The U.K. Health Secretary has made existing emergency measures banning puberty-suppressing hormones (blockers) “indefinite” for children aged under 18, following the official advice of medical experts.
A press release from the Department of Health and Social Care published this week (Dec. 11) confirmed that both the sale and supply of the puberty blockers via private prescriptions to treat gender dysphoria and/or gender incongruence for youngsters not already taking them is no longer allowed.
However, any of the National Health Service (NHS) patients already receiving the medicines as treatment for gender incongruence/dysphoria are allowed to continue receiving the blockers.
The banning order follows a consultation and advice on patient safety about the puberty blockers from the independent Commission on Human Medicines and the Cass Review, as reported by Christian Daily International.
Health and Social Care Secretary Wes Streeting said that Children’s healthcare must always be “evidence-led.”
“The independent expert Commission on Human Medicines (CHM) found that the current prescribing and care pathway for gender dysphoria and incongruence presents an unacceptable safety risk for children and young people,” said Streeting.
“Dr Cass’ 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.”
The U.K. Government and NHS will continue to “improve” children’s gender services, providing “all-round holistic support,” according to the press release.
“We are working with NHS England to open new gender identity services, so people can access holistic health and wellbeing support they need,” Streeting explained. “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.”
The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024 is effected from Jan. 1 2025, the same day when the current emergency order expires, and it will be reviewed in 2027.
The measure follows independent expert advice given by the CHM saying that any continued prescription of puberty blockers to children and young people carried an “unacceptable safety risk.” Recommendations for the indefinite restrictions were given “while work is done to ensure the safety of children and young people.”
Routine prescriptions for puberty blockers were stopped for under 18s by the NHS in March this year, 2024—following the Cass Review into gender identity services at the now defunct Tavistock gender clinic in London, England, which made headlines as an example of inappropriate support and care.
Official figures at the time show 382 children aged up to six were referred to the clinic before it closed in July 2022. About 70 of these youngsters were aged three or four years old.
An analysis of the Gender Identity Development Service run by Tavistock and Portman NHS Foundation Trust, by retired pediatrician Dr. Hilary Cass, commissioned by NHS England and known as the Cass Review, deemed services at the clinic such as giving puberty blockers neither “safe or viable.”
The Cass Review also found that clinical staff on an international basis have reported that adolescents “seem to have more complex presentations” (p90, Cass Review) and “with greater mental health and psychosocial needs, as well as additional diagnoses of ASD and/or attention deficit hyperactivity disorder (ADHD).”
Data also showed that “rates of depression, anxiety and eating disorders were higher in the gender clinic referred population than in the general population.”
“It is widely accepted that exposure to sexuality is happening at a younger age,” added Cass (p119, Cass report). “The impact of this on young people’s understanding of their sexuality and/or gender identity is unclear.”
The reality is that for young individuals, different social-cultural influences impact their understanding of both gender and sexual identity, opined Cass in her report, adding: “and this is an area that warrants better exploration and understanding.”
Commenting on the indefinite ban, Dr Hilary Cass called puberty blockers powerful drugs “with unproven benefits and significant risks.”
“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.”
Professor Steve Cunningham, CHM vice-chair, also commented on the government’s announcement.
He said that CHM had been requested by Streeting and the Northern Ireland Minister for Health to provide advice on the safety of GnRH agonists when used to suppress puberty. CHM made eight recommendations, he added.
“CHM has advised that a statutory indefinite ban is placed on the use of GnRH agonists for puberty suppression until our three recommended structures are in place to support safe U.K. prescribing, with a first review date of 2027,” Cunningham said.
“The indefinite ban is made in the context of a significant waiting list for gender specialist services in the UK. In making this decision, CHM considered the safety, actual and potential, of using GnRH agonists to suppress puberty, and also risks to children and young people associated with accessing GnRH agonists via alternative routes.”
James Palmer, NHS Medical Director for Specialised Services, said all the evidence reviews by the National Institute for Health and Care Excellence (NICE) and NHS England, supported by Cass, “clearly showed” there is not enough evidence to support either the safety or clinical effectiveness of puberty suppressing hormones for the treatment of gender dysphoria or incongruence. He stated that this is the reason why the NHS had decided to no longer routinely offer the blockers to children and young people.
“We welcome the government’s decision to further ban access through private prescribers,” added Palmer, “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.”
Both the Medicines and Healthcare Products Regulatory Agency and NICE will develop standards in this area of health for youngsters, following the recommendations of CHM, according to the press release. Recommendations from the Cass Review will also be implemented.
This work includes eight new regional centers giving mental health support for young people under 18 and a surety to see those on waiting lists “sooner.” Three of these new regional centers, in London and the North West of England, opened in April and another in the city of Bristol in South West of England opened last month, November. An East of England service is planned to open early next year, 2025.
A clinical trial to determine the effectiveness and safety of puberty blockers is also underway, following recommendations from the Cass Review. The National Institute for Health and Care Research (NIHR) is working with NHS England to start clinical trials and “aim to recruit the first patients by spring 2025.”
The indefinite ban also prevents any sale and support of these medicines from prescribers within the European Economic Area or Switzerland for any reason to those under 18.
For people whose access to puberty-suppressing hormones may have been discontinued and are not on the waiting list of children’s gender services, NHS England will offer targeted support from local NHS mental health services in England.
