Children Will No Longer Be Able to Access Puberty Blockers at England Clinics

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 some private practices.

Puberty blockers are used to delay the onset of puberty by blocking the body from making sex hormones such as testosterone and estrogen. The hormonal suppressants do not reverse any changes that have already happened, but can block physical changes like 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. The decision comes after a public consultation on the topic, interim policy, and independent review of gender identity services for underage children, the NHS England said. 

From 2021-2022, more than 5,000 youth were referred to the Gender Identity Development Service, a national health clinic in the U.K., compared to less than 250 a decade earlier. 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 of puberty blockers as medically accepted treatment for transgender and nonbinary youth.

The move has been widely criticized by LGBTQ+ groups. 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 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

LGBTQ+ advocacy organizations have largely disapproved of the policy change. “All trans young people deserve access to high quality, timely healthcare,” a spokesperson from U.K.-based advocacy organization Stonewall 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.” 

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. Gender-affirming-care is supported by numerous associations, including the American Academy of Child and Adolescent Psychiatry. 

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 this medical care, which many adolescents dramatically benefit from, be so woefully 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? 

Fewer than 100 youth are receiving puberty blockers through the NHS. The health agency said that those receiving treatment will be able to continue care at Leeds and University College London Hospital. 

Children who are seeking care will receive help from experts in neurodiversity, pediatrics, and mental health, the NHS added. 

The NHS England said it wants to perform a study into puberty blocker use by December 2024. There are about 262,000 people in England and Wales that identify with a gender that is different from the sex they were assigned at birth, according to Census data.