Guidance for care services in Scotland suggests children as young as 12 who believe they’re transgender could be given puberty blockers.
New advice issued by the country’s social care regulator says bodies responsible for looked after children can refer them to the Sandyford clinic, which has prescribed the medication that suppresses naturally produced sex hormones to kids as young as nine. The Care Inspectorate guidelines cite Scottish legislation which acknowledges that, while there will always be some exceptions, “a young person aged 12 and over is presumed to have sufficient capacity to make decisions about medical treatment”.
The guidance, which also states that facilities such as toilets are only sex-segregated owing to “social convention”, has been issued despite emerging research that has highlighted concerns about the adoption of an exclusively “affirming” approach to children who declare themselves transgender. In addition, it cites a case study in which a young cared for person has been “supported” by a child care home to have a mastectomy.
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Care providers have also been advised to refer to young people by their chosen names and pronouns and that young trans people should be able to share bedrooms with others who “share their gender identity”, pending risk assessments.
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The document does not refer to the findings of the interim Cass Review of gender identity services in England, which highlighted the potential dangers of encouraging “social transition” of young people and a lack of evidence to support puberty blockers. Dr David Bell, a consultant psychiatrist who wrote a report about the activities of the gender identity development service – a clinic at the Tavistock and Portman NHS foundation trust in north London where he worked – has criticised the guidance.
Quoted in the Telegraph, he said: “There is now considerable evidence that just affirming children is harmful and this guidance seems to just ignore all the emerging medical evidence.
“Children with a conflict about gender and sexual identity need to be treated with thought and understanding.
“Many of these children will have a history of abuse, trauma, depression and major family issues. Just referring to them as trans and sending them off down a medical pathway risks causing them more harm.
“Given the evidence we now have, this guidance is quite shocking and has the potential to be very damaging.”
The guidance was produced amid growing calls for clarity from services for young people in care over how they should treat an increasing number of children who identify as trans or non-binary.
The Care Inspectorate said its guidance had not suggested that referring children to the Sandyford gender clinic “should or must happen”, but was highlighting one possible course of action. A spokesman for the watchdog said: “We have a duty to support services to ensure high-quality care for all children and young people experiencing care.
“We have consulted with LGBT Youth Scotland, care services and care-experienced young people to develop the document, which is based on current good practice referenced in the document itself. Everyone in Scotland has the right to good quality, safe care which meets their needs and respects their rights.”