NHS bans puberty blockers

Under new rules, English children and teens can only access the puberty suppressing drugs through a clinical trial or via a limited number of private clinics.

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NHS England has banned the use of puberty blockers for people under the age of 18 with gender dysphoria, citing a 2021 National Institute for Health and Care Excellence review.  

The decision does not affect NHS Scotland or NHS Northern Ireland.  

The announcement comes just weeks before new gender identity clinics open at Great Ormond Street children’s hospital in London and Alder Hey children’s hospital in Liverpool.  

There are a number of additional regional clinics planned to open in the coming years, as NHS England moves away from the centralised model employed at the Tavistock centre.  

Children presenting to NHS clinics with other indications for puberty suppression, like precocious puberty or endometriosis, will still be able to access the drugs via the public system.  

Clinical trials and private gender clinics will be the only route to accessing puberty blockers for young transgender people.  

These options are also under threat: former English Prime Minister Liz Truss has introduced a private member’s bill seeking to make it an offence to prescribe or supply puberty blockers for gender dysphoria. 

The NICE evidence review that prompted the move was commissioned in early 2020 as part of Dr Hilary Cass’ independent review of gender identity services for children and young people.  

It looked at nine observational clinical studies and found no statistically significant difference in gender dysphoria, mental illness, body image and psychosocial functioning in adolescents treated with puberty blockers.  

The ban appears to have been in the works since at least April 2023, when the NHS said it re-ran a literature search to capture studies that had come out since 2020.  

“NHS England has carefully considered the evidence review conducted by NICE (2020) and has identified and reviewed any further published evidence available to date,” the new clinical policy document said.  

“We have concluded that there is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make the treatment routinely available at this time.” 

Proponents of puberty blockers argue that the drugs are a safe, reversible way to allow young people with gender dysphoria the time to access psychological care and decide whether proceeding with gender-affirming care is the right path.  

Detractors of the drugs argue that they have long-term negative effects on bone density and that the gender-affirming approach as a whole can amount to low-quality “conveyor belt” care. 

In any case, a West Australian study published earlier this month found less than 1% of young people who commenced puberty blockers for gender dysphoria reidentified with their gender assigned at birth while still under 18.  

The Guardian reports that fewer than 100 trans children in England are currently on puberty blockers.  

Technically, transgender adults could still access puberty-suppressing drugs under the new rules. This is a moot point considering that adults have already gone through puberty.