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Northern Ireland is preparing to participate in a clinical trial designed to evaluate the effects—both risks and benefits—of puberty-blocking medications in children experiencing uncertainty about their gender identity. This development was highlighted in a review of Northern Ireland’s gender identity services, conducted by Dr Hilary Cass, a consultant in paediatric disability and former president of the Royal College of Paediatrics and Child Health.
In the review, Baroness Cass emphasized the importance of thorough and comprehensive assessments for children and young people before they embark on any medical interventions related to gender transition. The findings revealed significant gaps in research, describing the existing evidence on medical treatment for gender-related care as “remarkably weak.” The upcoming trial aims to study how puberty blockers impact the physical health, social environment, and emotional wellbeing of the young individuals involved.
Baroness Cass outlined that becoming a research site for this trial would necessitate extensive staff training, modifications to clinical protocols, and the creation of appropriate research infrastructure in Northern Ireland. She indicated that urgent collaboration with the team from King’s College London, who are leading the trial, is crucial. Currently, Belfast Health Trust manages the Brackenburn Clinic in south Belfast, where adult gender dysphoria services coexist alongside a dedicated youth service known as Knowing Our Identity (KOI). Approximately 150 adults are served by the clinic, with around 25 new patients joining each month, while KOI sees about 60 to 80 young referrals annually. To better manage increasing demand, plans are underway to merge the under-18 and adult services into a Lifespan Gender Identity Service.
The review also explored whether planned changes to gender services for young people in Northern Ireland align with recommendations previously made for England. Baroness Cass conducted interviews with both service users and staff, describing gender identity medicine as a “challenging and contested area.” She stressed the importance of standardizing safe clinical pathways throughout assessment and treatment stages. The review further called for enhanced research into the profiles of children seeking care and tracking treatment outcomes. Although Child and Adolescent Mental Health Services (CAMHS) provide early mental health support by referring young people appropriately, some CAMHS personnel expressed concerns over children and young people remaining on waiting lists for KOI. The review highlighted the need for detailed, individualized assessments that cover physical, psychosocial, mental health, neurodiversity, and educational factors, enabling tailored care plans before considering medical interventions. It also recognized a small subset of children with persistent gender incongruence who may require ongoing support, cautioning that parent support to navigate options carefully is vital to prevent premature social transitions.
Health Minister Mike Nesbitt, who appointed Baroness Cass to conduct the review, expressed appreciation for her efforts during her visit to Northern Ireland. He stated hope that the findings would reassure the public that the new Lifespan Gender Service complies with the 2024 recommendations and affirmed that the decision to invest in enhanced psychological and psychiatric support represents the correct path forward
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