Children in England will no longer receive puberty blocker prescriptions, the National Health Service (NHS) of England said, confirming that the medicine will only be provided to youth who were taking part in clinical research trials. Children can still receive puberty blockers through private practices.
Puberty blockers are employed to postpone the start of puberty by stopping the body from producing sex hormones like testosterone and estrogen. The hormonal suppressants do not reverse any changes that have already happened, but can block physical changes such as breast development and facial hair.
“We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time,” an NHS England policy document released on Tuesday read. NHS England has announced that the decision is a result of a public consultation on the topic, interim policy, and an independent review of gender identity services for underage children.
In 2021-2022, the Gender Identity Development Service, a national health clinic in the U.K., received more than 5,000 referrals from youth, compared to only 250 a decade prior. The clinic is closing at the end of March.
Dr. Hilary Cass, a consultant pediatrician and former President of the Royal College of Paediatrics and Child Health, led the independent review and said that there was insufficient long-term evidence of what happens to youth who are prescribed puberty blockers.
In contrast, leading U.S. medical associations have approved puberty blockers as medically accepted treatment for transgender and nonbinary youth.
LGBTQ+ groups have strongly criticized the move. Mermaids, an organization that supports gender-diverse children and their families, called the decision “deeply disappointing, and a further restriction of support offered to trans children and young people through the NHS.”
Some government leaders have expressed their support. “We have always been clear that children’s safety and wellbeing is paramount, so we welcome this landmark decision by the NHS,” said Parliamentary Under Secretary of State at the Department of Health and Social Care Maria Caulfield. Ending the routine prescription of puberty blockers will help ensure that care is based on evidence, expert clinical opinion, and is in the best interests of the child.
Former Prime Minister Liz Truss is currently advocating for the passage of a bill she drafted that would ban the use of puberty blockers in private practices and the NHS.
Criticism of the decision
Most LGBTQ+ advocacy organizations have expressed disapproval of the policy change. All young transgender people deserve access to high-quality, timely healthcare, according to a spokesperson from the U.K.-based advocacy organization Stonewall. “For some, an important part of this care comes in the form of puberty blockers, a reversible treatment that delays the onset of puberty, prescribed by expert endocrinologists, giving the young person extra time to evaluate their next steps.”
While the recent decision by the NHS cites a lack of research surrounding the long-term effects of puberty blockers, the treatment has been a medically accepted practice since the late 1980s, according to Scientific American. Numerous associations, including the American Academy of Child and Adolescent Psychiatry, support gender-affirming care.
A 2020 study in the journal Pediatrics, the official journal of the American Academy of Pediatrics found that pubertal suppression during adolescence was associated with reduced odds of lifetime suicidal ideation among transgender folks.
“Research consistently links gender-affirming medical care (including pubertal suppression) for adolescent gender dysphoria to improved mental health outcomes,” said Jack Turban, director of the Gender Psychiatry Program at The University of California San Francisco and author of the upcoming book Free to Be: Understanding Kids & Gender Identity. The American Medical Association and The American Academy of Pediatrics oppose bans on these treatments. It is sad to see that medical care, which many adolescents greatly benefit from, is being so politicized.
The American Academy of Pediatrics has previously signed on to support access to healthcare for nonbinary and transgender youth, even filing amicus briefs to aid the ACLU in their slew of legal challenges against anti-transgender laws being passed in the U.S.
How will this affect transgender youth?
The NHS is providing puberty blockers to fewer than 100 young people. The health agency said that those receiving treatment will be able to continue receiving care at Leeds and University College London Hospital.
The NHS stated that experts in neurodiversity, pediatrics, and mental health will assist children who are seeking care.
NHS England has stated that it wants to conduct a study on the use of puberty blockers by December 2024. There are approximately 262,000 individuals in England and Wales who identify with a gender that is different from their birth sex, according to Census data.
