Gender change in children, paediatricians: “The English idea of ​​a center per region is excellent”

ROM – In Great Britain, the National Health Service (NHS) has just announced the introduction of a regional model forcare of children and young people with gender inconsistency, closing the highly specialized national referral centre, the Gender Identity Development Service for Children and Adolescents (GIDS) at Tavistock and Portman NHS Trust in London. The centre, which was established in 1983 and which today is burdened with booking lists and very long waiting times, will be replaced with several new regional centres, called Early Adopter services, to ensure a higher quality of service.

A MODEL FOR OUR HEALTH SYSTEM

“We can only applaudan initiative that can also act as a model for our health systemat least on paper, one of those that in Europe guarantees greater protection to young people through legal or administrative measures that ensure sex change, albeit with restrictions”, commented the Study Group of the Italian Society of Pediatrics (Sip) in a long document dedicated to ‘Children’s rights’ led by Pietro Ferrara.

THE MORE CENTERS THE BETTER THERE

“As a group of pediatricians who care about the protection of the rights and health of minors – the document continues – we believe that the presence of a greater number of expert centers, at least one per region, and passing on correct information to care for these minors and their families could preserve the rights of a minority who, because of their complex condition, are already exposed to challenges of extraordinary emotional strain that compromise their development and life potential”.

CONSTANTLY INCREASING NUMBERS

Data from the National Gender Identity Observatory tells chapand in Italy from 2005 to 2018, 251 families turned to specialist centres; however, the number has been steadily increasing in recent years. “These data should not be considered alarming – explains Sip the pediatricians – we know very well how this phenomenon occurs every time a social stigma begins to crumble, which created an overwhelming suffering and discomfort for many young people, and that he is now getting a little the hallway. out and ask to be taken care of”.

IN ENGLAND SERVICE IN CRISIS DUE TO. TOO MANY REQUIREMENTS

The UK service alone last year saw a doubling of demand compared to the previous year. In March 2022, a review of gender identity services for young people led by paediatrician, Hilary Cass, confirmed that the service was under “unsustainable pressure” as demand exceeded capacity, resulting in staff overload and waiting lists of up to two years, putting the mental health of young transgender people in the UK at risk. Cass therefore recommended the creation of a network of regional hubs to provide assistance and support, a recommendation accepted by the NHS.

SPECIALIZED PEDIATRICS WHO LEAD THE NEW CENTERS

The new regional centers will be composed of a multidisciplinary team and led by specialist pediatric hospitals. As a first step, NHS England is establishing two new Early Adopter Services, one in London and one in the North West. Early Adopter Services will be fully operational in the spring of 2023.

SIP: “A GREAT TRANSFORMATION UNDERWAY”

“These are just the first passesthat of a great transformation– emphasizes the Sip study group – which will ultimately result in the creation of a network of specialized competence centers in each region of the country.
But the announcement of the creation of this network “although positive in its goals – the pediatricians point out – did not fail to raise concerns determined by fear of an increase in gender confirmation pathways that have not been adequately considered. Emblematic was the case in 2020, when the center was taken to court by Keira Bell, a former patient who claimed to have been too young to give real valid informed consent at the time of the beginning of her gender transition path at GIDS. Despite initially winning the Bell case, the judgment was overturned on appeal in favor of Tavistock: the Court of Appeal confirmed the principle of Gillick’s jurisdiction, according to which “it is up to doctors and not judges to decide whether a person under the age of 16 can give consent to medical treatment“. This appeal judgment was a relief for the young transgender population assisted by GIDS, who, after the first judgment, were suddenly denied their right to health and the transition path”.

YOUNG PEOPLE OFTEN FIND EXPERTS TOO DOUBTFUL, THE EMOTIONAL IMPACT IS NEGATIVE

However, affirming gender pathways “often find obstacles in the gatekeeping attitude (filter implemented by experts who make decisions) – comments the Sip Study Group – supported by the incomplete knowledge and training of the health professionals to which transgender young people initially refer, find themselves in front professionals who tend to slow down the transition or deny it altogether. The gatekeepers’ arguments are based on the belief that transgender people are unable to determine their identity; some gatekeepers argue that mental health issues are a reason to delay or deny transition without taking into account that mental health issues are often caused by body dysphoria and stress of being denied the right to one’s gender confirmation which has a negative impact on young people’s mental health. Portekeeping can in all respects be considered a form of transphobia, as the power of the medical establishment replaces trans people’s autonomy to decide on their own lives”.

IN ITALY VERY FEW CENTERS, FOR YOUNG PEOPLE AND FAMILIES CLIMBING ROUTES

For Italian pediatricians, “it is necessary that children with atypical development of gender identity and their families be instructed by their relatives (pediatricians or general practitioners) to specialist centers with multidisciplinary teams of experts which processes the entire diagnostic-therapeutic process in appropriate times. Unfortunately, these facilities dedicated to minors in Italy can be counted on the fingers of one hand, making it difficult for families to access servicesoften characterized by long waiting times and great heterogeneity in terms of access methods and free treatment based on the region of origin.

In conclusion, the Italian pediatricians recall that “even the European Council, in a recent report of July 7, 2022, recognized that the removal of all obstacles that prevent the full legal recognition of the gender confirmed by a person is slow , and that it should also be made available to minors this option, based on the assessment of what is in their best interest”.

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