Children as young as nine can be prescribed sex change hormones

Children as young as nine who believe that they are transgender can be prescribed sex change hormones, according to new “best practice” international guidelines.

The standards of care from The World Professional Association for Transgender Health (WPATH), previous versions of which have underpinned NHS guidance on care, have removed minimum ages for children to receive puberty blockers, hormones and surgical interventions.

Instead the organisation recommends that young people can be prescribed drugs from the first physical signs of puberty, which can begin at the age of nine, and that surgery can be considered once an adolescent has been on “gender-affirming hormone therapy” for 12 months “if required”.

WPATH’s Standards of Care Version 8 also states that there “may be a benefit for some adolescents” in having their breasts removed or for boys who identify as female in having surgery to put in implants or create a vagina.

Previous versions of the WPATH guidelines, last updated in 2011, recommended that children could be given puberty blockers as soon as puberty started, hormones at the “age of majority”, which is 16 in most European countries, and most surgeries from 18.

Those versions have been used by the NHS England guidelines including for the gender identity service for children, which was “delivered in line with” the WPATH document.

Puberty blockers could have impact on brains A guide for GPs and other healthcare staff treating gender dysphoria was also “informed” by WPATH recommendations, NHS documents show.

A number of NHS Trusts across the country also refer clinicians to WPATH guidelines.

NHS England said on Friday that an independent review of services for young people was currently being carried out and it “not be changing” current rules which ban surgical interventions for under 18s.

Currently under 16s can only be given puberty blockers with parental consent and the agreement of a panel of experts.

The review is being carried out by Dr Hilary Cass, who has warned that puberty blockers could have long-term impact on young people’s brains.

The latest WPATH guidance was written by a committee which included Susie Green, chief executive of the controversial charity Mermaids, who has no known medical experience.

Jon Arcelus, a professor at the University of Nottingham who works as a doctor at the NHS’s Nottingham Centre for Transgender Health, a service for adults, co-chaired the committee.

Whilst noting that there are not many studies on the long-term impact and no clinical cohort studies of those who regret their decision and “detransition” after receiving “irreversible” treatment, they state that some under 18s may “benefit” from some surgery.

Given “the complexity and irreversibility of these procedures” an assessment should be made of their ability to “adhere to postsurgical care recommendations and to comprehend the long-term impacts of these procedures on reproductive and sexual function”, medics are told.

Phalloplasty, the surgical creation of a penis, is the intervention they say “it is not recommended this surgery be considered in youth under 18 at this time” because of the high rate of complications.

The guidelines adds that adolescents should demonstrate the “emotional and cognitive maturity required to provide informed consent”.

For both puberty blockers and cross-sex hormone treatments, which can lead to infertility, they say that patients should have reached “Tanner Stage 2”, when a child first shows physical signs of puberty on a scale of development.

WPATH has previously noted that “some children may arrive at this stage at very young ages (e.g., 9 years of age)”.

Campaigner: Removal of minimum age ‘terrible’ The documents states that they “recommend health care professionals prescribe sex hormone treatment regimens as part of gender-affirming treatment” for “eligible” trans children who have reached early puberty “with parental/guardian involvement unless their involvement is determined to be harmful or unnecessary”.

The recommended conditions for adolescents to have surgery include having “at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result”.

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Professor Kathleen Stock, the feminist campaigner who has raised concern about the treatment of trans children, said that the removal of the minimum age from the guidelines was “terrible”.

“The medical community internationally have got to stop outsourcing their brains to these organisations under the guise of medical best practice because they are clearly highly ideological and I would say totally irresponsible,” she told The Telegraph.

“This is a document that is taken to be the gold standard and it doesn’t seem to take seriously the many medical and ethical implications of these procedures.”

An NHS spokesperson said: “An independent review into the development of gender services for children and young people, led by Dr Hilary Cass, is currently underway. The NHS’ service specification for children and young people does not permit surgical interventions until the age of 18 and the NHS will not be changing this position.”