WWhen Victoria Atkins, then Health Minister, introduced a temporary ban on puberty-blocking drugs for transgender youth the day before the dissolution of Parliament, I saw it as a last-ditch effort by the Conservative Party to win votes before the general election.
Many of us had hoped to see how Labour would handle the ban, which expires in September. In a recent statement about XHowever, Wes Streeting, the new Minister of Health, announced that he wants to make the ban permanent, subject to consultation.
As a professional with expertise in this field – I am a clinical psychologist and worked in NHS gender services from 2016 to 2023. – I see that Streeting is clearly misinformed about the treatment, and his reasoning for making the ban on puberty blockers permanent is unfounded.
Thus, he emphasizes the use of the drug at a particular stage of development (adolescence) as a reason to take an exceptional approach in banning the drug in transgender teenagers and not in children with precocious puberty or adults with pancreatic cancer.
However, he overlooks the fact that this ban does not include teenage patients with differences in sex development (DSD), more commonly known as intersex. These individuals are prescribed puberty-blocking medications when they unexpectedly begin puberty that conflicts with their gender identity. DSD patients take the medications for much the same reason as transgender patients – i.e., the puberty they are going through is stressful, and pressing pause is likely to manage that stress and minimize the harm while a plan for ongoing care is developed. If we follow Streeting’s logic, the medications would be banned for this patient group as well.
My colleagues and I know that puberty blockers may be useful for a carefully selected minority of transgender youth who have a clear and consistent understanding of their gender identity, who have demonstrated distress in relation to the early stages of puberty, and who are mature enough—with the support of their parents or caregivers—to consider the likely implications of this treatment pathway, weighing potential side effects against potential benefits.. This position is supported by the Endocrine Society Guidelines 2017who has it revised and confirmed this year after the last Cass report.
Unfortunately, it seems that Streeting has not learned anything from the lessons of the inquest into the case of Bell v Tavistock, which was quashed in 2021 on appeal. The court of appeal ruled that it is “for clinicians to exercise their discretion” regarding the use of this drug and that “a court has no jurisdiction to assume the role of a clinician” in determining whether a patient can consent to puberty suppression treatment.
For five of my years working in NHS gender services I worked in the child and adolescent gender identity development services (Gids) where I saw first-hand what Dr Hilary Cass was doing in her final report; that only a minority (around 30%) of those who completed an assessment were ever referred for puberty blocking treatment – a much lower figure compared with our international colleagues.
I also saw something else at Gids that Cass reported: that for many, puberty blocking treatment was prescribed too late to be effective (at an average age of 15). As a result, it was seen by patients primarily as a stepping stone to their desired treatment of gender-affirming (masculinizing or feminizing) hormones (GAH).
For this reason I welcomed the NHSE GAH Policy document, published in March, which removed the requirement for puberty blocker treatment as a condition for gender-affirming hormones from the age of 16. If this had been introduced earlier, as some Gids clinicians had asked NHSE to do more than six years earlier, significantly fewer than the already small number of around 100 Gids young people each year would ever have had access to puberty blockers.
In this area of health care, like no other I know of, those professionals with the requisite expertise are portrayed by their critics as “captive to ideology” and therefore not credible. Meanwhile, those without the expertise are portrayed as “independent,” which critics say makes them better able to evaluate the evidence—despite never having worked in the field and having no understanding of its complexities.
The Cass review pointed to the upcoming NHS England puberty blocker trial as the start of a “programme of research” to establish a firmer evidence base. But the NHSE Research Oversight Board for the trial there is a distinct lack of significant clinical experience in the field. Cass, who is on the board, gained her own knowledge from conducting the NHSE review of gender services, which she was tasked with conducting despite having no direct experience of working in these services at the time. The Cass review was completed two years later than planned (in 2024 rather than 2022) and I fear that the NIHR research trial will suffer similar delays due to the lack of familiarity with the field.
Making the ban permanent is misguided, cruel and likely to make hundreds of young people less safe. It will mean that those young people who have started treatment will be forced to re-enter a puberty that they previously found stressful and in many cases damaging to their mental health.
Gender Plus, the private clinic where I am the director, does not prescribe puberty blockers, but we do work with transgender youth and their families and so hear first-hand the stress and uncertainty this ban causes. If Streeting is serious about his intention to have a consultation before making a final decision on this, we would be happy to meet him and introduce him to the families and young people who are directly affected by this ban.
At such a meeting we can explain how this ban makes young people less safe, that it is not supported by the Cass inquiry or the wider evidence, and that the singular approach to transgender young people is discriminatory and unfair.