Children from same school class seeking help from Northern Ireland's specialist transgender clinic

That is one of the findings of Baroness Hilary Cass, who has issued a report this week into those Belfast-based services.

One clinician has suggested to the News Letter this indicates a "social contagion" at work.

The term is often used to refer to the idea that transgenderism is spreading as a kind of trend, as opposed to natural occurrences of the medical condition gender dysphoria.

Other findings are that many of those presenting to gender services are autistic, gay, or have some kind of psychological trauma.

Baroness Cass began a high-profile survey of England's trans youth services in 2020, publishing her final report in 2024.

It caused a storm among transgender advocates, because it found that the evidence in favour of things like puberty blockers was "remarkably weak", and led to the use of the drugs being phased out across the NHS.

Last September, following a series of headlines about Northern Ireland's own Belfast-based gender services, health minister Mike Nesbitt asked baroness Cass to carry out a review of these too.

Her report was published on Tuesday.

When it comes to children and young people presenting before mental health staff over gender issues, she found that "many have a history of trauma, bullying and systemic challenges".

She went on to add: "Also, many are known to ASD [autism spectrum disorder] services.

"Historically they had seen the more ‘classically recognised’ children with a very long trajectory from pre-school years, but now the more usual age of presentation is 12-13, and they are more commonly female to male identities, and often same sex attracted.

"There were instances ofchildren presenting from the same school and class."

She also wrote: "Safeguarding concerns include cases where parental motivations may drive social transitions inappropriately, necessitating careful assessment and family support."

Dr Marcus Evans told the News Letter: "None of this is new."

He had documented the occurrence of co-morbidities (people presenting with multiple problems besides their claim to be transgender, such as trauma and autism) in a 2020 paper, as well as "the influence of fragile kids being prone to the effects of a social contagion".

Dr Evans, a psychotherapist, was one of the governors of The Tavistock and Portman NHS Foundation Trust, where England's youth gender services clinic was based, but quit in 2019 over concerns that children were being too quickly affirmed in their newly-declared gender.

He was quoted as saying at the time: "There is pressure from the child who is in a distressed state, there is pressure from the family and the peer group and from the pro-trans lobbies - and all of this puts pressure on the clinician who may want to help the individual to resolve their distressed state by going along with a quick solution."

He referred the News Letter to a recent self-authored article he had published online, in which he said: "Parents of gender-confused children have been failed by mental health and medical services.

"Puberty is a healthy developmental process essential to sexual maturation treated as if it were a pathology, despite there never having been an evidence base for doing so.

"Instead of supporting families to tolerate the turbulence of puberty and adolescent development, parents were placed under intense pressure from distressed children, online affirmation, activist cheerleaders, clinicians, and wider society to interpret developmental distress as evidence of a fixed condition requiring medical intervention.

"What was offered was an implicit bargain: the promise of avoiding psychic pain, anxiety, and conflict in the short term, in exchange for profound and irreversible losses in mature adult sexual functioning. "This trade-off was rarely named honestly and often denied altogether.

"Parents were confronted with weak and contested evidence, confidently presented by the medical establishment, and made to feel that questioning thoughtless affirmation caused harm to their children rather than representing adult experience, duty of care, and appropriate parental caution."