Concerns about the welfare of gender dysphoric children being seen at an NHS clinic were ignored, according to leaked documents.
The documents, revealed on BBC Newsnight, detail concerns that some children were being too quickly referred for gender transition treatment by the Gender Identity Development Service (GIDS).
The documents contained transcripts from staff interviews in which clinicians alleged that their concerns around child protection and safeguarding were "shut down".
The interviews were carried out as part of a review last year into GIDS, the only gender dysphoria clinic for children run by the Tavistock and Portman NHS Trust.
One member of staff said children may be "medically mismanaged" at the clinic.
"Let's pray that I am wrong because if I am not wrong, very many vulnerable children have been very poorly treated and will be left with, potentially, a lifetime of damage here," they said.
"The reality is, by not doing anything, children are potentially still being medically mismanaged."
In some interviews, staff alleged that they were discouraged from taking concerns to the GIDS' safeguarding lead, or referring suspected abuse or trauma in children to social services.
In one transcript, a staff member alleged that those who raised concerns were "seen as trouble making and difficult."
A former GIDS worker told the BBC: "I would say that perhaps that's why more than 40 clinicians decided to leave the service within three years."
The Tavistock and Portman Trust told the BBC that it "stands by" its review into GIDS and is "confident that it fairly addressed the issues raised".
"Safeguarding is of the utmost importance to the Trust," it said.
The transcripts also revealed concerns about puberty blockers, with some staff alleging that children were referred for this treatment after only one or two appointments.
The Tavistock Trust responded to the allegations by telling the BBC: "GIDS is a safe and caring service which supports a wide range of children. [We] strongly refute the allegations put to us by Newsnight."