England’s Health Service Halts Puberty Blockers

England’s National Health System will no longer prescribe puberty blockers at gender identity clinics, citing a lack of evidence of their safety and effectiveness.

Puberty-suppressing hormones are no longer available as a routine treatment option for children and young people with gender dysphoria. The NHS will still allow the use of medications for research purposes.

Young people currently prescribed puberty blockers by the NHS — fewer than 100 in England — will be able to continue their treatment, and the medications will be available in private practice.

Puberty blockers are used to delay puberty in transgender youth. They work by blocking hormones testosterone and estrogen that lead to puberty-related physical changes in the body, such as periods, breast growth, or facial hair growth.

The policy change, confirmed on Tuesday, is based on the findings of a Policy Working Group (PWG) established in January 2022 to review existing evidence.

The group concluded that there was no statistically significant difference in gender dysphoria, mental health, body image, and psychosocial functioning in children and adolescents treated with puberty blockers.

Moreover, the data on the short-term and long-term safety of these drugs is limited, and the use of puberty blockers may reduce the expected increase in bone density during puberty, according to the PWG findings.

An interim report published in February 2022 points to the limited research on the puberty blockers’ effects on sexual, cognitive, or broader developmental outcomes. Additionally, the authors called for a fundamentally different service model for addressing gender dysmorphia.

The number of children and adolescents referred to the Gender Identity Development Service in England increased from 210 in 2011 to 3,585 in 2021, with birth-registered females accounting for the largest group. Many of the youths referred are neurodiverse or have a wide range of psychosocial and mental health needs, according to the interim report.

Mermaids, a British advocacy group supporting transgender youth, called the NHS decision deeply disappointing and said it restricts the support offered to trans children and young people.

“It’s also important to note that puberty blockers can be just one possible part of a young person’s gender journey. However, this news still comes as a blow and will deeply affect our communities,” the group said in a statement.

Gender-affirming care is also a divisive issue in the United States, where transgender youth’s access to services is increasingly restricted.

The American Academy of Pediatrics recommends providing youth “comprehensive gender-affirming and developmentally appropriate health care.” The organization called for a systematic review of evidence last year, at the same time reaffirming its support for providing care to minors.

Other major medical associations, including the American Medical Association and the American Psychiatric Association, also advocate for access to gender-affirming care.

The Endocrine Society is currently reviewing clinical guidelines for gender-affirming care, which may take about three years.

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