A former psychologist at a Leeds clinic which treats transgender children has gone public with major concerns about the way the service is run.
Kirsty Entwistle, who worked at the Gender Identity Development Service (GIDS), based in Park Square in the city centre, wrote an open letter claiming some staff were misleading patients and branding anyone who questioned their approach 'transphobic'.
She also said that medical staff were immediately assuming young people were transgender - potentially putting them on a pathway to life-changing surgery - without exploring other reasons behind their wish to change gender.
Many of the youngsters attending the clinic are victims of parental abandonment, sexual abuse, domestic violence or extreme poverty, according to Dr Entwistle, but she claimed these factors were often 'minimised or dismissed'.
GIDS is the only children's gender clinic in the country and young people from across the north of England use the Leeds centre, as the only other GIDS clinic is in London.
In the open letter online to Polly Carmichael, the director of GIDS, Dr Entwistle wrote: "I think it is a problem that GIDS clinicians are making decisions that will have a major impact on children and young people’s bodies and on their lives, potentially the rest of their lives, without a robust evidence base."
Dr Entwistle said staff told children and their families that hormone blockers - given to stop the progress of puberty - are 'fully reversible'.
She wrote: "The reality is no one knows what the impacts are on children’s brains so how is it possible to make this claim? It is also a problem that GIDS clinicians are afraid of raising their concerns for fear of being labelled transphobic by colleagues."
She added that there was an 'unspoken rule' at the clinic which meant patients coming in for consultations were always assumed to be transgender.
GIDS, which is run by the Tavistock and Portman NHS Foundation Trust, say fewer than half their patients go on to hormone clinics.
Dr Entwistle was also critical of Yeadon-based transgender children's charity Mermaids
The charity has come under scrutiny over the past few years, with critics claiming it relies on pseudo-scientific claims about gender, and that it promotes life-changing surgery to parents of children who are questioning their gender.
Dr Entwistle, who worked in Leeds for one year until October 2018, wrote: "I am also concerned to see that Mermaids continues to receive financial support and endorsements from high profile people whilst not being subjected to any proper scrutiny of its practice.
"I believe that it is the duty of GIDS to disclose their concerns about Mermaids as GIDS is one, if not the only place, where information about what goes on at Mermaids is known via parent reports."
Dr Entwistle's claims echo the concerns of some other staff and former staff involved in GIDS.
A Mermaids spokesman said: “It is hard to imagine a charity in the UK which bears greater scrutiny than Mermaids and we are very happy to continue our policy of transparency whilst safeguarding the privacy of our service users, many of whom are vulnerable children.
"We have no influence over, or organisational association with, GIDS. In fact, our own views on the best way to support transgender and gender diverse kids and young people diverge from those of the Tavistock Clinic in some aspects.
"We continue to encourage frank and open discussion on how best to support transgender kids and young people who deserve to be listened to and empowered.”
A spokesman for the Tavistock Trust said GIDS worked in a 'contentious field' and stressed there 'have always been many spaces for staff to share their concerns about the work in general and specific cases they are involved with'.
He added: "It remains that there are different views about how best to support young people with gender dysphoria.
"Fewer than half of patients who present to the service go on to our endocrine clinics and we do not hold a view on what the outcome will be for a child when they come in to the service.
"There is no pressure to provide medical intervention from the service, though there can often be from the young person or family.
"Our work seeks to minimise the impact of distress associated with gender development on general development, whilst spending time exploring gender identity and the range of possible pathways which may or may not include physical treatment."