service some children and young people will have already socially transitioned or be in the process of effecting a social transition, while others may be considering this. It is important that the risks and benefits of social transition are discussed with the child or young person and family, referencing best available evidence. Decisions will be individual, and the agency to make the decision rests with the young person, along with their family. Individual autonomy to change or cease social transition is an important part of the discussion. This service ā€¦
Prescribing from unregulated sources and unregulated providers Children, young people and their families are strongly discouraged from sourcing puberty suppressing or gender affirming hormones from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies. The sale and supply of Gonadotropin-Releasing Hormone agonists via private prescriptions for the treatment of gender incongruence and/or gender dysphoria is banned in the United Kingdom for under 18s. The Service will not assume responsibility for prescribing medication initiated outside of The Service. The Service will not offer clinical supervision for the management of the endocrine intervention; and it will not enter shared care arrangements with a health professional who is making recommendations for prescribing / is prescribing to the child or young person.
In such cases psychosocial support may be offered as clinically appropriate. The Service will make the child or young person and their family aware of the risks, contraindications and any irreversible or partially reversible effects of the interventions; and will make the GP or local health professional (as appropriate) aware. The Service will consider what safeguarding protocols may be appropriate for the individual child or young personā€™s wider circumstances including the extent to which the parents / carers are able to protect or safeguard the child or young person. Safeguarding procedures may be necessary regardless of the endeavours and best intentions of the parents / carers in reducing risk of harm. Safeguarding protocols should be initiated immediately where the child or young person is at risk of immediate or significant harm. It would also be important for The Service (in conjunction with the GP or local health professional as appropriate) to explore what regulatory bodies may need to be informed if healthcare professionals registered with a UK professional body are prescribing medication contrary to NHS protocols.
Diagnosis and differential diagnosis The clinicianā€™s role in a consultation is to integrate information from a patientā€™s history, assessment and any investigations or tests, in order to determine the most likely cause of their symptoms, and how best to address them. In addition to the process of formulation described above, this often involves arriving at a formal diagnosis. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to understand the patientā€™s problem. Differential diagnosis is the process of ruling out other possible diagnoses that present in a similar way. There are two widely used frameworks which provide diagnostic criteria. The International Classification of Diseases (ICD), which is the World Health Organization (WHO) mandated health data standard, and the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the classification system for mental health disorders produced by the American Psychiatric Association. ICD-11 (WHO, 2022) has attempted to de-pathologise gender diversity, removing the term ā€˜gender identity disordersā€™ from its mental health section and creating a new section for gender incongruence and transgender identities in a chapter on sexual health. ICD-11 defines gender incongruence as being ā€œcharacterised by a marked incongruence between an individualā€™s experienced/expressed gender and the assigned sex.ā€ It refers to a mismatch between birth registered and experienced gender but does not include dysphoria (distress)
as part of its diagnostic requirements. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis. DSM-5 (American Psychiatric Association, 2013), revised in 2022 (DSM5-TR) (American Psychiatric Association, 2022) is the most widely used framework for diagnosing gender dysphoria. In addition to describing the incongruence between experienced/expressed gender and assigned gender, DSM-5-TR specifies that ā€œIn order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.ā€ There is no clear consensus across international guidelines as to whether DSM-5 diagnosis of gender dysphoria or ICD 11 diagnosis of gender incongruence is preferred. However, in clinical practice the DSM-5 diagnosis of gender dysphoria is more widely used, this also applies to research publications. Individualised care plan The holistic needs assessment and subsequent formulation should lead to the development of an individualised care plan with input from the multidisciplinary team. There should be a tiered approach to any intervention package outlined in an individualised care plan which: ā€¢ addresses urgent risk ā€¢ reduces distress and any associated mental health issues and psychosocial stressors, so the child/young person is able to function and make complex decisions ā€¢ co-develops a plan for addressing the gender dysphoria, which may involve a combination of treatment options

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