NHS ‘over-diagnosing children having transgender treatment’

The NHS is "over-diagnosing" children having medical treatment for gender dysphoria, with psychologists unable to properly assess patients over fears they will be branded "transphobic", former staff have warned.

Thirty five psychologists have resigned from the children's gender-identity service in London in the last three years, Sky News research suggests.

Six of those have now raised concerns about hormone treatment being given to children with gender dysphoria, a condition where a person experiences distress due to a mismatch between their biological sex and their gender identity.

A psychologist, who wished to remain anonymous, said: "Our fears are that young people are being over-diagnosed and then over-medicalised.

"We are extremely concerned about the consequences for young people… For those of us who previously worked in the service, we fear that we have had front row seats to a medical scandal."


The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust is where children with gender dysphoria are treated on the NHS.

GIDS had 2,590 children referred to them last year, compared with just 77 patients a decade ago.

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Image: The number of referrals to Tavistock & Portman NHS Trust

According to the Tavistock and Portman NHS Trust there are now around 3,000 children on the waiting list, with waiting times for an appointment at about two years.

Another psychologist, who wished to remain anonymous, described a service where staff are under immense pressure, with little time to thoroughly evaluate children.

"At the moment there's only one pathway through the service, which is a medical pathway, not a psychological one," the psychologist said.

"A junior clinician working full-time is expected to carry a caseload of 120 to 130 young people.

"Compared to child and adolescent mental health services where the equivalent would be 40 cases. So, it's three times larger than the average service."

Some 3,000 children are on the waiting list
Image: Some 3,000 children are on the waiting list

They described a service where psychologists are constrained in the work they can do with a patient for fear of being called "transphobic".

The psychologist said: "The alarm started ringing for me… I didn't feel able to voice my concerns, or when I did I was often shut down by other affirmative clinicians.

"Looking back there are young people who I now wouldn't necessarily put on medication."

In a statement, the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust said it "supports every young person on a case-by-case basis, as an individual".

GIDS sees children under 18, including some cases who are as young as three.

Around half of children who are seen at the clinic are put on drugs to pause their puberty, known as hormone blockers.

This is the first step of any medical intervention and is seen as a fully reversible form of treatment, allowing children time to explore their gender identity while "pausing" the physical, and non-reversible effects of puberty on the body.

The next stage in medical treatment is to take cross-sex hormones.

A trans-man (female-to-male) will take testosterone while a trans-woman (male-to-female) will take oestrogen.

Hormone therapy is not normally offered before the age of 16, with the NHS saying it makes both trans-men and trans-women less fertile and eventually infertile. Surgical procedures are offered only after a patient turns 18.

Leo recently began taking testosterone on the NHS shortly before his 16th birthday as part of his female-to-male transition.

He was 14 when he was asked by psychologists and doctors in the NHS to make the life-changing choice of whether he might want his own biological children in the future.

Leo was born a girl
Image: Leo recently began taking testosterone on the NHS

Describing the torment he felt living with a female body, he said: "If I couldn't live my life as a male or have the body of a male I don't think I'd be around by the age of 20, 30.

"When I started getting my periods it was an indicator that things weren't going to change, puberty worsened my mental health, worsened my gender dysphoria. It was excruciating."

Leo's experience at the Tavistock Centre was positive and he says his fertility was discussed with him in the sessions with clinicians.

He said: "I was asked questions about my future and if I wanted to freeze my eggs… Personally I didn't want to because the process was quite difficult, I would have had to go on oestrogen for a month, then there's the process of extracting the eggs.

"And if I want kids in the future, which isn't something I'm sure about, I could always adopt."

Leo and his mother Gemma
Image: Leo and his mother Gemma

In the last decade the proportion of patients being referred to the NHS children's gender service who were assigned female at birth has grown, from 44% to 74%.

Psychologists say there has been an increase in "female-born" teenagers, many of whom have underlying issues, identifying as trans.

The underlying issues range from experience of homophobia to a history of abuse.

Some of these teenagers do not find medical treatment helps their gender dysphoria.

For some, it's a mistake and they later Read More – Source