There has been a welcome shift in the way NHS England says it will provide care for children with gender dysphoria. In recent months, it has moved away from the ideologically driven “affirmative” model that views gender dysphoria in children purely as a sign of a fixed trans identity. It is instead adopting a more evidence-based approach – as laid out in the review by the distinguished paediatrician Dr Hilary Cass – that starts from the understanding that children’s feelings of gender incongruence are often transient and fluid, and can be associated with autism, childhood trauma, children grappling with their own developing same-sex attraction, and intense discomfort about puberty. Accordingly, the NHS now says social transition – treating a child as though they are of the opposite sex – should only be considered in cases where there is significant clinical distress or impairment in social functioning. Puberty-blocking drugs – the entry point of a medical pathway that can lead to cross-sex hormones and sex change surgery – will only be prescribed as part of a …

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