The news
Britain’s National Health Service announced Friday that it will restrict the use of puberty-suppressing drugs to children taking part in clinical trials. The change comes as the agency’s pediatric gender services struggle to keep up with rising demand.
A paper explaining the NHS’s reasoning stated that “there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment.”
The NHS had issued a draft of this policy change in October, but with Friday’s announcement the new approach was formally set after months of public comment. The policy will take effect later this year.
Why it matters: Other countries have also restricted the drugs
The change is part of a wider push in several countries to limit gender-based medical treatments for young people.
After conducting evidence reviews, Finland has begun restricting who can access gender-based treatments and Sweden has restricted the use of puberty blockers and hormones to clinical trials. A Norwegian health authority and the French National Academy of Medicine have also urged caution.
In the United States, more than 20 Republican-led states have passed laws banning the use of puberty-suppressing drugs and hormones, and some are making it a crime for doctors to prescribe them. Hundreds of clinicians across the country — including some who have expressed concern about which adolescents should receive gender-based treatments — have denounced the bans, saying such decisions should be made by patients, their families and their doctors.
Background: Data on the effect of blockers is scarce
Last year the NHS announced it would close the country’s only youth gender clinic after an external evaluation found the Tavistock Gender Identity Development Service had been unable to provide appropriate care to the rapidly increasing number of adolescents seeking was to gender treatments. The clinic had seen a surge in referrals, from 250 young people in 2011 to 5,000 in 2021.
Puberty blockers, which work by suppressing estrogen and testosterone, were first tested on children with gender dysphoria in the Netherlands in the 1990s. The Dutch researchers published their first study of 70 children in 2011 and found that the adolescents reported a decrease in depression and anxiety after taking the drugs.
But a British study of Tavistock patients published in 2021 found that blockers had no effect on children’s scores on psychological tests. The study found that 43 of the 44 participants later chose to start testosterone or estrogen treatments. One interpretation of the data is that they were all good candidates for hormone therapy. But the numbers raised concerns in the NHS about whether the drugs served their intended purpose of giving adolescents time to think.
“The hardest question is whether puberty blockers do indeed give children and young people valuable time to consider their options, or whether they effectively ‘lock’ children and young people into a treatment trajectory,” Dr. Hilary Cass, the pediatrician who oversees the independent assessment of the NHS gender service, wrote last year.
What’s Next: Britain launches lawsuit against children using blockers
The NHS is organizing a clinical trial for all children receiving puberty blockers from health care, with enrollment expected to begin in 2024.
Although the Tavistock clinic has closed, regional centers are opening across Britain to expand gender-based services for young people. The NHS said the new system for treating minors with gender-related problems will establish standardized assessments and include much more mental health support.
“The main aim is to alleviate the distress associated with gender incongruity and to promote the global functioning and well-being of the individual,” the NHS guideline said.
