The way transgender children are being treated by the Scottish NHS will “go down as a medical scandal as bad as lobotomy or thalidomide”, a doctor has warned.
In a letter to Gregor Smith, Scotland’s chief medical officer, the clinician raised fears that proposals to fast-track irreversible surgeries and make it easier to access hormones were not backed by evidence and would “cause harm to many vulnerable young people.”
In correspondence obtained by The Telegraph, the doctor, a female GP, claims to have raised concerns widely with senior NHS leaders and that “almost all” of them shared her concerns but were unwilling to speak out publicly.
The physician wrote to Dr Smith to raise the alarm over radical proposals set out in an internal NHS Scotland report, intended to inform revised treatment rules for how trans patients are treated in Scotland.
The internal recommendations called for “barriers” to gender surgeries to be removed.
They also backed an “affirming” model of care to be delivered to children with gender issues and said adult patients’ mental health need not be examined in detail before they are sent for irreversible procedures.
The doctor warned Dr Smith that there were “multiple, serious concerns” with the proposals and said that, if approved, there was “no doubt [they] will cause harm to many vulnerable young people”.
“I honestly think that the treatment of gender-dysphoric children as we are now doing – intervention, medication and surgery rather than understanding, exploration and minimising intervention – will go down as a medical scandal as bad as lobotomy or thalidomide,” she warned.
“I have seen young women hate their bodies, from anorexia and self-harm – this is just the same pattern.”
‘Appalling’ and ‘dangerous’
The NHS said almost a year ago that a new gender reassignment protocol would be published “imminently”, but it is yet to appear, suggesting there has been internal disagreement over its contents.
The physician denounced plans to rewrite leaflets to promote medical interventions as “appalling” and said a call to approve “gender affirming care” without the need for counselling or psychotherapy would be “negligent”.
“To proceed to irreversible surgery without adequate assessment is dangerous,” the doctor wrote.
“The statement in the report, ‘In fact, access to hormones and surgeries can act as a prophylactic measure against distress’ is not based on evidence.
“I am alarmed by the fast-track route to irreversible intervention without ensuring adequate assessment.”
While the doctor’s name was redacted in correspondence released under Freedom of Information laws it is understood the GP is currently practising in Scotland.
Hilary Cass, the respected paediatrician, is leading an independent review of gender services for young people in England.
While the Scottish Government and NHS have said they will study her findings, they have emphasised that the review applies only to services south of the border.
The Sandyford clinic in Glasgow, home to Scotland’s only specialist gender identity service for children, has continued to follow an “affirming” model of care, which Dr Cass’s interim findings questioned.
It follows similar practices to the disgraced Tavistock clinic in London, which Dr Cass found was not “safe”.
The Sandyford has referred children as young as nine for puberty blockers, while children aged 16 have been “referred for assessment for surgery”.
In theory those as young as 17 can undergo surgical procedures, which are carried out at English hospitals.
The letter from the doctor was replied to by Nicola Steedman, the deputy chief medical officer.
She said the new trans protocol would “take into account best practice from across and outwith NHS Scotland and be informed by advances in evidence, models of care and changes in terminology since 2012”.
Dr Steedman said the Cass review was not considering NHS Scotland services but would be “closely considered both by Scottish Government and NHS Scotland”.
A Scottish Government spokesman said: “The Chief Medical Officer’s key focus is on achieving the best possible health and wellbeing for everyone in Scotland.
“The Chief Medical Officer received a letter in 2022 which included concerns regarding a document developed as part of work to review and update the 2012 Gender Reassignment Protocol for Scotland.
“The document highlighted was not an update of the 2012 Gender Reassignment Protocol for Scotland. A response clarifying that and highlighting wider work underway was issued,” they said.
“Any suggestion that this or a final document has been “approved” by the Chief Medical Officer is incorrect.”
They added: “The Chief Medical Officer has received a revised and updated Protocol from NHS National Services Scotland. This is being carefully considered prior to any future publication.”