Puberty blocker ban for children with gender dysphoria to be made indefinite

A ban on puberty blockers for children with gender dysphoria in the UK is to be made indefinite after experts warned of an “unacceptable safety risk”.

The Department of Health and Social Care (DHSC) said the Commission on Human Medicines (CHM) had published independent expert advice that there is “currently an unacceptable safety risk in the continued prescription of puberty blockers to children”.

Indefinite

The department said the commission had recommended indefinite restrictions while work is done to ensure the safety of children and young people.

The NHS announced in March that children would no longer be prescribed puberty blockers at gender identity clinics, with the then-Conservative government saying this would help ensure care is based on evidence and is in the “best interests of the child”.

The following month, the Cass Review concluded that the quality of studies claiming to show beneficial effects for children and young people with gender dysphoria was “poor”.

Ban

Dr Hilary Cass – now Baroness Cass – said at the time of her final report into children’s gender care that a single Dutch study, “suggesting puberty blockers may improve psychological wellbeing for a narrowly defined group of children with gender incongruence”, had formed the basis for their use to “spread at pace to other countries”.

In May, a ban on puberty blockers was introduced by the then government with emergency legislation, preventing the prescription of the medication from European or private prescribers and restricting NHS provision to within clinical trials.

Wednesday’s announcement that the ban on sale and supply of puberty blockers through private prescriptions for under-18s is to be indefinite “closes a loophole that posed a risk to the safety of children and young people”, NHS England said.

While health is a devolved matter, the ban applies across the UK, the DHSC said, adding that the decision had been taken in consultation with the Scottish and Welsh governments, and in agreement with the Northern Ireland government.

Plans are in place to set up a clinical trial into the use of puberty blockers next year, with an aim to recruit the first patients by spring.

Caution

Health Secretary Wes Streeting said care for this “vulnerable group of young people” requires a need to act “with caution”.

He said: “Children’s healthcare must always be evidence-led. The independent expert Commission on Human Medicines found that the current prescribing and care pathway for gender dysphoria and incongruence presents an unacceptable safety risk for children and young people.

“Dr Cass’s review also raised safety concerns around the lack of evidence for these medical treatments. We need to act with caution and care when it comes to this vulnerable group of young people, and follow the expert advice.

“We are working with NHS England to open new gender identity services, so people can access holistic health and wellbeing support they need. We are setting up a clinical trial into the use of puberty blockers next year, to establish a clear evidence base for the use of this medicine.”

Baroness Cass welcomed the announcement, describing puberty blockers as “powerful drugs with unproven benefits and significant risks”.

She said: “That is why I recommended that they should only be prescribed following a multi-disciplinary assessment and within a research protocol.

“I support the Government’s decision to continue restrictions on the dispensing of puberty blockers for gender dysphoria outside the NHS where these essential safeguards are not being provided.”

“Lack of evidence”

James Palmer, NHS medical director for specialised services, said a lack of evidence “to support the safety or clinical effectiveness” of puberty blockers for children with gender dysphoria had led to the NHS decision to ban them outside clinical trials.

He added: “We welcome the Government’s decision to further ban access through private prescribers, which closes a loophole that posed a risk to the safety of children and young people, but this will be a difficult time for young people and their families who are affected, so we are extending an offer of targeted support to anyone affected by the banning order from their local mental health services.”

A third NHS children’s gender clinic for patients in England and Wales opened in Bristol in November, following in the footsteps of two hubs, led by London’s Great Ormond Street Hospital (Gosh) and Alder Hey Children’s Hospital in Liverpool, which opened in April.

In total, up to eight new NHS children’s gender clinics – for children of any age – are due to open by 2026.

These clinics have been set up following the closure of the Gender Identity Development Service, which had been run by the Tavistock and Portman NHS Foundation Trust, at the end of March.

NHS England has previously said its new approach to children’s gender care, which requires children newly referred for gender care to have been seen by a GP and mental health specialist or paediatrician first, is aimed at adding safety nets, rather than extra barriers, to their care.

– Anyone affected by the announcement can contact [email protected] or call 0300 131 6775 and select option 3.