Children to stop getting puberty blockers at gender identity clinics, says NHS England
Children who have gender dysphoria will no longer be given puberty blockers, NHS England has said, ahead of a radical change in how it cares for them.
There is not enough evidence about either how safe they are to take or whether they are clinically effective to justify prescribing them to children and young people who are transitioning, it added.
The government welcomed NHS England’s “landmark decision”, which it said was “in the best interests of children”.
NHS England made the announcement in response to the results of a public consultation on the ban, which it first proposed last June, and a review of available evidence by the National Institute for Health and Care Excellence (Nice).
A spokesperson said: “NHS England has carefully considered the evidence review conducted by NICE and further published evidence available to date.
“We have concluded that there is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make the treatment routinely available at this time.”
Puberty blockers arrest the physical changes in a child’s body that puberty brings, such as the development of breasts or facial hair. The NHS’s decision means that the new regional services caring for under-18s with gender dysphoria, which open next month, will not use them as part of the treatment.
From now on, children and young people will only be able to get them if they are taking part in a clinical trial. At least one such trial is due to start later this year, but no details, such as who will be eligible to join it, have been published.
The NHS’s decision reaffirms the position it adopted last year on puberty blockers after Dr Hilary Cass, who is leading an independent review into gender identity services for under-18s, issued interim advice warning against routine prescription of the drugs.
In late 2020 NHS England asked Cass, an ex-president of the Royal College of Paediatrics and Child Health, to look into gender identity services. At the time they were provided for the whole of England solely by the NHS’s Tavistock and Portman mental health trust in London. Its treatment of under-18s with gender dysphoria, including its use of puberty blockers, had attracted criticism.
Fewer than 100 children and young people are taking puberty blockers.
The trust’s gender identity development service is closing at the end of this month. The first two new centres will open in April at two specialist children’s hospitals: Great Ormond Street in London and Alder Hey children’s hospital in Liverpool. NHS England hopes to ultimately create seven or eight centres.
However, the services they provide will be what NHS sources say will be “fundamentally different from the current service, in line with the Cass recommendations”.
Maria Caulfield, the health minister, said: “We welcome this landmark decision by the NHS to end the routine prescription of puberty blockers and this guidance which recognises that care must be based on evidence, expert clinical opinion and in the best interests of the child.
“The NHS must ensure its Gender Identity Services protect, support and act in the best interests of children and we will continue to work with NHS England to protect children in this area.”
Stonewall voiced its concern about the new policy. “All trans young people deserve access to high quality, timely healthcare”, a spokesperson for the LGBTQ+ rights charity said.
“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. We are concerned that NHS England will be putting new prescriptions on hold until a research protocol is up and running at the end of 2024.”
Sex Matters, which campaigns on how sex is used in law and other environments, praised NHS England for what it said was a return to evidence-based policymaking in relation to gender identity services.
“This a momentous development in the course correction of NHS England’s approach to treating childhood gender distress,” said Maya Forstater, its executive director. “The significance of NHS England’s statement that there is not enough evidence to support the safety or clinical effectiveness of puberty blockers cannot be overstated, given the success that activist lobby groups have had in portraying them as a harmless and reversible treatment.”