More than 1,000 children were given puberty blockers at controversial Tavistock gender clinic ‘in scandal compared to doping of East German athletes’, new book claims

  • Clinic will close later this year after being slammed in a report by Dr Hilary Cass
  • It treated at least 9,000 children for gender dysphoria from opening in 1989

More than 1,000 children at the NHS’s controversial child transgender clinic were handed prescriptions for puberty blockers, a new book has claimed, as former staff compare it to the ‘doping of East German athletes’.

The Gender Identity Development Service (GIDS) at Tavistock and Portman NHS Trust in London will close later this year after being slammed in a report amid accusations it was rushing children onto puberty blocking drugs.

Now former clinicians at the service have revealed how ‘incredibly complex’ children were handed he life-altering drugs after just one assessment – despite having a multitude of mental health or background issues.

GIDS was formerly the sole provider of gender dysphoria and gender identity services for children and young people across the whole of the UK.

The controversial clinic treated at least 9,000 children for gender dysphoria from when it opened in 1989, but a review led by senior paediatrician Dr Hilary Cass warned it was that ‘it has become increasingly clear that a single specialist provider model is not a safe or viable long-term option’.

Tavistock and Portman NHS Trust in London will close later this year after being slammed in a report amid accusations it was rushing children onto puberty blocking drugs

It came amid reports the service had become overwhelmed with a waiting list of up to two years.

In a new book, former clinicians at GIDS have spoken of their ‘regret’ of how the clinic regularly prescribed children under the age of 16 with puberty blockers and cross-hormone treatment, The Times reports.

The claims made in Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children

Journalist Hannah Barnes sees former clinicians at GIDS speak of their ‘regret’ of how the clinic regularly prescribed children under the age of 16 with puberty blockers and cross-hormone treatment.

The claims include:

– Children as young as aged just three were living as the opposite gender with an altered name, appearance and pronouns

– The GIDS generated nearly a third of the Tavistock Trust’s income, with staff describing it as resembling a ‘tech start-up’

– GIDS made up just under a third of the trust’s income in 2021, with staff describing the culture as more like a ‘tech start-up’

– Then Mermaids chief executive Susie Green emailed the head of the clinic asking that the period of time children spend on puberty blockers before irreversible cross-sex hormones could be given

– She also requested that some children see a different clinician in the belief they were more likely to prescribe the drugs 

– The trust’s head of safeguarding Sonia Appleby revealed that staff were ‘demonised’ if they raised concerns.

It came despite concerns there was ‘scarce and inconclusive evidence to support clinical decision making’.

Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children, written by BBC journalist Hannah Barnes, will be published later this month, The Times reports.

Former medical staff compare the prescriptions to the doping of athletes representing East Germany through the 1960s and 1970s.

Governors, children and their parents have also contributed to the new book.

Figures show 354 children under the age of 16 agreed to puberty blocker at University College London Hospital Trust and Leeds Children’s Hospital over a nine-year period from 2012 to 2021 after being assessed by therapists and psychologists at its clinic.

From 2009 to 2017, a total of 1,256 children were referred for medical intervention – the ‘vast majority’ of whom were prescribed the puberty blocker.

In 2009-10, GIDS received 97 children, but this soared to 2,728 by 2019-20.

The significant jump left staff feeling overwhelmed, with some telling of how assessments of young people subsequently began to feel rushed.

Dr Anna Hutchison, senior clinical psychologist, recalled how the service began ‘accepting everyone’.

Instead of prescribing puberty lockers to provide children with adequate time to consider whether they wanted to make a full transition, almost all cases resulted in cross-sex hormones, including testosterone and oestrogen, being taken – with irreversible results.

She said: ‘It totally exploded the idea that when we were offering the puberty blockers, we were actually offering time to think.

‘Because what are the chances of 100 per cent of people, offered time to think, thinking the same thing? If the service was getting this wrong, it was getting it wrong with some of the most vulnerable children and young people.’

Dr Hutchison also said she believes some of the children would not have been identified as transgender now if they had not have been ‘put on the medical pathway’.

She added: ‘Of course, that doesn’t mean to say that identifying as trans is a bad outcome. But what is a bad outcome is creating a cohort of people who are medically dependent who’d never needed to be. 

Campaigners during Court of Appeal proceedings over whether under-16s can give informed consent to puberty blockers in June 2021


2005: Sue Evans, a nurse at Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS), warned that youngsters were being assessed too quickly and their treatment was influenced by transgender rights groups.

2009: GIDS became a national service responsible for treating all children in England with gender and identity issues. Demand skyrocketed, with fewer than 100 patients referred to the clinic in 2010, jumping more than 2,500 by 2018.

2018: A senior member of staff told the trust’s board that children were wrongly fast-tracked into changing their gender — with the mental health and social reasons behind their wishes being overlooked 

February 2019: An internal report by Dr David Bell, who was on Tavistock’s board, set out how patients were suffering ‘long term damage’ because GIDS could not ‘stand up to the pressure’ from ‘highly politicised’ campaigners and families.

February 2019: Consultant psychotherapist Dr Marcus Evans — who had worked at the trust for decades and whose wife Sue first raised concerns about its practices in 2005 — resigned in protest at the Tavistock’s response to doctors who raised the alarm.

July 2019: Dr Kirsty Entwhisle, a psychologist at GIDS Leeds hub, went public with accusations that staff misled patients and made decisions about young people’s ‘bodies and lives’ without ‘robust evidence’.

October 2019: Former GIDS nurse Sue Evans and an anonymous mother of a 15-year-old GIDS patient launched the first legal action against Tavistock. They claimed the trust should not prescribe puberty blockers to children who could not give informed consent. 

January 2020: Keira Bell, who was prescribed the drugs when she was 16-years-old, replaced Mrs Evans as lead claimant. She underwent breast-removal surgery but regretted transitioning, claiming she was given puberty blockers after ‘superficial conversations’ with social workers’ and was receiving testosterone shots a year later’.

December 2020: In response to the claim, the High Court decided that under-16s could not give informed consent to the treatment.

2020: NHS England asks paediatrician Dr Hillary Cass to conduct a review into Tavistock.

September 2021: Tavistock appealed the decision and it was overturned by the Court of Appeal, which claimed the previous ruling was ‘inappropriate’ and placed patients, parents and medics in a ‘very difficult position’. 

September 2021: Sonia Appleby, the trust’s safeguarding lead, awarded £20,000 by tribunal after claiming trust managers tried to stop her from carrying out her role when staff raised concerns.

January 2021: The UK’s health watchdog, the Care Quality Commission, gave GIDS the lowest rating it can, ‘inadequate’, after finding ‘significant concerns’ about how it operates. It demanded improvement.

March 2022: In an interim report, Dr Cass hit out at the lack of ‘open discussion’ at the trust about its treatment, which was not subject to quality controls. She found other mental health issues were ‘overshadowed’ in favour of gender identity issues when children were referred to GIDS. She called for a ‘fundamentally different service model’ and ‘rapid’ research on the use of the drugs after she found ‘insufficient evidence’ on their benefits.

July 2022: In a letter to the NHS, Dr Cass called for regional centres to be commissioned for gender identity treatment, with ‘strong links’ to mental health services and academic hubs that conduct ongoing research. 

July 2022: The NHS confirmed that GIDS will be replaced by regional centres at existing children’s hospitals, which will provide more holistic care with ‘strong links to mental health services’.  

‘And not only medically dependent, but perhaps – we don’t yet know – medically damaged.’

She went onto describe the clinic’s service as ‘scandalous in its negligence and scale’.

GIDS launched a study, involving 44 patients aged between 12 and 15, to better understand the long-term impact of puberty blockers in 2011.

But the drugs were introduced across the service in April 2014, before the data from he study had yet been made available.

It came after concerns were first raised in 2005, when one of its nurses warned youngsters were being assessed too quickly and their treatment was influenced by transgender rights groups.

There were further concerns that the drugs may affect the growth of children’s brains or stunt their growth and bone strength.

Little is known about the long-term effects of puberty blockers and almost all patients who receive them go on to start treatment with cross-sex hormones, which can also cause irreversible changes such as breast development and deepening of the voice. 

They can also cause infertility.

But the clinic used a ‘stage, not age’ approach based on where a child was in terms of their development.

Family therapist Anastassis Spiliadis told of how outside groups and parents often influenced decisions to refer children for the drugs.

He worked at the service for four yeas, during which time he decided against prescribing puberty blockers to particular children.

But he said ‘both ended up on the blocker’ when their families complained.

Dr Spiliadis also said parents were aware that families were aware it was easier to be prescribed drugs by certain clinicians than others.

He recalled how Susie Green, then chief executive of trans charity Mermaids, would step in and request a change in clinician on occasion.

He said: ‘I remember thinking and talking to Paul (Jenkins, Tavistock chief) and saying that this is really inappropriate – how come a person who’s the director, or the CEO of a charity, is entitled to request a change of clinicians on behalf of a family?’

Other former staff have accused the clinic of being ‘institutionally homophobic’ and giving in to pressure applied by parents who would rather their child was transgender than gay.

The book also highlights how the trust was under financial constraints at the time.

GIDS’ national contract with the NHS, in which it did not have to compete with another service, was seen as ‘gold dust’.

Ms Barnes says: ‘Bell argued that knowledge of GIDS’ economic importance had made it difficult for those with legitimate criticisms to raise them.’

Instead, the clinic could not be questioned ‘because it was bringing in so much money’.

It comes after campaigner Keira Bell was prescribed the drugs by the clinic when she was 16 and has since claimed she was given them after ‘superficial conversations’ with social workers’.

Ms Bell, who said she was suffering from anxiety and depression at the time, has previously said that medics should have considered her comorbidities, ‘not just reaffirm my naïve hope that everything could be solved with hormones and surgery’.

She said Tavistock ‘failed to protect young patients’ and had ‘conducted what amounted to uncontrolled experiments on us’.

A spokesperson for the Tavistock and Portman NHS Trust said: ‘GIDS works on a case-by-case basis with every young person and their family, working thoughtfully and holistically with them to explore their situation, with no expectation of what the right outcome for them might be. 

‘Only the minority of young people seen in the service are referred for any physical interventions. 

‘At the Tavistock and Portman we wholeheartedly support our staff to raise concerns, and have recently strengthened our mechanisms for doing so. 

‘Concerns relating to young people’s wellbeing are taken seriously and investigated.’

Mermaids has been contacted for comment. 

The confirmed closure of the service for young people at Tavistock later his year has been hailed as a victory by campaigners.

The NHS has confirmed that the clinic will be replaced by these local hubs at existing children’s hospitals, which will provide more holistic care with ‘strong links to mental health services’.

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