Sex hormones and surgeries

Sex hormone therapy

The NHS does not currently allow children under the age of 16 to be prescribed cross-sex hormones such as testosterone or estrogen.  However, once your child reaches 16 then treatment with cross-sex hormones can be obtained on the NHS. This is a particularly crucial stage in the process because treatment no longer requires parental consent AND treatment with cross-sex hormones will have irreversible effects.

The irreversible nature of testosterone takes effect very quickly. Taking testosterone for as short as 1 year will be long enough to leave someone with permanent beard growth if they change their minds and want to de-transition.

It is not illegal for children be prescribed sex hormones under the age of 16. Private gender clinics will and do prescribe sex-hormones under the age of 16, although parental consent will be required and treatment will of course need to be paid for.

Dr Helen Webberley runs a private gender clinic and has prescribed cross-sex hormones on four occasions to children under the age of 16 (three 15 years old and one aged only 12). Link here. She is currently under investigation by the General Medical Council (GMC) after complaints by two GPs. Her works with transgender patients is now suspended pending investigation (link here).

Some trans-activists argue that the NHS should remove the lower age limit of 16 for cross-sex hormones from their guidelines. This would allow children to progress through a cross-sex hormone induced ‘puberty’ and the same age as their peers. This has been resisted due to the irreversible nature of the changes and the lack of evidence to support this change, nonetheless the pressure for ever earlier treatment is there.

Gender Reassignment Surgeries

There are a number of surgeries available on the NHS available to adults over the age of 18. These are commissioned by adult Gender Identity Services.

NHS England is currently undergoing a consultation process and is proposing a number of changes to adult gender services. Transgender Trend attended one of the consultation meetings and has also submitted detailed feedback as part of the consultation process. For more details see this post.

One of the most concerning changes is the proposal to reduce the age at which adult services are accessed from 18 to 17 years old. This means referrals to adult services will start at 16.  Adult services are very different to children’s services.  Children’s services are very much about understanding and supporting the development of gender identity in children and is based largely around talking therapies until puberty when blockers may be prescribed. In contrast adult services are focused on the implementation of gender reassignment pathway; both surgical and non-surgical. Psychological support is no longer mandatory (unlike in children’s services).

If the proposals are implemented this means children aged 17 will have access to NHS funded hormones and surgeries. Transgender Trend opposes this change.

How effective are gender reassignment treatments in curing or alleviating gender dysphoria? Does it work and what are the risks? We know from the stories of detransitioners that gender reassignment treatment was not effective in alleviating their underlying psychological problems, trauma or other co-morbidities and in some cases even increased dysphoria.

The only long-term follow-up study of people who have under-gone sex reassignment surgery suggests that it is not the simple solution we are led to believe. This study found substantially higher rates of overall mortality, suicide, suicide attempts, and psychiatric hospitalisations in sex-reassigned transsexual individuals compared to a healthy control population.

In particular, it may not be the ‘cure’ for suicidal ideation which is stressed to parents as the reason they must allow their children to start gender transitioning in the first place.

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