Children NOT to be prescribed puberty blockers: landmark NHS ruling is ‘in the best interests of children’ after warnings about dangers of powerful drugs

Children will no longer be prescribed puberty blockers in gender identity clinics, a landmark NHS ruling has confirmed.

The government said it welcomed the decision, adding it would help ensure care is based on evidence and in the “best interests of the child”.

Puberty blockers, which interrupt the physical changes of puberty such as breast development or facial hair, will now only be available to children as part of clinical research trials.

It follows a public consultation on the issue and an interim policy, and comes after NHS England commissioned an independent review of gender identity services for children under 18 in 2020.

However, the drugs are still available and are prescribed privately ‘off-label’ by some clinicians at non-NHS based gender clinics.

Puberty blockers, medically known as gonadotropin-releasing hormone analogues, halt the physical changes of puberty in teens who are questioning their gender. Pictured here is an example of these medications called Triptorelin

Puberty blockers, medically known as gonadotropin-releasing hormone analogues, halt the physical changes of puberty in teens who are questioning their gender.

For example, they stop the development of breasts in girls and facial hair in boys.

The review, led by Dr Hilary Cass, followed a sharp increase in referrals to the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (Guide), which is closing at the end of March.

In 2021/2022 there were more than 5,000 referrals to Guide, compared to just under 250 ten years earlier.

The clinic has been repeatedly scrutinized.

In February 2022, Dr Cass published an interim report stating the need to move away from one unit and recommending the creation of regional services to better support young people.

She also pointed to a lack of long-term evidence and data collection on what happens to children and young people who are prescribed medicines.

She added that Gids had not collected routine and consistent data “which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service.”

Following the closure of Tavistock, two new NHS services will open in early April, located at London’s Great Ormond Street Hospital and Liverpool’s Alder Hey Children’s Hospital.

The NHS has said that children attending these clinics will be supported by clinical experts in neurodiversity, paediatrics and mental health, ‘resulting in a holistic approach to care’.

Following the announcement, Health Secretary Maria Caulfield said: ‘We have always been clear that the safety and wellbeing of children comes first, so we welcome this groundbreaking decision from the NHS.

‘Ending the routine prescribing of puberty blockers will help ensure that care is based on expert evidence and clinical advice and is in the best interests of the child.’

The consultation on the future of services received more than 4,000 responses, including around a quarter from members of the public, 22 per cent from patients, 21 per cent from parents, 10 per cent from trans adults and 5 per cent from doctors.

John Stewart, national director of specialist commissioning at NHS England, said: ‘As the debate is often very polarised, so were the responses to the consultation.

‘Many people said the policy did not go far enough in still allowing potential access (to puberty blockers) through research, and others clearly said they fundamentally disagreed and that these should be routinely available are for anyone who thinks they need them.’

Speaking about the new clinics, he said: “This is just the first step in building a regional model, with our aim being to establish seven to eight specialist centers over the next year to two years, including the northern and southern hubs. ‘

It follows a public consultation on the issue and an interim policy, and comes after NHS England commissioned an independent review into gender identity services for children under 18 in 2020. The research, led by Dr Hilary Cass (pictured), followed a sharp increase in referrals to the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (Guide), which is closing at the end of March

It is expected that approximately 250 patients will be transferred to the new Gids clinics when they open.

Currently, around 5,000 children and young people are still on the waiting list for referral to the new clinics.

Mr Stewart said: ‘Our two new providers on their own won’t be able to make an immediate significant dent in that waiting list, but what they are doing is helping us establish a new and fundamentally different service model, in line with advice from the Cass review .’

He said other regional centers will hopefully be up and running soon “and once we get to that point we should start to see significant movement in that waiting list and a drop in numbers.”

‘The speed and pace at which the clinics can bring new patients off the waiting list will depend largely on how successful their ongoing recruitment into the service is, and that is not easy.’

Fewer than 100 young people currently use puberty blockers.

They will be able to continue their treatment and be seen by specialist endocrine services in Leeds and University College London Hospital.

It is understood that NHS England hopes to have conducted a study into the use of puberty blockers by December 2024, with eligibility criteria yet to be determined.