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首先，非常感谢你分享Cass报告，大概读了一下，学习了很多东西。
但是，很明显，你自己是没有仔细读过的，因为你说的跟Cass报告表达的完全是两码事，严重曲解了报告的内容。
Cass报告没有任何地方提到反对未成年人性别转化，相反多次强调要扩展和加强相关服务，比如把儿童和青少年服务机构的服务对象从17岁以下扩大到0-25岁。Cass报告还强调了反对转化（掰直）疗法，心理干预的目的不是改变人们对自己的看法，而是与他们合作，探索他们的担忧和经历，帮助缓解他们的痛苦，给他们提供情感支持。
Cass报告也没有说要禁止青春期阻断剂，而是说在过去五到十年里，寻求帮助的未成年人迅速增加，且主要为生理女性，而以前的临床治疗方法是基于生理男性的，所以需要更多证据证明其有效性。青春期阻断剂已经被暂停提供给新患者，英国正在进行一项临床试验，如果结果证明青春期阻断剂确实对患者有益，那么就会恢复使用。同时，Cass报告也提到了荷尔蒙治疗，强调需要谨慎使用，但16岁就可以使用，无需等到18岁。
Cass报告从头到尾都在谈如何更好地为未成年性别焦虑症患者服务，让他们得到更有效的治疗，这才是治病救人的应有态度。跟特朗普这种一刀切、污名化医生、否认治疗必要性的政策从根本上是对立的。
https://cass.independent-review. ... /final-report-faqs/
Has the Review recommended that no one should transition before the age of 25 and that Gillick competence should be overturned?
No. The Review has not commented on the use of masculinising/feminising hormones on people over the age of 18. This is outside of the scope of the Review. The Review has not stated that Gillick competence should be overturned.
The Review has recommended that:
“NHS England should ensure that each Regional Centre has a follow through service for 17-25-year-olds; either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey. This will also allow clinical, and research follow-up data to be collected.”
This recommendation only relates to people referred into the children and young people’s service before the age of 17 to enable their care to be continued within the follow-through service up to the age of 25.
Clarification:
Currently, young people are discharged from the young people’s service at the age of 17, often to an adult gender clinic. Some of these young people have been receiving direct care from the NHS gender service (GIDS as was) and others have not yet reached the top of the waiting list and have “aged out” of the young people’s service before being seen.
The Review understands that this is a particularly vulnerable time for young people. A follow-through service continuing up to age 25, would remove the need for transition (that is, transfer) to adult services and support continuity of care and continued access to a broader multi-disciplinary team. This would be consistent with other service areas supporting young people that are selectively moving to a ‘0-25 years’ service to improve continuity of care.
The follow-through service would also benefit those seeking support from adult gender services, as these young people would not be added to the waiting list for adult services and, in the longer-term, as more gender services are established, capacity of adult provision across the country would be increased.
People aged 18 and over, who had not been referred to the NHS children and young people’s gender service, would still be referred directly to adult clinics.
Is the Review recommending that puberty blockers should be banned?
No. Puberty blocker medications are used to address a number of different conditions. The Review has considered the evidence in relation to safety and efficacy (clinical benefit) of the medications for use in young people with gender incongruence/gender dysphoria.
The Review found that not enough is known about the longer-term impacts of puberty blockers for children and young people with gender incongruence to know whether they are safe or not, nor which children might benefit from their use.
Ahead of publication of the final report NHS England took the decision to stop the routine use of puberty blockers for gender incongruence/gender dysphoria in children. NHS England and National Institute for Health and Care Research (NIHR) are establishing a clinical trial to ensure the effects of puberty blockers can be safely monitored. Within this trial, puberty blockers will be available for children with gender incongruence/dysphoria where there is clinical agreement that the individual may benefit from taking them.
Clarification:
Puberty blockers have been used to suppress puberty in children and young people who start puberty much too early (precocious puberty). They have undergone extensive testing for use in precocious puberty (a very different indication from use in gender dysphoria) and have met strict safety requirements to be approved for this condition. This is because the puberty blockers are suppressing hormone levels that are abnormally high for the age of the child.
This is different to stopping the normal surge of hormones that occur in puberty. Pubertal hormones are needed for psychological, psychosexual and brain development, and there is not yet enough information on the risks of stopping the influence of pubertal hormones at this critical life stage.
When deciding if certain treatments should be routinely available through the NHS it is not enough to demonstrate that a medication doesn’t cause harm, it needs to be demonstrated that it will deliver clinical benefit in a defined group of patients.
Over the past few years, the most common age that young people have been receiving puberty blockers in England has been 15 when most young people are already well advanced in their puberty. The new services will be looking at the best approaches to support young people through this period when they are still making decisions about longer-term options.
What is the Review’s position on conversion therapy?
Whilst the Review’s terms of reference do not include consideration of the proposed legislation to ban conversion practices, it believes that no LGBTQ+ group should be subjected to conversion practice. It also maintains the position that children and young people with gender dysphoria may have a range of complex psychosocial challenges and/or mental health problems impacting on their gender-related distress. Exploration of these issues is essential to provide diagnosis, clinical support and appropriate intervention.
The intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not. It is harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve and make clinicians fearful of providing this group of children and young people the same care as is afforded to other children and young people.
No formal science-based training in psychotherapy, psychology or psychiatry teaches or advocates conversion therapy. If an individual were to carry out such practices they would be acting outside of professional guidance, and this would be a matter for the relevant regulator.
Overview of Recommendations
The recommendations set out a different approach to healthcare, more closely aligned with usual NHS clinical practice that considers the young person holistically and not solely in terms of their gender-related distress. The central aim of assessment should be to help young people to thrive and achieve their life goals.
- Services must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.
- Capacity should be expanded through a distributed service model, based in paediatric services and with stronger links between secondary and specialist services.
- Children/young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.
- Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and cooccurring conditions, including support for parents/carers and siblings as appropriate.
- Services should establish a separate pathway for pre-pubertal children and their families, ensuring that they are prioritised for early discussion about how parents can best support their child in a balanced and non-judgemental way. When families/carers are making decisions about social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a clinical professional with relevant experience.
- NHS England should ensure that each Regional Centre has a follow-through service for 17–25-year-olds; either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey. This will also allow clinical and research follow up data to be collected.
- There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.
- A full programme of research should be established to look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.
- The puberty blocker trial previously announced by NHS England should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/ feminising hormones.
- The option to provide masculinising/feminising hormones from age 16 is available, but the Review recommends extreme caution. There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18. Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT).
- Implications of private healthcare on any future requests to the NHS for treatment, monitoring and/or involvement in research, and the dispensing responsibilities of pharmacists of private prescriptions needs to be clearly communicated.
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宝宝趣事-萱萱的成长故事 (2007-10-1) Mylittlelover 
楼主:edith921
发表于 2025-1-31 06:56
