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Children will not be prescribed puberty blockers, NHS says

Children will no longer be prescribed puberty blockers at gender identity clinics, NHS England has confirmed.

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

Puberty blockers, which pause 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.

The NHS England policy document, published on Tuesday, said: “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.”

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

That review, led by Dr Hilary Cass, followed a sharp rise in referrals to the Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust, which is closing at the end of March.

In 2021/22, there were over 5,000 referrals to Gids, compared to just under 250 a decade earlier.

Great Ormond Street Hospital
The Great Ormond Street Hospital sign in central London (Kirsty Wigglesworth/PA)

The clinic has come under repeated scrutiny.

In February 2022, Dr Cass published an interim report saying there was a need to move away from one unit and recommended the creation of regional services to better support youngsters.

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

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 Tavistock’s closure, two new NHS services will now open in early April, situated in London’s Great Ormond Street Hospital and Alder Hey Children’s Hospital in Liverpool.

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

UK Parliament portraits
Maria Caulfield welcomed the decision (Chris McAndrew/UK Parliament/PA)

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.”

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

John Stewart, national director of specialised commissioning at NHS England, told the PA news agency: “Given that the debate is often very polarised, so too were the responses to the consultation.

“Many people said the policy didn’t go far enough in terms of still allowing potential access (to puberty blockers) through research, and others saying clearly they disagreed fundamentally and that these should be routinely available to everyone who believes they need it.”

Regarding the new clinics, he said: “This is just the first step in building a regional model, where our aim is to establish between seven and eight specialist centres including the north and the south hubs over the next year to two years.”

Around 250 patients are expected to be transferred to the new clinics from Gids when they open.

Some 5,000 more children and young people are currently on the waiting list for referral into the new clinics.

Mr Stewart said: “Our two new providers on their own are not going to be able to make a significant dent immediately 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 centres could hopefully be commissioned quickly “and once we get to that point we should begin to see significant movement in that waiting list and numbers falling.

“The speed and pace at which the clinics will be able to see new patients off the waiting list is in large part going to be dependent on how successful their ongoing recruitment into the service is, and that is not straightforward.”

Fewer than 100 young people are currently on puberty blockers via the NHS.

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

Puberty blockers are also available through some private gender identity clinics.

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

Former prime minister Liz Truss, whose Health and Equality Acts (Amendment) Bill includes a ban on the prescription of body-altering hormones to children questioning their sex, both privately and on the NHS, said: “I welcome NHS England’s decision to end the routine prescription of puberty blockers to children for gender dysphoria.

“I urge the Government to back my Bill on Friday which will reinforce this in law and also prevent these drugs being supplied privately.”

Mermaids, a transgender youth support charity, described the move as “deeply disappointing, and a further restriction of support offered to trans children and young people through the NHS”.

A Scottish Government spokesperson said: “The Scottish Government and NHS Scotland are engaged with NHS England on its planned study into the use of puberty blockers in young people’s gender identity healthcare, and discussions are ongoing to determine what future engagement is appropriate.”

A Stonewall 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.

“We are concerned that NHS England will be putting new prescriptions on hold until a research protocol is up and running at the end of 2024.”