Children: Gender Dysphoria

Lord O'Shaughnessy Excerpts

Wednesday 17th October 2018 Lords Chamber

[Lord Lucas]

To ask Her Majesty’s Government what is their assessment of whether treatments for gender dysphoria currently offered to children by the National Health Service are evidence-based, and do no long-term harm if the diagnosis turns out to be mistaken.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, clinical practice for those with gender dysphoria is informed by a series of guidelines outlined in both NHS England’s service specification and the clinical commissioning policy on the use of cross-sex hormones: for example, guidelines produced by the Endocrine Society on the use of puberty blockers. Research into the long-term impact of such interventions is in its infancy, with further studies required.

[Lord Lucas (Con)]

My Lords, I am grateful to my noble friend for that reply. However, would he not agree that when clinicians are faced with a choice between whether to leave the child in a state of psychological distress due to gender dysphoria or to set them on a course of treatment which, most of the time, will end in sterilisation, we need to put a lot more effort into and emphasis on research so that we understand this condition better?

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[Lord O'Shaughnessy]

I absolutely agree with my noble friend that more research is required. Clearly, long-term research is also required here to track people throughout their lifetime and to understand the physical and psychological outcomes. The NHS England service was developed on the basis of peer-reviewed research—the best research available. However, it is still in its infancy, and we need more research to make sure that the correct services are being given to children and young people who, in many cases, are in quite significant distress.

[Baroness Barker (LD)]

My Lords, will the Minister confirm that surgery for gender dysphoria is never carried out before the age of 18, and that young people receive hormone treatment only after extensive periods of assessment, not just by psychologists and psychiatrists but also by endocrinologists, all of whom have to work to clinical guidelines?

[Lord O'Shaughnessy]

Yes, I am happy to confirm to the noble Baroness that no surgery should be offered to under-18 year-olds; no cross-sex hormones, which change biological gender, should be available to under-16 year-olds and even the use of hormone blockers is highly unusual for those under the age of 15. That is set out in the guidance and adhered to by the Tavistock and Portman trust, which delivers the service for children.

[Baroness Thornton (Lab)]

My Lords, gender dysphoria is described by the NHS as the discomfort or distress caused by a mismatch between a person’s gender identity and their biological sex assignment at birth. This is not a new condition, but we must be grateful that it is recognised today as a real issue and a real cause of harm to those children and young people affected. I declare an interest as a health commissioner in the area of the Tavistock Institute.

Does the Minister agree that we need not only more research on the medical, psychological and emotional solutions for this cohort of children and young people, but also resources to be made available? The Tavistock, with its excellent work, is currently the only institute in the UK providing this support.

[Lord O'Shaughnessy]

I agree with the noble Baroness that this is a very real condition; it is rare, particularly in children, but nevertheless it is real. Therefore it is appropriate that those who have it should get the right support. As the noble Baroness, Lady Barker, pointed out, that support may be psychological or endocrinological —whatever is required, multidisciplinary teams will provide it. There has been an increase in the number of resources available as well as a cultural change towards greater acceptance. Ultimately, what this comes down to, and what people worry about, is that children are pressured into being one thing or another when they should be allowed to be themselves.

[Baroness Nicholson of Winterbourne (Con)]

The Minister has mentioned the GRA consultation document already, which is on the web. Would he consider reviewing, withdrawing and reissuing that document? I have known a number of people try to fill it in and it is a little difficult; the language is complex, opaque and many of the linguistic terms are not readily used. I am not certain whether the general public, with whom we are consulting, are normally ready to read 100 pages of explanation before finding a small number of questions in the middle. It is a monumentally complicated paper, which has had little academic consultation, and people with less than a higher level of education have told me they simply cannot understand it. Will the Minister consider reviewing that document?

[Lord O'Shaughnessy]

It is important to distinguish the provisions of the Gender Recognition Act from the health services provided for people with gender dysphoria. Nevertheless I take the noble Baroness’s comments on board; I know some concerns over the document have been raised with the Government Equalities Office, which has responsibility for it; the Department of Health does not have direct responsibility.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, this is an issue not only for children in this country but in many countries throughout Europe and, particularly, in the United States. Will the Minister tell us what mechanisms exist for exchanging information between the countries that recognise this problem, which is a genuine problem in many families? What mechanisms are there for exchange of information on how best to deal with it?

[Lord O'Shaughnessy]

The noble Baroness is right that this is an international trend; we see in many countries similar figures for people coming forward, although, frankly, some cultures deal with the issue better than others. I am sure there are international health forums—indeed, I know there are—that deal with trans health issues and I can write to her with specific details

[Baroness Brinton (LD)]

My Lords, following the comments of the noble Baroness, Lady Nicholson, will the Minister take back also the alternative view? This is an extremely complex issue—on the current consultation on gender recognition, the survey is complex, the information provided by the Government is extremely helpful and, as a result, it has informed a lot of people as well as enabling them to answer questions properly.

[Lord O'Shaughnessy]

I am happy to do so.