A major new NHS clinical trial investigating the effects of puberty blockers on children will include questions for participants as young as 12 about whether they identify as 'two spirit'. The £10.7million study, called Pathways, has received ethical approval and is scheduled to begin early next year.
Details of the Pathways Trial
The trial, commissioned by the NHS and run by a team at King's College London, aims to recruit 250 boys and girls aged between 10 and 15 who have been diagnosed with 'gender incongruence'. More than half of these young participants will be given hormone-suppressing drugs that pause the physical changes of puberty.
The primary objective of the Pathways trial is to evaluate the risks and benefits of giving puberty blockers to children who identify as transgender and have parental consent. This comes after a landmark review by paediatrician Dr Hilary Cass found there was weak evidence to support their use in treating children, leading the NHS to stop routinely prescribing them in March last year.
The Gender Identity Questionnaire
As part of the trial, children will be asked to complete a detailed gender identity questionnaire. The document begins by defining gender identity as 'someone's internal sense of self'.
Participants will be asked 'what best describes' their gender identity and given a series of options to tick, including 'definitely' a boy or girl, 'mainly' a boy or girl, 'neither a boy or girl', 'not sure' and 'none of the above'.
For those over 12, the questionnaire delves further into 'gender identity labels', presenting terms such as 'two spirit', 'agender', 'genderqueer' and 'other'. The term 'two spirit' originates from indigenous North American cultures, where it describes a person believed to have both a masculine and feminine spirit.
Criticism and Legal Challenges
The trial has already faced significant criticism, with some groups threatening a High Court challenge. Critics argue it risks subjecting children to experimental treatment which could cause harm.
Gender-critical health practitioners have voiced strong concerns about the questionnaire. Dr Louise Irvine, a GP and co-chairman of the Clinical Advisory Network on Sex and Gender, stated that the questions show a clear bias towards 'gender affirmatory ideology'.
'It's absolutely ridiculous,' Dr Irvine told The Times. 'It shows that the whole trial is imbued with gender affirmatory ideology. What this question will do is reinforce the ideology in the eyes of the children. It will be confusing and most kids won't even know what it means.'
Sue Evans, a psychotherapist and former clinical nurse specialist at the now-closed Tavistock clinic, also argued that the use of the term 'two spirit' suggests gender ideology is at play, noting that a concept from Native American culture had been 'transferred in an ideological way'.
Despite the controversy, the trial is intended to fill the critical evidence gap identified by Dr Cass. It will study potential health risks associated with the drugs over time, focusing on bone density, brain development, and mental health.
