NHS trans clinic doctor backs ‘non standard procedures’ like having both male and female genitalia

Cass Review concluded that children have been let down by 'remarkably weak' evidence on medical interventions in gender care
Cass Review concluded that children have been let down by 'remarkably weak' evidence on medical interventions in gender care - iStockphoto

An NHS transgender clinic doctor endorsed procedures such as enabling patients to have both male and female genitalia, leaked messages reveal.

Last month, messages were leaked from a cache of files from the World Professional Association for Transgender Health (WPATH), which sets guidelines that have influenced NHS treatment, by investigative journalist Michael Shellenberger and his think tank Environmental Progress.

They showed that doctors are carrying out life-changing surgery and prescribing puberty blockers even though they are aware the adults and children may not fully understand the long-term ramifications. One doctor talked about a transgender person who died of cancer as a result of his hormone treatment.

Current NHS guidelines facilitate some patients who experience gender dysphoria to transition to a different gender, with treatment through hormones and surgery.

However, The Telegraph has been sent unredacted screenshots of the leaked messages, which identify a leading NHS doctor, Jonathan Arcelus, a professor in mental health and transgender health at the University of Nottingham, as among those discussing and endorsing controversial procedures which are currently not allowed on the NHS.

Prof Arcelus is a member of WPATH and works as a medical doctor at the NHS’s Nottingham National Centre for Transgender Health where he provides psychological support to patients as well as hormone treatment and referrals for gender-related surgery.

Earlier this week, the landmark Cass Review was published by the paediatrician Dr Hilary Cass. The report was commissioned by NHS England in 2020 following a sharp rise in the number of patients who were questioning their gender and assessed gender identity services for under-18s. It concluded that children have been let down by a lack of research and “remarkably weak” evidence on medical interventions in gender care.

In her report, Dr Cass was highly critical of WPATH, saying that while it had been “highly influential in directing international practice”, its “guidelines were found by the University of York appraisal process to lack developmental rigour”.

Refusing to share data

Dr Derek Glidden, who, like Prof Arcelus also works at the Nottingham National Centre for Transgender Health and is its clinical director and is NHS England’s gender dysphoria national speciality adviser, was also criticised after refusing to share data about his patients with the Cass Review.

However, in the leaked WPATH messages, seen by The Telegraph, which form part of an internal message board discussing standards of care for non-binary patients, various members discuss a range of procedures, including patients keeping their original genitalia, as well as having all genitalia removed entirely.

The thread begins with one member asking how they come up with appropriate standards and best practices for non-binary patients, adding: “I’ve found more and more patients recently requesting ‘non-standard’ procedures such as top surgery without nipples, nullification, and phallus-preserving vaginoplasty.”

In response to the message thread, Prof Arcelus suggests that such controversial procedures may become “standard” in future, and, as such, should not be referred to as “non-standard”.

According to the unredacted screenshots, Prof Arcelus said: “Is ‘non-standard’ procedures the best term to use? They may become standard in the future… any more possible terms that could be used to describe these kinds of procedures without having to describe them?”

In 2022, WPATH, which is a self-regulated membership body, published its updated Standards of Care: Version 8. Prof Arcelus was the co-chair of the guidelines, which have since been widely criticised by gender-critical campaigners and medical professionals.

The new guidance that he oversaw contains a chapter on non-binary identities, as well as a chapter on eunuchs, which defines groups of people who have been castrated, as well as individuals who are “assigned male at birth and wish to eliminate masculine physical features, masculine genitals, or genital functioning”.

‘Eunuch gender identity’

In response to the comments, Helen Joyce, director of advocacy at the charity Sex Matters, said: “It’s deeply worrying that someone so closely associated with the second-largest NHS gender clinic in the UK played a key role in developing the Standards of Care Version 8 from WPATH, a discredited international organisation that lobbies globally for removing gatekeeping from gender medicine.

“This is the notorious document that claims baby boys can be born with a ‘eunuch gender identity’ and that removed all suggested age limits for children to have irreversible procedures.

“It endorsed so-called ‘non-binary’ gender surgeries – giving men fake vaginas alongside their penises, or women fake penises alongside their vaginas, or even ‘nullification’ – removal of all sex organs. There is, to put it mildly, no evidence that these risky and bizarre procedures are ever clinically indicated.

“It is shocking that the leaked WPATH files seem to show Professor Arcelus suggesting that these Frankenstein procedures may become standard in future.

“He has questions to answer about his simultaneous involvement in WPATH and in the NHS. Will the clinic he’s linked to start offering these surgeries? Does he think the NHS should be paying for them?”

In contrast, Dr Jane Hamlin, president emerita of the Beaumont Society, a charity that supports transgender people, said: “The important issue for trans people is that the most appropriate support and treatment is available for those who need it.

“Sex Matters is an organisation that is openly hostile to trans people and regularly spreads misinformation about us. I would not take anything they say very seriously.

“With waiting lists at all UK gender clinics at heart-breaking length – even in the unlikely event that these controversial procedures were to be adopted – it would be years before it was offered to anyone.”

Nottinghamshire Healthcare NHS Foundation Trust, the University of Nottingham and Prof Arcelus were contacted for comment.