Children will not be prescribed puberty blockers at gender identity clinics, NHS says
NHS England has banned puberty blocker prescription for children in a 'landmark decision', ITV News' John Ray explains the implications of the new rules
Words by Daniel Boal, ITV News Producer
Children will no longer be prescribed puberty blockers at gender identity clinics, NHS England has confirmed.
The government said it welcomed the “landmark decision”, adding it would help ensure care is based on evidence and is in the “best interests of the child”.
The NHS England policy document, published on Tuesday, said: “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.”
It follows a public consultation on the issue and an interim policy, and comes after NHS England commissioned an independent review in 2020 of gender identity services for children under 18.
What are puberty blockers?
Puberty blockers, which pause the hormones that bring on physical changes during puberty, will now only be available to children as part of clinical research trials.
They pause the hormones that act as messengers telling the body to develop things such as breasts, periods, facial hair or a deeper voice.
Blockers were prescribed to some children who are experiencing gender dysphoria, to temporarily stop their bodies developing.
The NHS describes gender dysphoria as "a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity."
Drugs have also been used to treat conditions that cause premature puberty.
Fewer than 100 young people are currently on puberty blockers.
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What did the review into Gender Identity Development Services find?
A review, led by Dr Hilary Cass, followed a sharp rise in referrals to the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust, which is closing at the end of March.
In 2021/22, there were over 5,000 referrals to Gids, compared to just under 250 a decade earlier. The clinic has come under repeated scrutiny.
In February 2022, Dr Cass published an interim report saying there was a need to move away from one unit and recommended the creation of regional services to better support youngsters. She also pointed to a lack of long-term evidence and data collection on what happens to children and young people who are prescribed medication.
She added that Gids had not collected routine and consistent data “which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service”.
What happens now?
Following the Tavistock’s closure, two new NHS services will now open in early April, situated in London’s Great Ormond Street Hospital and Alder Hey Children’s Hospital in Liverpool.
Regarding the new clinics, John Stewart, national director of specialised commissioning at NHS England said: “This is just the first step in building a regional model, where our aim is to establish between seven and eight specialist centres including the north and the south hubs over the next year to two years.”
The NHS has said children attending these clinics will be supported by clinical experts in neurodiversity, paediatrics and mental health, “resulting in a holistic approach to care”.
Around 250 patients are expected to be transferred to the new clinics from Gids when they open.
Some 5,000 more children and young people are currently on the waiting list for referral into the new clinics.
Those currently on puberty blockers will be able to continue their treatment and are being seen by specialist endocrine services at Leeds and University College London Hospital.
It is understood NHS England hopes to have a study into the use of puberty blockers in place by December 2024, with eligibility criteria yet to be decided.
Why are they controversial?
Puberty blockers have been linked to changes not just in the body but also in the brain.
NHS England has also said that long-term cross-sex hormone treatment may cause temporary or even permanent infertility.
There is some uncertainty about the risks of long-term cross-sex hormone treatment.
They have also stirred up controversy after cases of patients not understanding the implications of using puberty blockers - or deciding that they had changed their mind over transitioning.
How have people reacted?
LGBT+ rights group Stonewall said it is concerning that new policy has been established before research has been set up.
A spokesperson for Stonewall said: “All trans young people deserve access to high quality, timely healthcare.
"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.
"The group who it will affect are young people who are currently in the system, but who haven’t been referred to the endocrine pathway.”
Health minister, Maria Caulfield, however welcomed the NHS decision.
She said: “We have always been clear that children’s safety and wellbeing is paramount, so we welcome this landmark decision by the NHS.
“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.”
John Stewart, national director of specialised commissioning at NHS England said: “Given that the debate is often very polarised, so too were the responses to the consultation.
“Many people said the policy didn’t go far enough in terms of still allowing potential access (to puberty blockers) through research, and others saying clearly they disagreed fundamentally and that these should be routinely available to everyone who believes they need it.”
Former prime minister Liz Truss, who has mooted an amendment to the Health and Equalities act, that includes a ban on the prescription of body-altering hormones to children questioning their sex, both privately and on the NHS, said: “I welcome NHS England’s decision to end the routine prescription of puberty blockers to children for gender dysphoria.
"I urge the government to back my Bill on Friday which will reinforce this in law and also prevent these drugs being supplied privately.”
Mermaids, a transgender youth support charity, described the move as “deeply disappointing, and a further restriction of support offered to trans children and young people through the NHS”.
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