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First, do no harm

In this section the focus is on physical and mental health issues, and our communications with the Sandyford Clinic

Mental Health in children with gender dysphoria
An account of the importance of research, by a GP


It is essential that we look at evidence of pre-existing mental health issues in children who present with gender dysphoria. If the onset of gender dysphoria (GD) is associated with prior major mental health problems, then we should see if there is a causative link.   A study of 256 reports from parents of children with GD by Littmann (Littmann, 2019) recorded that over 60% had a formal diagnosis of at least one mental health disorder or neurodevelopmental disorder (particularly autism) before the onset of GD 


Using evidence and studies on gender dysphoria

A study by Hisle-Gorman et al. (2019) of 48,762 children diagnosed with Autistic Spectrum Disorder (ASD) found that these children were over four times as likely to be diagnosed with gender dysphoria (GD)  compared with matched controls.

An investigation by the Hamburg Gender Identity Service (Hebly et al., 2020) showed that before any treatment for children with GD: ‘At baseline, both psychological functioning and quality of life scores were significantly below normal for all intervention groups’. 

Bechard et al. (2017) looked at psychosocial and psychological vulnerabilities in 50 consecutive referrals of adolescents diagnosed with GD. Over half had six or more vulnerabilities, 80% had had some form of outpatient assessment for psychosocial or psychological problems, over 20% had been inpatients for such problems, over 50% had been on psychopharmacological medication, 34% had dropped out of school, 36% had self-harmed, 20% had a history of physical abuse and 10% had a history of sexual abuse.

It is also a fact that the considerable increase in girls presenting recently with GD parallels a similar increase over the past decades in anorexia nervosa and self-harm among girls (Cybulski et al. 2021), suggesting a common underlying cause, for a significant number of cases.

When we look at the evidence given by these studies along with the many testimonies from those who have detransitioned, such as Keira Bell (Bell K, 2021), we see a pattern of pre-existing significant mental health issues, that cannot be ignored. 


When a child presents with GD, a full psychological assessment must be made to attempt to unravel the mental health problems facing these vulnerable people. A clinical approach that merely affirms the GD without proper psychological diagnosis and support, is a serious neglect of our responsibilities to these young people. We know, from the UK Tavistock GIDS (Gender Identity Development Service), that over 90% of young people who are started on puberty blockers are on a path to having the irreversible effects of cross-sex hormones and surgery (Carmichael et al. 2021). Such medicalisation of young people, who in most cases have foundational mental health issues, is an abrogation of normal medical ethical principles.

Dr Antony Latham



Bechard, M., et al., 2017. Psychosocial and psychological vulnerability in adolescents with gender dysphoria: a ‘proof of principle’ study. Journal of sex & marital therapy, 43 (7), 678–688

Bell, K., 2021. Keira Bell: my story. Persuasion. Available from:

Carmichael, P., et al., 2021. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS one, 16 (2), 1–26.

"Gender-affirming care is dangerous- I know because I helped pioneer it"
Water Ripple

Our questions to the Sandyford Clinic and the Scottish Government

have never been answered fully.






To : Sandyford Clinic

17th October 2022 

To whom it may concern,


Freedom of Information request


I would be grateful if you could provide, in line with the FOI protocols, information in

relation to the following questions:


1) Can you give numbers of children and young people referred to the clinic in each year

since 2009?


2) Of those who were referred before onset of puberty, or in early puberty, what

percentage were prescribed puberty blockers?


3) Of those prescribed puberty blockers and who reached the age of 16, what percentage

went on to be prescribed cross-sex hormones?


4) Of those prescribed cross-sex hormones, what percentage went on to gender-

affirming surgery, what percentage did not go on to gender-affirming surgery, and

what percentage are currently being assessed with no decision as yet taken?


5) How does the assessment process that you use distinguish between children and

young people who are likely to persist in a transgender identity and those who are likely

to desist?


6) What outcome data do you routinely collect?  


7) What changes to practice have you made in light of the findings of the Cass review?


8) How many of your patients have detransitioned? What follow-up and support do you

give to them?


I look forward to your reply in due course.









1st July 2023 


Dr D Gerber

Clinical Lead, Young People’s Gender Service

Sandyford Clinic, 6 Sandyford Place

Sauchiehall Street, GLASGOW G3 7NB

Dear Dr Gerber,


Implications of Cass Review findings for the Sandyford Gender Clinic


We write on behalf of a group of Scottish health and education professionals who are

concerned about the medicalisation of gender dysphoria and the apparent failure of

Scottish services to learn from the English Cass review.  We are aware that the findings

of the Cass review are not binding in Scotland.  Nevertheless, we are surprised that,

as far

as we can see, the Sandyford Clinic has not taken the opportunity to revise any of its

practices, despite the fact that the service appears to operate in such a similar manner,

and with such a similar population, as the now-discredited Tavistock.  Indeed, the effect

of the affirmative model goes beyond health and has a bearing on the safeguarding of

pupils in schools and other institutions which have been heavily influenced by the

affirmative model.  


We would be grateful if you could address the following questions:


1)    Is it the case that the Sandyford CYP Gender Clinic operates according

to a theoretical and philosophical model that is broadly similar to the ‘affirmative’

model offered by the Tavistock?

2)   What is the role of exploratory therapy in the assessment and treatment of

CYPs referred to the service?

3)    What measures are in place to follow up your patients into adulthood, and what

proportion of patients participate in follow-up reviews?

4)    Of the many recommendations of the Cass review, which does the Sandyford YPGS

consider are relevant to its own service?

5)    Do you recognize potential safeguarding issues for the Sandyford YPGS and NHS

Scotland more generally as a result of continuing to offer interventions in Scotland that

have been discredited by the Cass review?


We believe that this is an urgent and important issue and as such, we hope that you

can reply within thirty days of receipt of this letter.  


Scottish Gender Bill

is a betrayal of children


Article in The Times, May 2023 by retired Scottish GP

What healthcare professionals say
Comments taken with permission from signatories to our petition to the Scottish Government


The Scottish Government needs to urgently listen to the increasing evidence that the current approach of medicalising young people with gender dysphoria is extremely harmful. Why is the Sandyford Clinic in Glasgow continuing to act as if the Cass Review does not apply to them? We are causing irreversible damage to vulnerable young people, most of whom are going through a phase. They should be nurtured and counselled, not chemically castrated.

Health professional

Vulnerable children in Scotland are being damaged by the lies of gender ideology. Puberty blockers do irreversible damage, social transition is dangerous and they cannot change their sex. These children need their Government, health services and schools to protect and support them, not set them on a path of medicalization and surgery. Our children deserve better.

NHS Psychotherapist

The current contagion of delusion sweeping through institutions is very damaging to the wellbeing of children and young people. We must support them and ensure safeguarding for the young and vulnerable members of society. We must also challenge the naivety of a government that does not consult professionals before making vital decisions concerning mental health, but instead consults ideologues and political activists

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