The care and treatment of young people in relation to their gender identity in the UK (2019)

Introduction

Between September and December 2019, the Nuffield Council on Bioethics organised a series of meetings to explore experiences, expertise and ethical challenges in the care and treatment of young people in the UK in relation to their gender identity. We endeavored to hear from a range of different people, including medical practitioners, academics and researchers with expertise in this specific area, and people or representatives of people who have personal experiences of gender identity services.

Key points and recommendations

• Engagement with a wider range of young people would have been desirable during this process but time and resources prevented this. We recommend that any review of policy in this area should listen to the views of young people directly.
• There was strong disagreement among the people we met on a number of issues, but there were some areas of agreement as well. For example, the participants were clear that the needs and well-being of young people should always be the central focus of any discussion about their care.
• There was broad agreement among participants that the current NHS model of care for young people in relation to their gender identity needs to develop to respond to the needs of young people today and changing social contexts.
• Many participants thought there is a need for good quality, up-to-date evidence on the long-term outcomes of using puberty suppressants and cross-sex hormones in young people with gender dysphoria. There was disagreement over what the current evidence base means for clinical practice.
• Some participants questioned the ability of young people to consent to the use of puberty suppressants for gender dysphoria, a question now being considered by the High Court. Concerns were expressed about the discriminatory nature of this claim and the wider implications of the case for young people’s rights.
• There was disagreement among participants about whether young people should automatically be supported by parents and others to transition socially if they express a desire to do so.
• More work is needed to understand fertility issues in this area. We heard that most young people do not pursue fertility preservation before hormone treatment.
• Discrimination and prejudice against gender diverse young people was identified as having a significant impact on their lives.
• We heard media reporting in relation to gender identity in young people can be misleading and convey contradictory messages that can be upsetting and confusing for young people and others to hear. To improve accuracy, balance and sensitivity in reporting, we recommend that accessible summaries of any evidence reviews should be made available and a greater diversity of experiences should be represented in media accounts.
• Many people we spoke to called for more or different research to be carried out in order to fill gaps in the evidence base.
• We recommend that a broad review of existing evidence and ongoing research should be undertaken by healthcare commissioners, so that any significant gaps can be identified.

Download the summary of exploratory meetings.