Overview

The Gender Identity Development Service (GIDS) was the NHS's national clinic for children and teenagers in England and Wales who were distressed about their sex or gender. It began in 1989 as a small specialist service, grew into the largest youth gender clinic in the world, and closed at the end of March 2024. It was run by the Tavistock and Portman NHS Foundation Trust in north London, so it is usually called "the Tavistock".

The rise and fall of GIDS is the central story behind the UK's change of course on youth gender medicine. Referrals rose from about a hundred a year to more than 5,000. The patients changed from mostly young boys to mostly adolescent girls, many with autism or mental health problems. A puberty blocker programme was brought in without good outcome data. Staff who raised concerns described being ignored or labelled transphobic. These problems led, one after another, to a judicial review, an "inadequate" rating from the regulator, the Cass Review (an independent NHS review of youth gender services led by paediatrician Hilary Cass), and the clinic's closure.

This page covers the clinic as an institution. The court case brought by former patient Keira Bell has its own page: Bell v Tavistock. The wider evidence reviews are covered under evidence reviews.

Timeline

Origins and early years

Domenico Di Ceglie set up the service in 1989 after working with a small number of young people who wanted to be the other sex. It was first based at St George's Hospital and later moved to the Portman Clinic, where staff joked that it worked out of "a broom cupboard" (Undark 2023). It then became a national service under the Tavistock and Portman trust, a mental health trust known for its psychoanalytic tradition.

For most of its first two decades the service was small and its approach was mainly psychological. Until 2011 puberty blockers were offered only from around age 16, and in the 1990s most of the young people it saw were boys. One detrans male who attended GIDS in that period remembers both the sex ratio and the gatekeeping:

I remember Di Ceglie and Tavistock and Mermaids as they all were back then. It's crazy how rapidly everything flipped upside down from the then 75% male to the 70% female it is today. —cagedbunny83, detrans male

He also credits the slower process with protecting him, while admitting that as a teenager he campaigned against it:

I can thank 1990's NHS gatekeeping for preventing me from getting too far down the medical pathway over the several years I was under the gender clinic but you can bet I and the other trans teens I associated with through Mermaids didn't lament daily at how slow and "cruel" the offical NHS process was and we all joined in on protests to remove the 2 year social transition "real life test" roadblock they had. —cagedbunny83, detrans male

This shows a pressure that ran through the clinic's whole history. Some young patients, parents and support groups such as Mermaids pushed for earlier and faster medical treatment. Clinicians who wanted to slow down were seen by some families as obstacles.

Referral growth and the changing patients

The numbers

Referrals to GIDS grew roughly fifty-fold in a little over a decade:

• 97 referrals in 2009/10 and about 2,519 in 2018, according to figures the trust gave the High Court (High Court 2020, paras 31–32).
• 210 in 2011/12, rising to over 5,000 in 2021/22, according to the UK Parliament's science office (POST 2023).
• The 2021/22 figure combined more than 3,500 referrals made directly to GIDS with more than 1,500 made through a new NHS England referral service. The trust called this "another doubling in demand" (Tavistock and Portman 2022).

The rise was not limited to GIDS. A 2025 study of GP (family doctor) records in England found that recorded gender dysphoria in under-19s rose about fifty-fold between 2011 and 2021, rising fastest in girls from 2014 (Jarvis et al. 2025). Waiting lists grew faster than the clinic could cope with. By late 2020 more than 4,600 young people were waiting, many for over two years.

Who was being referred

The patients changed as well as their number. Females made up about half of referrals in 2011 and 76% by 2019. The High Court noted that the trust "did not put forward any clinical explanation" for the change (High Court 2020, paras 31–32). Many referrals were now adolescent girls, often without gender distress in early childhood. GIDS staff worried that the evidence behind the medical pathway, the Dutch protocol (puberty blockers from about 12 and hormones from 16, developed in the Netherlands), came from a different group of young people from those now seeking help (BMJ 2023). For more on the shift, see demographic shift in trans identification.

Many of the young people had other needs. According to Hannah Barnes's reporting, GIDS's own data showed that around 35% of referrals "present with moderate to severe autistic traits" (Telegraph 2023). When the High Court asked how many children referred for blockers had an autism diagnosis, the trust said it did not have the data. The Cass final report found that many referred young people had mental health or neurodevelopmental conditions, and that once gender distress was identified these could be "overshadowed" (Cass 2024). See autism and mental health.

GIDS at the Tavi is being shut down partly because so many clinicians ignored other diagnoses & comorbidities and acted as if medical transition was hung to fix everything. —MadRadDangereux, desisted female

The Early Intervention Study

In 2011 GIDS, working with University College London Hospitals, started the Early Intervention Study. It allowed puberty blockers (GnRH analogues) to be given from about age 12 instead of 16, inside a research framework (Tavistock and Portman 2021). The younger starting age soon became routine practice, years before any results were published.

The results were published in February 2021, nearly ten years after the study began and only after the High Court had ruled in Bell (BBC 2020). The study followed 44 young people aged 12 to 15 with no control group (Carmichael et al. 2021). It found:

• No change in psychological function. The authors "identified no changes in psychological function", with no change from baseline in total problem scores or self-harm measures at 12 or 24 months.
• Bone development stalled. Spine and hip bone density mostly stayed level instead of rising as it normally does in adolescence, so the young people fell behind their peers.
• Almost everyone went on to hormones. 43 of the 44 (98%) went on to cross-sex hormones. One stopped blockers and continued puberty in their natal sex.
• Positive reports from patients. Most participants reported positive, or mixed positive and negative, changes on the blockers.

The trust described blockers as "a well-received intervention in carefully selected patients" and has argued that blockers and later hormones are separate decisions (BBC 2020). Critics read the same data differently. The stated reason for blockers was to "buy time to think". If 98% go on to hormones, blockers look less like a pause and more like the first step of one pathway, which is what the High Court concluded in Bell. The study could not show whether blockers cause young people to stay on that path or whether the clinic simply chose those who would have stayed anyway. More detail on the drugs is on the puberty blockers page.

Whistleblowers and internal concerns

The 2018 Bell report

In 2018 Dr David Bell, a consultant psychiatrist and staff governor at the trust, wrote an internal report based on concerns brought to him by GIDS clinicians — ten staff members, according to later accounts (Stella O'Malley 2025). It described young people being referred for blockers too quickly, complex histories going unexplored, and staff afraid to speak up. According to the Guardian it branded the service "not fit for purpose" (Guardian 2019). Bell later faced disciplinary action from the trust (Channel 4 News).

The trust commissioned an internal review by its medical director, Dr Dinesh Sinha. It reported in March 2019 that there were "no immediate issues in relation to patient safety or failings in the overall approach taken by the service" (Women Are Human, citing the trust). Newsnight later read transcripts of the staff interviews for that review. Staff described cases where they feared a child had been sexually abused or traumatised but were not able to refer them on (BBC 2020). When the Bell report leaked, the trust said it "presented hypothetical vignettes, rather than actual case studies" (Guardian 2024).

Marcus Evans and the resignations

Marcus Evans, a psychoanalyst with decades at the trust, resigned as a governor in February 2019. He accused management of an "overvalued belief in" the expertise of GIDS "which is used to dismiss challenge and examination" (Guardian 2019). He has since written about earlier warnings, including a 2006 report by the then medical director David Taylor calling for more research, which he says was largely ignored (Evans, spiked 2023).

In December 2019 Sky News and the Telegraph reported that 35 psychologists had left the service in three years. Six who spoke out said children were being "over-diagnosed" and that staff feared being called transphobic if they questioned a referral (Telegraph 2019). Not everyone found the number convincing. One detrans male argued:

35 people resigning from a huge, underpaid, zone 1 clinic over 3 years is fairly standard turnover - especially when the NHS is being critically underfunded. They found six employees out of the mass that work there that had reservations. —reclaimingkevin, detrans homosexual male

That is a fair point about the headline figure. The stronger evidence came later, from the regulator, the tribunal and the Cass Review, which all reached similar conclusions independently.

Sonia Appleby's tribunal

Sonia Appleby was the trust's safeguarding lead for children. In September 2021 an employment tribunal found that the trust's treatment of her after she raised concerns about GIDS had damaged her professional reputation and "prevented her from proper work on safeguarding". She was awarded £20,000 (Guardian 2021). Reports of the case describe evidence that GIDS clinicians had been discouraged from bringing safeguarding concerns to her (HR Director 2021). The trust said it was "disappointed" by the decision (BBC 2021).

Time to Think and Newsnight

BBC Newsnight journalist Hannah Barnes reported on GIDS from 2019, including the staff transcripts above. Her book Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children (Swift Press, 2023) draws on more than 100 hours of interviews with clinicians, former patients and others (Guardian review 2023; Swift Press). It describes young people with autism, eating disorders and histories of abuse being given blockers, and clinicians who said they did not know how many patients later changed their minds (New Statesman 2023). It was shortlisted for the Baillie Gifford and Orwell prizes.

Why the warnings went unheard

The pattern is common in institutional failures. A small specialist service became the only national provider in its field, so there were no peers to compare it with. Its leaders were sincere and sure of their model. Outside pressure, from families, support groups and a growing political movement, pushed only one way: towards faster treatment. In that setting, clinicians who asked about trauma, autism or same-sex attraction could easily be seen as obstacles rather than colleagues. Cass made a similar point in 2022, saying the clinical approach "has not been subjected to some of the usual control measures" applied to new treatments (Cass interim report 2022).

The CQC inspection

The Care Quality Commission, England's health regulator, inspected GIDS between 14 October and 6 November 2020 after concerns from healthcare professionals and the Children's Commissioner about "clinical practice, safeguarding procedures, and assessments of capacity and consent to treatment". Its report, published on 20 January 2021, rated the service inadequate overall (CQC 2021):

Inspectors found more than 4,600 young people on the waiting list, some waiting over two years. Staff "did not always assess and manage risk well" (CQC report), and records did not always show how consent had been obtained or why treatment was given (Spectator 2021). The CQC took enforcement action. The trust apologised for the waits and brought in outside experts (ITV 2021). Notably, inspectors rated staff as caring. The problems they found were with systems, records and leadership, not with clinicians' kindness. A 2023 follow-up inspection found record keeping still falling short.

Bell v Tavistock

In 2019–20 former patient Keira Bell and "Mrs A", the mother of an autistic teenage girl on the waiting list, brought a judicial review arguing that under-18s could not give valid consent to puberty blockers. The High Court largely agreed in December 2020, and GIDS paused new blocker referrals. The Court of Appeal overturned the ruling in September 2021. The lasting effect came from the record: the court documented that the trust had not collected data on patients' ages, autism diagnoses or how many went on to hormones. The full story is on the Bell v Tavistock page.

Keira Bell was not better off staying hidden. She has entered LGBT history as a woman whose courage has helped expose an abusively incompetent system. —Takeshold, detrans and female

The Cass Review and closure

Interim report (2022)

NHS England commissioned paediatrician Dr Hilary Cass in 2020 to review gender services for under-18s. Her interim report, dated February 2022 and published that March, found a single service overwhelmed by demand, inconsistent data collection, and a clinical approach that had developed "organically" without normal checks (Cass interim report 2022; BMJ 2022). In a follow-up letter Cass wrote that "a single specialist provider model is not a safe or viable long-term option" (Sky News 2022).

On 28 July 2022 NHS England announced that the GIDS contract would end and that regional services led by specialist children's hospitals would replace it (Guardian 2022). Closure was planned for spring 2023 but was delayed by about a year because of difficulty recruiting staff (BBC 2023). Meanwhile the waiting list grew to 5,766 (Guardian 2023).

Closure and the new services

GIDS closed at the end of March 2024. About 250 patients under its active care moved to the new services on 1 April 2024, and about 5,000 young people on the waiting list were transferred with them (Evening Standard 2024). The new Children and Young People's Gender Services are:

• London: Great Ormond Street Hospital with Evelina London Children's Hospital, with mental health support from South London and Maudsley NHS Foundation Trust.
• North West: Alder Hey Children's Hospital in Liverpool with Royal Manchester Children's Hospital (CYP Now 2022; NHS England).

These services are meant to work as children's hospitals do: full assessment for autism, mental health and family context, with psychological care first. That is close to what gender exploratory therapy supporters had asked for.

Puberty blocker restrictions

On 12 March 2024, just before closure, NHS England confirmed that puberty blockers would no longer be routinely prescribed for gender dysphoria, because "there is not enough evidence" about their safety or clinical effectiveness (Guardian 2024). Emergency legislation in 2024 extended the restriction to private and overseas prescribers, and in December 2024 the ban on new prescriptions outside research was made indefinite. The NHS PATHWAYS trial of blockers and its pauses are covered on the evidence reviews page.

Final report (2024)

The final Cass report, published on 10 April 2024, found that youth gender medicine had been built on "remarkably weak" evidence and recommended a holistic, psychology-first model (Cass 2024). It also reported that GIDS had declined to take part in one of the review's research studies, comparing practice across European clinics (SEGM 2024). Its systematic reviews are discussed on the evidence reviews page. The Cass findings also shaped the UK's wider legal debate. See the law in the United Kingdom.

The missing data

What GIDS did not record

Throughout its history GIDS did not track what happened to its patients after they left. Patients were transferred to adult gender clinics at 17 or 18, and their records went with them. One former patient explained:

having been a patient at the Tavistock, you only stay there until you turn 18 and then you're passed on to the adult clinic in west London... So I'm not sure how much info gets passed down to the Tavistock and to the clinicians you as a patient originally dealt with. —Souf1duh, detrans female

Nobody knew how many former GIDS patients were doing well, how many regretted treatment, or how many had detransitioned. This is the same gap found across youth gender medicine.

The data linkage study

To fill that gap, the Cass Review commissioned a data linkage study. It would use existing NHS records to follow about 9,000 former GIDS patients into adulthood and compare outcomes for those who did and did not receive medical treatment. Cass called this a "world leading opportunity". But six of the seven NHS adult gender clinics "co-ordinated" a refusal to share their data (Tortoise 2024). The chair of NHS England's clinical reference group on gender dysphoria, whose clinic was among those refusing, was named in press reports (Telegraph 2024). Some adult clinics said they had ethical concerns about sharing records (TransActual briefing).

Cass recommended that the clinics be directed to take part. NHS England took over the study (NHS England) and commissioned the Levy review of adult clinics, published on 18 December 2025 (NHS England 2025). In February 2026 the government made the Gender Recognition (Disclosure of Information) (England) Order 2026. It makes it lawful to share protected information about former GIDS patients for the data linkage study (legislation.gov.uk). In June 2026 MPs were still asking in Parliament why the study was taking so long, and whether a new puberty blocker trial should go ahead before its results were known (Hansard 2026). As of October 2026 no outcome results have been published.

Some evidence already exists on adults. A review of 175 patients discharged by an NHS adult gender clinic found that 6.9% had detransitioned, and that neurodevelopmental conditions and adverse childhood experiences were linked to poorer access to care. The authors concluded that "detransitioning might be more frequent than previously reported" (Hall et al. 2021).

Legal claims against the trust

In August 2022 the law firm Pogust Goodhead announced a planned group medical negligence claim against the trust. Its chief executive said it expected "at least 1,000" families to join, alleging that young people were "rushed into treatment without the appropriate therapy" (Gender Clinic News 2022; BMJ 2022). As of October 2026 no group litigation order has been reported. Individual negligence claims in the NHS are often settled without a public trial, so it is hard to know how many claims exist.

In February 2026 a freedom of information response showed that the trust had recorded only eight complaints about its gender care in the ten years before closure. Supporters of GIDS have used this to argue that the scandal was exaggerated by the media (PinkNews 2026; Yorkshire Bylines). There are other ways to read it. Patients who regret treatment often take years to realise it, by which point they have left the service. Complaints also measure a person's willingness to complain, not the harm itself. One detrans woman described why that is hard:

I keep trying to find the courage to file a malpractice complaint but the NHS is so cherished it’s pretty taboo. I feel like having accidentally transed a sexual abuse survivor is pretty good grounds for malpractice though. —warpdusted, detrans female

For the US cases and other claims, see detransitioner lawsuits.

Detransitioner accounts

Former patients of GIDS and of the trust's adult services have described assessments that felt brief and affirming. This detrans woman described her time there:

Two hour long appointments a year and a half apart and alright get your hormones, 100% affirmative, no investigative action? I have a suspicion from the time I was there that a lot of the psychs (esp. the women) know that something is amiss but they need to hold their jobs. —warpdusted, detrans female

A commenter referred to "the Tavistock & Portman" (which also ran an adult gender clinic) described learning what to say:

At the end of the first session I knew enough on what to do to secure a recommendation for hrt on my second session. All I had to do was nod and give the answers I thought were right at the time. … at no point was I given help with my existing mental health issues or given any alternate options on how to manage the dysphoria. —Wondringlisa, questioning own transgender status

These accounts match the themes in the CQC report, the staff transcripts and Time to Think: short assessments, other problems going unexplored, and clinicians unsure whether they were allowed to question a young person's self-diagnosis. They also show something harder to admit: some former patients say they knew what answers would get them treatment, and gave them. A system that relies on a teenager's account of themselves, without time for exploration, puts the weight of a lifelong decision on the person least able to carry it. See informed consent critique.

Across about 4,300 r/detrans stories analysed by detrans.ai, the median age at transition was 17 (n = 1,137), meaning many began as minors or very young adults. These are self-selected posts, analysed by AI, and are not a sample of GIDS patients (detrans.ai stats).

Responses from the trust and its supporters

The trust and the clinicians who led GIDS have consistently rejected the claim that they rushed children into treatment:

• A minority received medication. Supporters, including the Yale Integrity Project's critique (a 2024 response to the Cass Review by Yale-affiliated academics), argue that the Cass Review's own data show only a small minority of young people seen at GIDS received puberty blockers, and that the trust's own description of its patients was "carefully selected" (Yale Integrity Project 2024).
• Demand was the main problem. The trust welcomed the regional model, saying the level of need "cannot and should not be met by a single highly specialist national service" (Tavistock and Portman 2022).
• Patient safety. A trust spokesperson said in response to the planned group claim that the service was "committed to patient safety" (Gender Clinic News 2022).
• Cass herself warned against triumphalism. In 2022 Cass rejected claims that the closure was a "win" for campaigners against trans healthcare, and said GIDS staff would be vital to the new services (PinkNews 2022).

Critics from the other side also attacked GIDS, but for being too slow. The online provider GenderGP wrote to the CQC in 2019 about long waits at the service (GenderGP). Trans advocacy groups, and the Yale Integrity Project's 2024 critique, have argued that the Cass Review exaggerated the weakness of the evidence (Yale Integrity Project 2024). The evidence reviews page assesses those critiques.

Trans perspectives on the closure and waiting lists

In the accounts of trans commenters in the UK, the main experience of GIDS, its successors and the adult clinics is waiting. They describe waits of several years, and young people who age out of the children's service and join adult waiting lists:

i was referred the month before i turned 17 and its taken me just under 4 years on the waitlist to get hrt —Aiden1975, trans man (FTM)

At the rate that most Gender Identity Clinics are seeing patients, it will take 30+ years for them to see patients who were referred today —lilpij, trans woman (MTF)

Some saw the closures as political:

I was first referred to a gender identity clinic with a really long waiting list but the clinic was shut down soon after as transphobia started to become more prominent in the UK. —LuckyValentine777, trans man (FTM)

Some trans commenters reject the Cass Review outright. One trans man called it "a piece of right wing British political propaganda" (ratty_lad, trans man (FTM)). Some recommend private or black-market hormones as a way around the NHS wait (see DIY hormones).

The waits caused real distress, and commenters on both sides describe them as harmful. They disagree about the remedy. The trans commenters quoted here want faster access to medicine. The detransitioner accounts on this site more often ask for prompt psychological help while people wait, so that time spent waiting is used to explore rather than simply endured. The new services were set up on the second model.

What the Tavistock story shows

• A treatment spread faster than its evidence. The lower age for blockers began as a study and became routine before the study reported. When results came, they showed no psychological benefit.
• The patients changed but the model did not. A protocol designed for a small group of young boys was applied to thousands of teenage girls with very different histories.
• No one tracked outcomes. A national service treated thousands of children with lifelong interventions without following them up, and adult clinics later refused to share the data that would have filled the gap.
• Whistleblowers were proven largely right, despite being dismissed at first.

Whether GIDS caused widespread harm, and how many former patients regret their treatment, will not be known until the data linkage study reports. What is already documented is that the service could not answer those questions itself. If you are a former patient looking for support, see the support directory and gender exploratory therapy.

Related pages

• Evidence reviews: Cass Review and youth gender medicine
• Bell v Tavistock
• Puberty blockers
• Autism
• The WPATH Files
• The law in the United Kingdom
• Detransitioner lawsuits
• Study archive

References

• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page, source.
• Cass Review (2022). Interim report. source.
• 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): e0243894. source.
• Jarvis et al. (2025). Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England. study page, source.
• Hall, R., Mitchell, L. & Sachdeva, J. (2021). Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic. BJPsych Open. study page, source.
• High Court of England and Wales (2020). R (Bell and A) v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274 (Admin). source.
• Care Quality Commission (2021). Care Quality Commission demands improved waiting times at Tavistock and Portman NHS Foundation Trust. source; inspection reports: source.
• Parliamentary Office of Science and Technology (2023). POSTbrief 53. source.
• Tavistock and Portman NHS Foundation Trust (2021). Early Intervention Study shows puberty blockers are a well-received intervention in carefully selected patients. source.
• Tavistock and Portman NHS Foundation Trust (2022). Regional model for gender care announced for children and young people. source.
• NHS England. Children and young people's gender services: implementing the Cass Review recommendations. source; Implementing advice from the Cass Review. source.
• NHS England (2025). Operational and delivery review of NHS adult gender dysphoria clinics in England (Levy review). source.
• UK Government (2026). The Gender Recognition (Disclosure of Information) (England) Order 2026, SI 2026/173. source.
• Hansard (2026). Puberty Blockers, House of Commons, 23 June 2026. source.
• Barnes, H. (2023). Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children. Swift Press. publisher; review: Guardian; New Statesman; Undark.
• Block, J. (2023). Gender identity services in the UK are on pause as evidence comes under scrutiny. The BMJ. source.
• BMJ (2022). Services for children with gender dysphoria need fundamental reform, says interim review. source; Tavistock to face possible clinical negligence claims. source.
• Spectator (2021). Tavistock gender clinic whistleblowers have been vindicated. source.
• Yale Integrity Project (2024). An Evidence-Based Critique of the Cass Review. source.
• News reports: Guardian 2019 (Evans resignation); Telegraph 2019 (resignations); BBC Newsnight 2020 (staff transcripts); BBC 2020 (Early Intervention Study); Guardian 2021 (Appleby); BBC 2021 (Appleby); HR Director 2021; ITV 2021 (CQC); Channel 4 News (David Bell); Women Are Human (Sinha review); Sky News 2022; Guardian 2022 (closure); CYP Now 2022; PinkNews 2022 (Cass); Gender Clinic News 2022; Telegraph 2023 (autism); Evans, spiked 2023; BBC 2023 (delay); Guardian 2023 (waiting list); Guardian 2024 (blockers); Guardian 2024 (closure); Evening Standard 2024; Tortoise 2024 (data linkage); Telegraph 2024 (data linkage); SEGM 2024; TransActual briefing; GenderGP; Stella O'Malley 2025; PinkNews 2026 (complaints FOI); Yorkshire Bylines.
• detrans.ai (2026). Detransition statistics from /r/detrans stories. stats page.