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Academics are to study thousands of children who seek support from gender identity services run by the NHS in the largest study of its kind. The research comes as experts acknowledge there is "limited evidence about how best to support young people who experience gender incongruence".
Previous studies have examined fewer children and research teams have reported high dropout rates among participants. Academics from King's College London will track up to 3,000 children who seek help through NHS Children and Young People's Gender Services, with recruitment expected to start in the autumn.
Cass Review findings drive research
The announcement follows the Cass Review of NHS gender identity services last year, which concluded children had been let down by a lack of research and evidence on medical interventions in gender care. The new research project, dubbed Pathways Horizon, will track the physical and mental health and wellbeing of children seeking help from NHS gender services over several years.
The study could highlight differences among children with autism and ADHD, and potential differences among those seeking care based on their gender at birth. Emily Simonoff, professor of child and adolescent psychiatry at King's College London's Institute of Psychiatry, Psychology and Neuroscience and chief investigator of the study, said there had been a 20-fold increase in children and young people presenting to gender services in the UK.
International trend puzzles experts
"That's actually an international trend in other high-income countries in Europe, the US and Australia, and we don't fully understand why," Simonoff said. "We know that there are differences in the children and young people who are presenting to services. And, most notably, that there's a marked increase in the number of birth-registered females who are presenting to services."
She added that what was considered a rare problem 15 years ago is now much more common, creating recognition that substantial, large-scale research is needed to address important questions. Under-18s involved in the study and their parents will complete questionnaires focusing on gender identity, physical and mental health, and quality of life and wellbeing.
Comprehensive tracking approach planned
The surveys will also ask children how they feel about their bodies, their relationships and their school life. They will be tracked for several years and their information will be linked to their health and education records.
The study is observational, meaning the research team will track children over time without changing any elements of their care. Dr Michael Absoud, deputy chief investigator from King's College London, said the goal is to understand how different types of support can best promote young people's wellbeing.
Evidence-based care the ultimate goal
"Ultimately, our goal is to help in shaping the future services to help children, improve child health, support families and also clinicians working with services in the UK, to make more informed, compassionate and personalised decisions grounded in good evidence and data, and shaped by the voices of those affected," Absoud said. Professor Richard Emsley, study statistician from King's, said they would describe young people coming to the service more comprehensively than other studies.
This will include adverse childhood experiences, social transitioning, neurodiversity such as autism and ADHD, and mental health symptoms including anxiety, depression, eating problems and difficulty managing emotions. Puberty blockers are not prescribed on the NHS to children for the treatment of gender dysphoria following a ban.
Clinical trial plans remain active
Plans remain in place to set up a clinical trial into the use of puberty blockers in children, although no patients have yet been recruited while ethical and regulatory approval is awaited. Experts from the new trial expect some of the children they will study will be part of the puberty blocker trial.
The studies will be "linked" but will run independently. Two children's gender hubs, led by London's Great Ormond Street Hospital and Alder Hey Children's Hospital in Liverpool, opened in April 2024.
New service structure emerges
This followed the closure of the gender identity development service run by the Tavistock and Portman NHS Foundation Trust. A third service opened in Bristol last November while another is planned for the east of England and is expected to open soon.
The aim is for there to eventually be up to eight specialist children's gender clinics covering the seven NHS regions in England.
(PA) Note: This article has been edited with the help of Artificial Intelligence.
