#sandyford

By: Mary McCool

Published: Apr 18, 2024

Scotland's NHS has paused prescribing puberty blockers to children referred by a gender identity clinic.

The Sandyford clinic in Glasgow also said new patients aged 16 or 17 would no longer receive other hormone treatments until they were 18.

It follows a landmark review of gender services for under-18s in England.

Dr Hilary Cass's review said children had been let down by a lack of research and there was "remarkably weak" evidence on medical interventions.

NHS England confirmed it would stop prescribing puberty blockers in March.

Puberty blockers work by suppressing the release of hormones that cause puberty and are often prescribed to children questioning their gender as a way of stopping physical changes such as breast development or facial hair.

Like other parts of the UK, Scotland has seen a rapid rise in the number of young people questioning their identity or experiencing gender dysphoria.

The only specialist service for under-18s is the Sandyford clinic in Glasgow, where people can self-refer or can be referred through their GP.

Figures released to BBC Scotland News under a freedom of information request, showed that at the end of 2023, 1,100 patients were on the waiting list.

As well as referrals for puberty blockers, the Sandyford also refers patients for "gender affirming hormones" such as testosterone or oestrogen to 16 and 17-year-olds.

In the NHS in England, fewer than 100 children - who had already started a prescription - are now taking puberty blockers.

In Scotland, the number is likely to be far smaller.

Following the position taken by NHS England, NHS Greater Glasgow and Clyde (NHSGGC) and NHS Lothian deferred starting new patients on the treatment in mid-March.

The Glasgow health board said patients had now been formally notified, however existing patients currently receiving treatment would not be affected.

Dr Emilia Crighton, NHSGCC's director of public health said: "The findings informing the Cass review are important, and we have reviewed the impact on our clinical pathways.

"The next step from here is to work with the Scottish government and academic partners to generate evidence that enables us to deliver safe care for our patients."

Review findings 'considered'

Scottish Health Secretary Neil Gray welcomed the decision, saying the government and health boards are considering the recommendations of the Cass review.

He said: "We have been clear it is for clinicians and health boards to make decisions about clinical pathways, and that these decisions should be made carefully and based on the best evidence available.

"This is what both health boards have done and their position is supported by the chief medical officer.

"More broadly, the Cass review's final report and findings are being closely considered by both the Scottish government and health boards, in the context of how such healthcare can be best delivered in Scotland."

Vic Valentine, of Scottish Trans and the Equality Network, said pausing puberty blockers was the wrong decision and said it would "harm trans children and young people".

A statement said: "This decision has been taken within the context where the reality of trans people's experiences and lives is questioned almost daily in some of the media and some political circles.

"This makes us worry that the decision has been influenced by that context rather than solely through consideration of the best interests of trans children and young people."

Scottish Conservative deputy leader Meghan Gallacher said the decision was "long overdue" and accused the government of leaking the news to the press "before having the decency to update parliament".

She called for an urgent ministerial statement so MSPs had a chance to ask questions on the matter.

She said: "I'm beyond fed up with this lackadaisical approach to gender care. They are failing children and young people."

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Hi Anon,

November last year, a year ago today in fact was my consultation at the Sandyford about being put on a surgery list and having my injections on the NHS.

Today in November I'm walking around my flat shirtless looking at my scars wondering how the hell I got here.

So, in brief: I started identifying as non-binary round about 2010. I began to socially transition at that time – came out to friends and family and started using they/them pronouns but was unsure if I wanted to pursue any medical transition. I had been experiencing dysphoria about my chest since before I came out as non-binary, but between 2010-14, it became compellingly distressing enough for me to eventually refer myself to the Sandyford gender clinic in Glasgow in early 2014. As the Sandyford clinic takes self-referrals, I didn’t discuss anything with my GP beforehand.

A leisurely thirteen months later I had my first appointment at the gender clinic in early 2015, with a psychiatrist who no longer works at the clinic. A small aside: many, many non-binary people fly under the radar at gender clinics because they can present themselves as a binary trans man or woman. Gender clinics’ historic hostility to non-binary identities means that people are understandably unwilling to come out and possibly jeopardize their treatment, but it does also mean that doctors severely underestimate the numbers of non-binary people among their patients. However, I do not want to take testosterone and am really not at all masculine, as well as being a terrible liar. So, I felt I really had no choice but to go in and present as an openly non-binary person, who has dysphoria and wants to get top surgery. Going in, I didn’t think my chances were very good at all, but it seemed important to at least try, as it would be difficult for me to fund it privately.

Confirming my worst fears, this first appointment was a total, crushing disaster. The psychiatrist I saw appeared totally non-plussed by non-binary identity, and not at all open to learning about it. Among other uninformed and dispiriting statements during the course of the appointment, she said that I seemed like a ‘regular girl’, implied I wanted surgery for the androgynous fashion opportunities and told me point blank that I would not get top surgery on the NHS. I hadn’t exactly expected it to go well, but I wasn’t quite prepared for such outright dismissal and misgendering. She said that I could have a second appointment in 6 months, but her entire manner suggested that it was just a formality.

Approximately 6 months later, then, I had my second appointment, this time with a different doctor. I was originally scheduled to see the first one again, but something happened that meant I ended up seeing Dr Ewan instead. This turned out to be a fantastically good thing, and if I could go back I would have specifically requested not to see original doctor again after that horrible first appointment. The difference between the two doctors was astounding; while Dr Ewan still seemed to be fairly new to treating openly non-binary people, he was willing to listen to what I had to say, and learn from it. He even apologized for asking searching personal questions, which is unusual from a gender doctor. He confirmed that the issue of treatment for non-binary people was the hot-button topic of the day for gender clinics, and seemed interested in what I was saying about experiencing gender dysphoria without wishing to ‘fully transition’. He said that he would have to discuss my case with the other doctors, but I left the appointment with the impression that he would advocate for me.

I made a point of reassuring him that my expectations of top surgery were ‘reasonable’. I.e. I knew that having surgery wouldn’t suddenly mean that everyone would gender me correctly, but that I believed it would make me feel a lot happier and more congruent with my body regardless. I also tried to show just how long I had been thinking about this (about 4 years active consideration at this point).

A couple of months later, I got a letter from the clinic saying that I had been referred for surgery. Hooray! By this point we’re at about October 2015. For several months, I waited to hear something, and didn’t. By February 2016, I was worried, and attended the monthly drop-in service to see if I could chase up what was happening. I saw a different doctor again at the drop-in service, and explained what had happened. She promised to look into it and get in touch within the month. Nothing happened again.

At the start of April, I called the secretary of the gender clinic, to see if I could find out what was happening. The person on the phone told me that my surgery hadn’t been approved by the funding board, and seemed surprised that no-one had told me. I was also surprised that no-one had told me. They said that I would need to take hormones before having surgery, contradicting what the clinic head had said in a Q&A I had attended, and what Dr Ewan himself had recommended. The guidelines for top surgery had only recently been updated to be inclusive of non-binary people, and I assume that she had not read or been informed of the updated guidelines.