子どもと若者のためのジェンダー・アイデンティティ医療に関する独立審査報告書
ジェンダー・アイデンティティをめぐるさまざまな複雑な問題を抱える子どもや若者が、医療を通じて最善のサポートと専門知識を得ることは、全くもって当然のことです。
ヒラリー・キャス博士
Contents
議長による序文 p.12
この報告書について p.16
言葉 p.18
要約と推奨事項 p.20
・キーポイントと推奨事項 p.23
・中間報告 p.25
・患者コホートの理解 p.26
・臨床的アプローチと管理 p.27
・アセスメント p.28
・診断 p.29
・その人個人にぴったりの治療計画 p.30
・Assessment 28
・Diagnosis 29
・Individualised care plan 30
・Psychological interventions 30
・Social transition 31
・Medical pathways 32
・Long-term outcomes 33
・Challenges in clinical decision making 34
・Service model 36
・Workforce 37
・Training and education 38
・Service improvement 39
・Clinical research capacity 40
・Pathways 41
・Pathways within the service 41
・Transfer to adult gender services 42
・Detransition 43
・Private provision 43
・NHS number 44
・Implementation 44
・Wider system learning 45
Approach 46
1. Methodology 47
・Understanding evidence 47
・Building on evidence 52
・Stakeholder engagement 60
・Summary 64
・Context 66
2. History of gender services for children and young people 67
・Early gender services for children and young people 67
・Emergence of the Dutch protocol 68
・Move to an affirmative model 70
・Use of puberty blockers in the UK 70
3. Why this Review? 75
・NHS England Policy Working Group (PWG) 75
・NICE evidence reviews 75
・Commissioning of the Independent Review 77
4. Wider context 78
・Bell v Tavistock 78
・Care Quality Commission (CQC) report 79
・Interim report and subsequent developments 80
・Understanding the patient cohort 82
5. Changes in the patient profile 84
・Sources of information 84
・Demographics 85 Gender characteristics 90
・Co-occurring conditions 90
・Changes in the patient profile 97
6. Developmental considerations for children and adolescents 98
・Changes from adolescence into adulthood 102
7. Growing up in the 2000s 106
・Generational beliefs and gender identity 106
・Online stressors and harm 109
・Mental health in children and adolescents 110
8. Possible factors influencing the change in patient profile 114
・Biological factors 114
・Psychosocial factors 117
・Conclusion 121
・Clinical approach & clinical management 124
9. International practice and guidelines 126
・Guideline appraisal 126
・Key points of learning for the NHS 132
10. Assessment and diagnosis 134
・International practice 134
・NHS practice 136
・Perspectives from service users and families 138
・Holistic assessment framework 139
・Formulation, diagnosis and care plan 143
11. Psychological and psychosocial interventions 150
・Perspectives from service users and families 151
・International guidelines and practice 152
・Understanding the evidence 153
・Current NHS practice 154
・Summary - psychological and psychosocial interventions 155
12. Social transition 158
International practice 158
Reflections from the Multi-Professional Review Group 159
Perspectives from service users and families 159
Understanding the evidence 161
Summary - social transition 163
13. Medical pathways 166
Perspectives from service users and families 166
Existing endocrine practice in the UK 167
International practice 170
Summary - medical pathways 171
14. Puberty blockers 172
Normal pubertal development 172
Rationale for the use of puberty blockers for gender dysphoria 173
International practice 174
Understanding intended benefits and risks of puberty blockers 175
Summary - puberty blockers 179
15. Masculinising / feminising hormones 182
International practice 182
Understanding the evidence 183
Key considerations 184
16. Challenges in clinical decision making 192
Assessing whether a treatment is clinically indicated 193
Best evidence and information 194
Competency and capacity to consent 195
Best interests of the child/young person 196
Conclusion 196
Service model 198
17. Existing service models 200
NHS England’s interim service - establishing Phase 1 providers 201
International practice 202
Different service models in the NHS 204
18. A new model for gender services for children and young people 206
Summary - service model 210
Workforce 211 Training and education 212
Service improvement 214 Research capacity 215
19. Pathways 217
International practice 217
Current referral pathway 217
Recommended referral pathway 220
Pathways within the service 223
Discharge 224
Detransition 227
Private provision 227
Changing NHS number and access to healthcare 228
20. Implementation 230
Wider system learning 231
Final thoughts from the Chair 232
Glossary 234
References 248
Appendices 264
Appendix 1 264
Appendix 2 268
Appendix 3 270
Appendix 4 272
Appendix 5 274
Appendix 6 276
Appendix 7 278
Appendix 8 280
Appendix 9 282
Appendix 10 286
Appendix 11 288
Appendix 12 290
【記事紹介】
— ジェンダー医療研究会（JEGMA） (@JEGMA2024) 2024年4月16日
《BBCラジオインタビュー
：キャス・レビューについてキャス博士本人にインタビュー》
『The Cass Review』の議長ヒラリー・キャス博士が、BBCラジオで答えたインタビューに字幕を付けました。
現在のジェンダー医療の問題点について、わかりやすくお話ししてくださっています。 pic.twitter.com/F29FDXbf2E
