NHS ends use of puberty blockers for transgender children
Puberty blockers will no longer be prescribed to children on the NHS.
The decision follows a review of evidence carried out by the National Institute for Health and Care Excellence (NICE) on behalf of NHS England.
It found that there was “no statistically significant difference in gender dysphoria, mental health, body image and psychosocial functioning” in children and adolescents treated with puberty suppressing hormones (PSH).
As a result, NHS England said: “We have concluded that there is not enough evidence to support the safety or clinical effectiveness of PSH to make the treatment routinely available at this time.”
The background
PHS, used to pause the physical changes of puberty in children and young people questioning their gender identity, has grown significantly in recent years.
It has been administered by the country’s only centre for treatment - the Gender Identity Development Service (Gids) based at London’s Tavistock and Portman NHS Foundation Trust.
However, the centre faced criticism from some quarters. In 2020 Keira Bell, who was prescribed puberty blockers aged 16 but later regretted her transition, won a High Court case against Tavistock.
The court ruled children under 16 were unlikely to be mature enough to decide to take puberty blockers.
In 2021 social worker Sonia Appleby, who worked at Tavistock, was awarded £20,000 after a tribunal found she had been vilified and sidelined by her employer for raising safeguarding concerns.
The future of the service was questioned in 2022 in interim findings by the Cass review looking into service provision.
Its author Dr Hilary Cass concluded a “fundamentally different service model” was needed, one which provided “the same level of psychological and social support as any other child or young person in distress”.
Dr Cass also said there was a lack of long-term evidence of the effect of puberty blockers and recommended a move away from having one national centre for treatment.
NHS England subsequently announced the planned closure of Gids to be replaced by two regional hubs – one in London’s Great Ormond Street Hospital, the other at Liverpool’s Alder Hey Children’s Hospital.
Reaction
The government welcomed NHS England’s decision to no longer prescribe puberty blockers. Health minister Maria Caulfield 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.”
However, LGBTQ+ rights group Stonewall said the new policy has been established without proper research.
A spokesperson 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 view from social work
Opposing views were expressed within the social work profession.
Rachel Hubbard, senior lecturer in social work at UWE Bristol, said: “It is sad to see that the NHS have chosen to step further away from the international consensus on trans medicine for young people, although effectively it has not been prescribing blockers for young people for years considering the length of time young people have been waiting on any kind of NHS gender care.
“What is more worrying is the increasing politicisation of healthcare. Taking guidance from the Cass Review that has explicitly excluded people with trans lived experience and their families, is leading to decisions informed by agendas other than those most directly impacted which is a cause of great concern as a social worker.”
Retired social worker Kay Beaumont, who is a member of the Evidence-Based Social Work Alliance, said: “Along with colleagues in EBSWA I am relieved the decision of NHS England acknowledges that the use of puberty blockers is 'not supported by evidence of safety and clinical effectiveness'.
“Finland, Sweden, Holland and France have or are reaching the same conclusion. Among other harms, rushing to socially and/or medically transition – a process linked to affirming a gender identity rather than recognising biological sex – denies children the opportunity of exploring who they are.”