Children allowed to ‘socially transition’ face psychological harm, review warns

The Tavistock clinic
The Tavistock clinic was shut down following the publication of the Cass review's interim report

Transgender children face grave psychological consequences if they are allowed to “socially transition”, a landmark review is expected to say this week.

The warning comes amid a huge rise in the number of children identifying as transgender, and deep concern that schools have been allowing pupils to change gender without their parents’ knowledge, despite Government guidance to the contrary.

The Cass review into gender identity services for children, which will be published on Wednesday, has promised to consider the “important role of schools” and the challenges they face in responding to “gender-questioning” pupils.

The review, led by Dame Hilary Cass, will include an analysis of scientific literature on the effects and outcomes of social transitioning.

It is expected to say that children may experience “psychological” repercussions as a result of being allowed to change their name and pronoun to the gender of their choice. The interim report released in 2022 noted that changing a child’s name and pronouns was “not a neutral act”.

Prepubescent children should not be put on the same “pathway” as older adolescents who wish to identify as the opposite gender, the final review is expected to say.

The review’s findings are likely to be reflected in the Department for Education’s (DfE) official guidance for teachers on how to deal with transgender children, the final version of which is due to be published later this year.

Following the publication of the interim review in 2022, it was announced that the Tavistock transgender clinic would be shut down after it was deemed to be unsafe for children.

NHS England said it would instead move young people who believed that they were trans into regional centres that take a more “holistic” approach to treatment and look at other mental health or medical issues they may have.

Concern over ‘schools to clinics pipeline’

Since the publication of the interim review, concerns have been raised with Dame Hilary about the “schools to clinics pipeline”, in which children are allowed to live as the opposite gender, thereby creating demand for more serious medical interventions later.

Earlier this week, the biggest survey of its kind revealed that primary school teachers were letting pupils change their name and pronoun without informing their families.

An analysis of more than 600 school equality and trans policies reveals that up to three-quarters misrepresent laws protecting sex and gender, with some implementing rules that allow boys to use girls’ lavatories and changing rooms if they say they are a girl.

It also emerged this week that a group of Church of England schools told teachers that they would probably be breaking the law if they said a person cannot change their biological sex.

Maya Forstater, the chief executive of the charity Sex Matters, who has spoken to Dame Hilary and her team, said: “Doctors are having to deal with gender-confused children who have already been socially transitioned at school for years, and are, as a result, very disturbed by the idea of going through puberty, which will develop their secondary sex characteristics. If social transitioning in schools is stopped, it will take the pressure off clinics.

“The Department for Education needs to say there is no way to keep children safe in schools while you are pretending that a boy is a girl, or that a girl is a boy. You are putting children through a psychological experiment with no clinical oversight. The whole thing is a fantasy being sold to children by adults who should know better.”

Prof Michael Biggs, a sociologist at Oxford University, said: “We do know from a longitudinal Dutch study that there is compelling evidence that socially transitioning does lock in transgender identity.

“It measured gender dysphoria before puberty and then came back several years later. You cannot treat it as an innocuous measure.

“I am hoping that the review will acknowledge that this was a major intervention which prepared the ground for medical interventions. We have to at the very least understand that this is the beginning of the process of physical transition.”

Role of puberty blockers

Last month, the NHS announced an immediate ban on prescribing puberty blockers to under-18s unless they are part of a clinical trial. Ministers said the “landmark decision” was in children’s “best interests” and would help to ensure youngsters who feel their gender is not the same as their sex are treated using medical evidence.

But campaigners warned of a loophole since there is nothing to stop transgender children getting hold of puberty blockers from private clinics.

The Cass review is expected to note the dangers of obtaining such drugs from private doctors and also raise the prospect that this could restrict their access to future NHS care for gender dysphoria.

In 2021-22, the NHS reported more than 5,000 referrals to the Gender Identity Development Service run by Tavistock and Portman NHS Foundation Trust, up from just under 250 who were questioning their gender a decade earlier.

Draft guidance from the DfE, published at the end of last year, told schools to presume that a child could not change gender.

Under the new “parent-first” approach, head teachers must tell parents if their child wants to change gender. The guidance had been promised since 2018 but was delayed amid a disagreement within the Government over how to respond to the rise in the number of children who say they are trans.

Some gender-critical campaigners have said it does not go far enough because it does not ban social transitioning completely.

Ministers had considered an outright ban on social transitioning, but Victoria Prentis, the Attorney General, advised that such a move would be unlawful under the Equality Act 2010.

A Government source said: “We are absolutely clear about the importance of biological sex, particularly in the context of safeguarding, and the role parents must play in decisions about their children.

“Our guidance for schools is clear that in nearly every case they should not support the social transition of primary-aged children, including not using pronouns that do not align with the child’s sex.”

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