Chalmers GIC pauses surgery referrals for transgender adults under the age of 25
On Friday 18 October, Trans Safety Network reported that Chalmers Gender Identity Clinic (GIC), which handles transgender healthcare for the Edinburgh and West Lothian region, temporarily paused all surgery referrals for under-25s, citing the recent Cass review of NHS provision of gender-affirming care for under-18s. This follows Health Secretary Wes Streeting’s decision to temporarily ban the prescription of puberty blockers to trans youth in England and Wales, which a recent preprint study revealed has caused serious adverse mental health effects for a number of children, including suicidal ideation. Sandyford GIC, which covers the Glasgow region, has also put puberty blocker prescription on hold.
According to Trans Safety Network, NHS Lothian issued a letter to the MP of an affected patient saying that referrals were paused on 2 May and restarted on 17 October. Detailed information was provided to those affected by the pause from 13 September onwards. Given that waitlists for initial appointments with a GIC can be in excess of 5 years, with no guarantee of being quickly moved onto a further waitlist for surgery referral, this pause is likely to have caused anxiety and disappointment among Chalmers patients.
The Chalmers pause is unique as so far Cass-review-led bans or pauses have only affected provision of transgender healthcare to under-18s. The Cass review explicitly avoided making prescriptions about adult gender-affirming care as that did not fall within its scope. However, the Cass review did recommend that a review of adult transgender healthcare be undertaken, and the NHS has since announced that Dr David Levy will be leading the review.
The British Medical Association (BMA) announced in July that following concerns from a number of their board members, they would conduct an evidence-led evaluation of the Cass review. The review has also been criticised by practitioners in Canada, Australia and New Zealand, as it goes against standards for transgender care set by the Canadian Pediatric Society (CPS), the American Academy of Pediatrics and World Professional Association for Transgender Health. The review has come under scrutiny for rejecting the vast majority of research into puberty blockers on qualitative grounds, to the extent that 98% of existing studies under review were deemed by Cass and her team as low-quality.
Moreover, independent journalist Erin Reed has reported a number of concerns surrounding Hilary Cass’s impartiality and fitness for conducting such a polarising review. Among these concerns include the claims of two youth gender clinicians that Cass had endorsed Abigail Shrier’s book Irreversible Damage, which has been widely criticised as an anti-trans polemic. Members of Cass’s team as well as Cass herself have also been involved in American anti-trans legislation in Florida – the team included no transgender people. According to Conservative politician and former Women & Equalities Minister Kemi Badenoch, governmental health roles were deliberately filled with gender-critical people prior to the release of the Cass review.
