• The teenager is being assisted in his fight for action by The Good Law Project
• It says the NHS has ‘legal obligation’ to provide specialist care within 18 weeks
• But the average waiting time for a first appointment is 18 months, group says
• NHS England insists an independent review into the service is already underway

A transgender teenage boy is launching legal against against NHS England over delays to gender reassignment treatment, having waited more than a year for a referral to the specialist clinic.

The 14-year-old is being assisted in his fight by The Good Law Project, which says the NHS has ‘a legal obligation’ to provide specialist care, or an alternative, within 18 weeks.

However, the average waiting time for a first appointment with the Gender Identity Development Service (GIDS), based at London’s Tavistock Centre, is 18 months, the organisation says, with some even waiting up to four years.

This is not even to actually get what the NHS describes as fully reversible puberty blockers, but just to begin the process of being assessed for eligibility.

Some 10,000 more young people have been referred to the already over-subscribed GIDS, according to figures obtained by the BBC.

NHS England says an independent review into the service has been launched, and insists any legal action ‘will only cost taxpayers’ money and not help the actions already under way’.

The service, which is run by the Tavistock and Portland NHS Foundation Trust, provides support to people under the age of 18 who experience difficulties related to their gender identity.

Reece, who came out to friends and family in primary school, told the BBC he would not want to bring such action ideally, but felt he didn’t have a choice as ‘nobody else is sticking up for trans young people’.

He added: ‘I know more than 30 trans people, from school and LGBT groups. Everybody’s been waiting for months, or even years, but nobody’s been able to get in yet.

‘It’s scary because it shows the service isn’t available to the people who need it.’

In a statement he added: ‘The length of the NHS waiting list means the treatments which are essential for my wellbeing are not available to me.

‘By the time I get to the top of the list it will be too late, and in the meantime I suffer the fear and terror that gender dysphoria causes, every day.’ 

Gender dysphoria is when a person feels a sense of unease because of a mismatch between their biological sex and their gender identity.

The NHS announced in September that an independent review into GIDS would be carried out.

An NHS England spokesman said it would include ‘how and when’ young people are referred to specialist services.

Jolyon Maugham QC, director of the Good Law Project said: ‘Whatever your views about the right treatment regime for young people with gender dysphoria, it can’t be right that they face lengthy waiting lists – on some reports up to four years – for a first appointment.

‘Children are losing the opportunity to be seen within a window in which they can secure effective treatment and so are, in practice, being denied access to that treatment.’

The Good Law Project said the case was not about the treatment GIDS should provide, but the ‘lengthy delays’ in accessing it.

The GIDS’ website says it is aware that young people are having to wait a ‘long’ time for their first appointment. 

An NHS England spokesperson said: ‘There has been more than a 500% rise in the number of children and young people being referred to the Tavistock’s gender identity service since 2013 as more people come forward for support and treatment.

‘The NHS has already asked Dr Hilary Cass to carry out an independent review including how and when children and young people are referred to specialist services, so legal action against the NHS will only cost taxpayers’ money and not help the actions already under way.’

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Virtual fertility clinic Apricity has launched an online fertility predictor tool. The interactive tool is designed to predict a woman’s chances of conceiving naturally based on information input about her lifestyle choices, cross-analysed with her age.

The tool’s key findings include:

• Getting your weight to a healthy BMI (between 18.5-25) can increase your chance of pregnancy by more than half (58%)
• Reducing your alcohol intake to less than four drinks per week can increase your chance of pregnancy by almost one fifth (19%)
• Quitting smoking can increase your chance of pregnancy by almost half (49%).

Apricity’s algorithm has found that being even moderately over or underweight has a much bigger impact on fertility than doctors have traditionally communicated to patients. For example, a 33-year-old woman (who neither smokes nor drinks), with a BMI of 27.7, has a 57% chance of getting pregnant. If she were to lose seven kilograms, her chance of getting pregnant increases by 58%.

The tool combines a woman’s age with questions about her lifestyle choices (weekly alcohol intake, smoking habits, body mass index) – via a short quiz – in order to predict her chances of conceiving naturally, with the result displayed as a percentage. Users can then see how that percentage would change on the back of lifestyle changes.

After receiving the results, users are directed to a ‘fertility treatment’ tool, an accompanying tool Apricity has designed, which provides recommendations on how users can optimise their chances of natural conception and/or estimates their chances of success through different types of fertility treatment (based on official UK HFEA data of 500,000 fertility cycles from 2010 to 2016).

Apricity has plans to build out the tool’s sophistication in the coming months, by adding other qualifying factors like stress, sleep and nutrition into the tool. Consistent studies on the impact of these factors are still in development.

Dr Mara Kotrotsou, Apricity’s chief medical officer, said: “Doctors often struggle to have frank discussions with patients about the impact of weight on the chances of pregnancy. In reality, being outside of a healthy BMI can cause hormonal imbalances that interfere with female cycles, normal development of eggs and implantation of embryos. Our fertility predictor has found that losing just six or seven kilos to reach a BMI that’s in the healthy range can increase the chance of pregnancy by more than half, which is very significant. We want hopeful couples to use the tool as motivation that some small lifestyle changes can dramatically increase their chances of conceiving.”

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A New York mother has become the third American woman to die in the last month after undergoing cosmetic surgery at a clinic in the Dominican Republic.

Alexandra Medina, 33, of New Rochelle, New York, underwent a tummy tuck at the Dr. Ureña Arias clinic in Santo Domingo on July 4. She later died of a pulmonary embolism, Noticias Sin reported.

Medina leaves behind a partner and a 14-year-old son, according to the New York Post.

Her death follows the deaths of two other Americans who underwent cosmetic surgeries at the same clinic.

Alabama woman Alicia Williams, 45, died on June 7, and 26-year-old Sharlim Paulino of New York died on June 20, according to El Nuevo Diario.

On a Facebook page Medina’s family page created, they said she flew to the Dominican Republic to have the same doctor perform her surgery as the other two victims.

But they allege that Dr. Félix Almánzar pulled out at the last minute and had another doctor take over because he was “scared” after the deaths of the two other patients.

Medina’s sister, Maxine David, told CBS New York that doctors in the US refused to perform the procedure unless she lost some weight first, but that Almánzar said it wasn’t an issue.

Her family said they warned her not to go through with the procedure after he asked for the full bill up front.

“They are criminals,” Medina’s mother, Kanny Toro, said in a videoposted on the Facebook page. “You don’t like your fat? Go to the gym. Workout. Sacrifice some food. Don’t do any body procedures on you because there’s always a risk … I urge you, I beg you, don’t do this.”

“It’s a dark lucrative business,” Toro added. “That’s all they want is money. They don’t care about lives.”

On Monday, officials in the Dominican Republic announced that the clinic had been closed while they investigate the deaths.

They said the clinic had only recently reopened after it was previously shuttered for suspected irregularities, Noticias Sin reported.

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A dermatologist has revealed her top tips to protecting your skin from damaging city pollution, which can reduce antioxidants in skin and disrupt collagen production, aging skin as a result.

Shocking statistics released by the Department for Environment Food & Rural Affairs recently revealed that city pollution increases by a staggering 20 per cent on weekdays compared to weekends.

And now a skin expert has told FEMAIL that as well serious environmental implications and health consequences, pollution can have an ageing impact on our skin.

According to leading skincare clinic group sknclinics.co.uk only 23 per cent of Brits know how to protect their skin from harm, while 75 per cent of Londoners feel their commute has a negative impact on the condition of their skin.

Consultant Jinah Yoo revealed that deep cleansing at night to rid the pores of deep-set grime, as well as using SPF on a daily basis – even in the winter – and drinking eight glasses of water by 8pm, are all ways to keep your skin looking youthful.

Explaining how pollution can affect the skin, Jinah Yoo said: ‘There are several mechanisms by which air pollution can affect the skin.

‘Ozone, which is one of the major air pollutants, generates free radicals which leads to a reduction in the antioxidants in our skin, as well as disrupting collagen production and destroying the skin’s barrier. As a result, it promotes skin ageing.

‘With long-term exposure to air pollutants, you may see the signs of skin ageing which will appear as wrinkles, brown spots, uneven skin tone, dehydration and loosing elasticity of the skin.

‘Air pollutants also cause skin inflammation and increased pigment production.

‘What’s more, some of the air pollutants are small enough to penetrate into pores which can be trapped and cause acne-like spots.’

Advising how the ideal daily skincare routine should look, she continued: ‘There are four important daily skincare steps you should consider: deep cleansing, antioxidant application, moisturiser and sunscreen.

‘Firstly, deep cleansing at night will help to remove pollutants accumulated on the surface of the skin during the daytime.

‘After cleansing, application of an antioxidant cream containing vitamin C and E, which inhibit free radical formation, will help to delay the skin ageing process caused by extrinsic factors such as air pollution or UV.

‘However, choosing the right antioxidant and using it correctly is important. Vitamin C cream comes in various concentrations (5-20 per cent), it is best to start with a low concentration, then gradually increase the concentration as starting with high strength can occasionally cause skin irritation’.

Medical Director and specialist in Laser and Cosmetic Dermatology, at sk:n, Dr Hussein, shared his top daily skincare tips for keeping your face clean and clear in the city.

Keep an eye on the pollution forecast and air quality which will have a colour-coded map to show the areas of the UK worst effected by pollution.

Avoid spending unnecessary time near busy roads and traffic ingested areas when the map is coded in red, which is a ‘high’ air pollution banding, or purple, which signifies very high.

If you do find yourself unavoidable in a pollution hotspot, try to avoid touching your face during the day, and wash your face as soon as you get home.

Thoroughly cleansing your skin at night will help to remove pollutants accumulated on the surface of it during the daytime.

Exfoliating is a great way to remove the top layer of mostly dead, epidermal cells on the outer surface of the skin to expose fresher brighter skin.

Try an exfoliating cleanser that contains glycolic acid and glycerine to remove dead skin cells, clear pores, moisturise and rejuvenate the skin.

After a busy day avoid the temptation to use make-up wipes to cleanse your skin – they’re not a viable alternative to a proper cleanse and you could be doing more harm than good.

Make-up wipes can simply spread make-up, dirt and skin over your face, leaving irritated skin in their wake, and often contain ingredients such as alcohol or certain preservatives that will irritate more delicate skin types.

The scrubbing action that is often accompanied with their use can cause inflammation that, over time, can promote skin pigmentation.

After cleansing, application of an antioxidant cream containing vitamin C and E, which inhibit free radical formation, will help to delay the skin ageing process caused by extrinsic factors such as air pollution or UV.

Vitamin C cream comes in various concentrations (5-20 per cent), and it is best to start with a low concentration, then gradually increase the concentration as starting with high strength can occasionally cause skin irritation.

Keeping your skin well-moisturised will help to maintain an intact skin barrier, vital for protection against pollution.

Apply moisturiser morning and night after cleansing your face. You may wish to use a heavier moisturiser in the evening and a lighter one in the day.

Air pollution can affect everyone, however patients with underlying skin conditions with a broken skin barrier, such as eczema, may experience worsening of their eczema with exposure to air pollution.

Sun cream should be a key element of everyone’s daily skin routine, and not just in the summer.

Using sun cream which contains UV and visible light block will help to reduce signs of skin ageing.

It’s tempting to use more cosmetics to cover up any skin imperfections, however, by doing this it clogs your pores even more and triggers further outbreaks or can be what caused one in the first place.

Going cold turkey isn’t always a realistic option more some people so instead why try going one day a week with no make-up or using mineral cosmetics instead.

The worst culprits for causing breakouts are heavy use of foundation – look for products that are non-comedogenic, sheer, and fragrance-free.

When skin is dehydrated, it will be dull, lack moisture and therefore lustre.

The phrase ‘8 by 8’ is useful at keeping track of how many glasses of water you consume before the end of the day; simply drink eight glasses of water by 8pm, a minimum of 2 litres, and you’ll have had your fill for the day.

Whilst maintaining a good daily skincare routine will help protect your skin from damage, there are a variety of treatments that can help improve skin pigmentation and tone whilst rejuvenating the skin – including hydrofacials and laser treatments.

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Community health care leaders met in May to discuss high blood pressure in our community, and how we have a lot of people experiencing complications from untreated or undertreated high blood pressure. We have excellent hospitals, clinic systems and primary care physicians in our community. We have an engaged public health department and multiple clinic locations for uninsured members. We have a fully accredited heart hospital and excellent cardiologists. We have many primary care clinics who have received patient-centered medical home certification and have processes in place to screen for and treat high blood pressure. So why do we still have a lot of people in our community with undertreated high blood pressure?

Some people simply have not been screened. High blood pressure often offers no symptoms, and patients do not know how their blood pressure is doing simply based on the way they feel. Sometimes people will only go to the doctor when they are sick, and often they assume that their elevated blood pressure was because they did not feel good and are not due to true blood pressure problems. This is a dangerous assumption, and reduces our ability to intervene.

Many pharmacies provide free use of blood pressure machines that are fairly accurate. Ideally, the person would sit at the blood pressure station for 5 minutes to be sure their resting heart rate and blood pressure goes back to its normal value, especially if they walked a lot around the store. If their blood pressure is high after sitting for three to five minutes and the person is not sick or in pain, chances are they truly do have high blood pressure that is not being treated as well as it should be.

Other challenges we have in our area are a high smoking rate and a diet that is high in fat and salt. We also have high obesity rates. All three of these things — smoking, diet and obesity — are risk factors for high blood pressure. Ideal treatment of high blood pressure would not just involve the use of medications, but would also encourage healthy eating behaviors and exercise.

It is important for patients to be informed about what untreated and undertreated high blood pressure can do. This can lead to strokes, heart failure, heart attacks, kidney failure, poor leg circulation, sexual side effects in men and other long-term problems. Common causes of death from long-term, undertreated high blood pressure are heart attacks and strokes. The tricky thing is that these complications do not always occur right away, and patients feel a reduced sense of urgency to treat their blood pressure problems. Sometimes the heart attack or the stroke was caused by years of missed opportunities to treat the high blood pressure when it could have made a difference.

There are many blood pressure medications on the $4 medication discount list at several local pharmacies. Treatment of high blood pressure is often inexpensive, yet many patients simply do not know where to go nor understand why it is important to take their medication. Even though we have many clinics that will see patients at reduced or no cost if they are uninsured, patients do not know that these clinics exist or understand how to access them.

While blood pressure targets are adjusted based upon a person’s risk factors, a good rule of thumb is that normal blood pressure is 120/80, and most doctors agree treatment is needed if the blood pressure stays over 140/90. What is your blood pressure? If you do not know your blood pressure, then please get screened ASAP, either at a local clinic or using a blood pressure machine at a local pharmacy. If your blood pressure is high and you do not know how to access locations for care, please call the Center for Healthy Living at 903-593-7474, or visit it from 8 to 11:30 a.m., and from 1:30 to 4:30 p.m. Monday through Friday. You can receive a free blood pressure reading and get connected to other local health resources that will help you control your high blood pressure.

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MONTGOMERY, Ala. (AP) — As the federal government prepares to launch an ambitious initiative to end the HIV epidemic, the director of the Centers for Disease Control on Friday applauded an Alabama HIV clinic’s commitment to providing health services to rural communities.

Director Robert Redfield met with state public health officials and toured the Medical Advocacy & Outreach clinic in Montgomery to begin laying the groundwork for the decade-long federal campaign. HIV is the virus that causes AIDS.

Alabama is one of seven states the federal government is planning to target with additional expertise, resources and technology for its relatively high rate of new HIV infections among residents in rural areas.

The initiative — first announced by President Trump in his State of the Union address in February — aims to reduce new HIV infections by 75% in five years and at least 90% in 10 years.

The South accounted for more than half of the nearly 40,000 new HIV diagnoses in 2017, with 23% of new diagnoses occurring in suburban and rural areas, a disproportionately high distribution compared to the rest of the U.S., according to data from the CDC.

Redfield said targeting the epidemic in rural areas is particularly difficult because of both the limited access to health services and the increased stigma associated with homosexuality and HIV/AIDS as an illness.

“The true enemy of public health is stigma,” Redfield said after a meeting with state lawmakers, public health officials and physicians. “In rural America, stigma is an even greater issue.”

Redfield said the federal initiative, which has yet to be allocated funding, will focus on improving diagnoses, getting people into treatment, implementing prevention strategies, working with health departments on identifying hot spots and helping local communities develop a workforce to engage individuals living with HIV.

Scott Harris, Alabama’s state health officer, said the initiative will rely on conversations with local health-care providers to help design the kind of unique programs that will be most effective there.

“We have an opportunity to use people at the local level to help us understand exactly what’s going on in these particular communities,” Harris said.

Redfield, who began researching the virus more than 30 years ago, got a first-hand look at how Medical Advocacy & Outreach targets rural communities during a walk-through of the facility that included a brief presentation on the clinic’s telemedicine program, a video chat setup between a doctor and a patient described by some staff as the “crown jewel” of the clinic.

On a flat-screen TV situated at the front of a small room in the Montgomery clinic, Redfield greeted a nurse located in one of the organization’s ten satellite clinics. He then put on a pair of Bluetooth headphones which allows physicians to remotely hear the hearts, lungs or bowels of a patient via a digital stethoscope dozens of miles away.

Thomas Stephens, a spokesman for the clinic, said he hoped the visit gave Redfield a “personal,” ”human” perspective on the kind of on-the-ground programs aimed at stemming HIV/AIDS in rural Alabama.

“We want to suppress viral loads. We don’t want to suppress self-esteem,” said Jamil Dawson, MAO’s director of support services, to Redfield during his tour.

“I think I’m going to steal that,” Redfield said.

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