A major study of the health of transgender and gender nonconforming young people is set to begin later this year in Britain, King’s College London announced on Thursday.
Researchers plan to track the mental and physical well-being of up to 3,000 children and teenagers who have a gender identity that differs from their sex at birth, and who have sought treatment from the country’s National Health Service. They will carry out annual surveys that look at their quality of life, body image and gender identity.
The study is part of a wider 10.7 million pound, or about $14 million, initiative from King’s College that aims to find out how Britain’s health service can best support trans and gender nonconforming children and young people. It is funded by the N.H.S. and by the government’s clinical research agency.
Last year, puberty-blocking drugs were banned in Britain for children under the age of 18, except in clinical trials, following the publication of a landmark review released by Dr. Hilary Cass, an independent British pediatrician. Dr. Cass argued that there was an urgent need for more robust research into youth gender treatments, saying: “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
The new study will track young people’s physical, social and emotional well-being, and the care they receive over time, the researchers said. Participation in the study will be voluntary and it will be observational in nature, meaning researchers will not alter any treatments the children are receiving. The researchers will survey the individuals and their parents or caretakers over several years without providing additional interventions.
“What is clear from the current evidence as highlighted is there’s no single story or experience that defines these young people,” Dr. Michael Absoud, a chief investigator on the study who specializes in pediatric neuroscience, said. “This study is about listening to them — understanding their stories and their journeys and building a robust evidence base that reflects that diversity,” he added.
There has been a sharp increase in the number of young people seeking support from N.H.S. gender services in recent years, said Emily Simonoff, the chief investigator of the study and a professor of child and adolescent psychiatry at King’s College, which is one of Britain’s leading universities and research institutions. The rise, part of an international trend, has been particularly significant in individuals who were registered female at birth, she added.
“There’s been a real shift in the number of referrals, over the last 10 or 15 years,” she said. “What was considered a rare problem 15 years ago is now much more common.”
The wait time for an appointment has also steadily increased, according to N.H.S. data.
Professor Simonoff said that questions over the evidence for youth gender treatment, and the polarization of the public debate over transgender care, had created additional uncertainty for patients. The limited knowledge around long-term outcomes for young people receiving treatment was a main factor in driving the polarization, she said.
“A lack of evidence base allows toxic views to be more rampant,” she said, adding: “What we hear from young people and their parents and caregivers is that they’re worried about the lack of robust evidence to guide what treatment is going to be most helpful for them.”
The Cass report concluded that the evidence around gender care for young people was “remarkably weak” and urged “extreme caution” in providing puberty blockers to minors without a “clear clinical rationale.” Trans rights groups pushed back on the review. TransActual, a British-based advocacy group, called it “fundamentally flawed” and argued that it imposed higher evidential requirements than for several other medical treatments in the N.H.S.
The review prompted the closure of Britain’s only youth gender clinic, which had grappled with long wait times after a surge in the number of young people seeking gender treatment.
In its place, the N.H.S. opened several regional centers for gender services that aim to provide comprehensive care to young people, including support for neurodiversity and mental health issues — all of which Dr. Cass suggested should be factored into an individual’s “holistic assessment” in gender services.
The study will collect information on the care provided by the new regional centers, including support for other issues that can be experienced by children with gender incongruence, like autism, A.D.H.D., anxiety and depression.
A clinical trial measuring the effects of puberty blockers on young people’s physical, social and emotional health is also part of the wider King’s College initiative. It was slated to begin in 2024 but is still awaiting regulatory approval. Some experts cited ethical concerns around participation, as enrolling in the trial is the only way young people can receive puberty blockers. But others pointed to the influx in individuals seeking gender-related health care and insisted it would be unethical to not conduct the study.
Amid statewide bans on gender-affirming care in more than half of the United States and culls in research around gender-based health care for young people in the nation, some experts said the King’s College initiative was a step forward.
“Investments in research and clinical trials should be lauded,” Scott Leibowitz, a U.S. child and adolescent psychiatrist and a board member of the World Professional Association for Transgender Health, wrote in an email.
But he expressed concern about the ban on puberty blockers in Britain and how that affected the well-being of trans young people, saying that the new studies “have come at the expense of youth and families in the U.K. being able to access care for the last year.”
Chloe W. Shakin is a social media editor for The Times, based in London.
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