Scotland’s only NHS gender identity clinic is facing growing pressure to close following publication of a review which found its medical ethos was based on “remarkably weak evidence”.
The Sandyford Clinic should shut immediately, according to a leading child psychiatrist, while other critics called for “an urgent redesign of services for gender questioning children”.
The centre in Glasgow follows the model of “gender-affirming” care called into question by the Cass report, which found the clinical practice of prescribing hormones to under-18s to halt puberty or transition to the opposite sex was based on “wholly inadequate” research.
Compiled by Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, the report was commissioned by NHS England but its criticisms of gender identity development services (Gids) run by the Tavistock and Portman NHS Trust are widely seen as applicable to Scotland.
David Bell, a senior psychiatrist who in 2018 first warned that Gids was failing vulnerable children, said he had no doubt that Sandyford should close.
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He said the Cass review had “put the last nail in the coffin” of the services, adding: “The wrong treatment is affirmation, just agreeing with the child if they say that they have a different gender to their natal sex and put them on a medical pathway.”
Bell described Cass as “the most thorough, extensive and reasoned review” ever completed. “It’s evidence base is huge,” he said. “How can anyone say it doesn’t apply to Scottish children?
“One of the things Cass points out is that the ordinary canons of clinical judgment have been overtaken by gender ideology and this is continuing in Scotland. Children are still being damaged in plain sight because of ideological capture instead of proper clinical evidence-based work with these children.”
In a letter to Professor Sir Gregor Smith, the chief medical officer, Joanna Cherry, the SNP MP, and Robin Harper, the former leader of the Scottish Greens, said he should “urgently consider the findings of the Cass review and commit to implementing its recommendations in Scotland.”
The politicians highlighted the fact that guidelines published by the World Professional Association of Transgender Healthcare (WPATH) and used by the Sandyford had been found by Cass to be based on poor research.
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They added that they were not “a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.”
“These guidelines are clearly no longer acceptable and must be urgently reviewed,” Cherry and Harper said.
“Children and young people in Scotland deserve individualised care. As the Cass review notes, this should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.
“The prescription of puberty blockers places gender questioning children and young people on a medicalised pathway which has lifelong implications.”
Cass said her review had vulnerable children at its heart, but from the start had stepped into a “toxic, ideological and polarised debate”.
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The debate has been particularly heated in Scotland, where the Gender Recognition Reform Act was passed in December 2022, permitting gender self-identification from the age of 16, only to be blocked by Alister Jack, the secretary of state for Scotland.
The Scottish Greens, coalition partners with SNP, campaigned for improved access to gender identity clinics at the last Holyrood election, though the policy has proved contentious within its ranks.
Harper has been a vocal critic of the party’s stance and is no longer a member, while Andy Wightman, the former Green MSP for the Lothians, quit over the Greens’ “censorious” approach. “The minute you talk about it [sex and gender] , you’re accused of being a bigot and a transphobe, which is, obviously, ridiculous,” he said.
Maggie Chapman, the party’s equality spokeswoman, said that “trans rights are human rights”, adding: “As the report acknowledges, the ongoing culture war around trans rights is doing a huge amount of damage.
“Trans people are not and must not be used as political weapons. Scottish Greens will continue to work with trans people and equalities organisations to build a system where the priority is to make the lives of trans people easier, happier, healthier, and to help them be who they are.”
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A spokesman for NHS Greater Glasgow and Clyde said : “The Sandyford follows strict protocols and guidelines in relation to all aspects of our service. Any patient with gender incongruence engaging with the service receives consultations with a multi-disciplinary team over an extended period.
“This system … ensures that clinical teams in our and other health boards can make informed decisions about onwards referral to other services.”
The Scottish government said: “We agree with Dr Hilary Cass when she highlights that ‘increasingly toxic, ideological and polarised public debate’ does nothing to serve the young people accessing this care, their families and the NHS staff working hard to care for them.
“While the Cass Review extends only to services provided by NHS England, we will now take the time to consider the findings of the final report in the context of how such healthcare can be best delivered here in Scotland.”
At the end of 2023, there were 1,100 patients on the waiting list for the child gender service at the Sandyford.
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Between 2016 and December last year, almost 100 children aged 16 or under were referred to endocrinologists for possible puberty blocker prescriptions by the Scottish clinic.
