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Blocking Puberty Blockers

As you have probably been seeing on the news, the Northern Irish and UK Government have placed a ban on the prescription of puberty blockers, both via the NHS and Private Health Services. The ban on puberty blockers has been in effect in Northern Ireland since August 2024 but was first introduced in England in May 2024. The temporary ban was then made indefinite in December, for both the UK and Northern Ireland and is not sent to be reviewed until 2027. It is important to note that this ban was made with the knowing that there is a significant waiting list for gender specialist services within the UK and Northern Ireland, making it that much harder for those seeking treatment to actually be given any help whatsoever. The Government has said that this is following a review on puberty blockers from the Independent Commission of Human Medicines and the Cass review. However, in order to understand what this means, let’s take a look at what puberty blockers are, what they do, and why they are so important.

Please note, this column is the opinion of the columinst and not that of GNI or Romeo & Julian Publiccations Ltd.

Puberty Blockers have been around since the 80’s and were first developed to prevent precocious pubertywhere puberty begins too early for an individual. The use of puberty blockers does exactly that, it prevents puberty from taking place until the person is question is of age. Puberty blockers have been used more recently to prevent puberty more indefinitely for trans individuals, to give them time to explore their options and to prevent the turmoil that can be caused by growing parts that they don’t want to exist in the first place such as breasts, facial hair or other gender affirming body parts. This is a treatment with 40 years of safety and effectiveness in all of its uses but in trans youth specifically it has an abundance of proven benefits – so why has it been banned?

The CHM (Commission of Human Medicines) have, according to Gov.com, given the government independent expert advice that puberty blockers are ‘currently an unacceptable safety risk’ and recommended that the government placed ‘indefinite restrictions while work is done to ensure the safety of children and young people’. Apart from the Cass review, which has been widely discredited based on its methods and its guess work in drawing conclusions, the government have not provided any insight to what these proposed safety risks actually are. They have not released any information regarding this review which has left many of those in the transgender, LGBTQIA+ and ally communities questioning the validity of these claims, and whether this was truly a decision that was made based purely on safety and medical concerns, or whether certain ancient views played a role.

The Health and Social Care Secretary Wes Streeting spoke regarding this situation, relaying pretty much verbatim what the Gov website said, but also said that the UK government was working with NHS England to ‘open new gender identity services, so people can access holistic health and wellbeing support they need’ and they are ‘setting up a clinical trial into the use of puberty blockers next year, to establish a clear evidence base for the use of this medicine’. While this does sound like they are trying – it is important to note that medicines go through extensive clinical trials before they are able to be given to the public, and that there has been an abundance of clinical trials previously, so until they release the information as to why we need more trials, and what the medical concerns truly are, we need to keep questioning – especially as there is no evidence to suggest that these drugs are banned for precocious puberty or any other use for them bar for gender affirming care, so what are the medical concerns that keep being discussed, and why are they not valid for other uses?

One medical reason that is often said to be a con when talking about puberty blockers is a delay in Bone Mass Development, which can lead to bone conditions such as Osteoporosis. The fact of the matter is, while this can occur when it does it is years into puberty. Additionally, Bone Mass Development occurs from a lack of hormones, not necessarily from puberty blockers. While it is true that puberty blockers do inhibit hormones, the effects of this can be mitigated by hormone affirming therapy, such as oestrogen or testosterone being administered in a timely manner. All medications have risks, and the transgender community does need to understand and be aware of this, but we do also need to question why other hormone based medicines, such as the contraceptive pill which has far more side effects, are still allowed to be prescribed to under 18s. This is because, according to medical professionals, the pros outweigh the cons.

However, there are many pros when it comes to puberty blockers. Puberty blockers are completely reversable. You simply stop taking them and natural puberty will kickstart and run its course. Puberty itself is not reversable. Puberty is tough for everyone with all of its mood swings, spots, growing things, smells – it isn’t a walk in the park for anyone. For transgender youth, puberty is so much harder. It makes gender dysmorphia harder as parts that don’t feel like your grow and develop even further into a person that doesn’t feel like you, plus all of the other stuff. Puberty blockers can postpone these sexual characteristics from starting which helps provide transgender youth with vital time, to explore, discover, and understand their gender identity without pressure and emotions that would come with the onset of puberty. This time also allows transgender youth to figure out if they want further gender affirming care, such as hormone therapy and prevents young teens and adults from rushing into gender affirming surgery which they may not be physically, mentally or emotionally ready for – which is irreversible unlike puberty blockers. In this way puberty blockers can help to alleviate symptoms of gender dysphoria. Treating aspects of gender dysphoria improves emotional wellbeing by reducing mental health issues such as anxiety, depression and suicidal tendencies in transgender youth. Supporting gender affirming care is supporting mental health by reducing the stress and confusion that comes with the onset of puberty. This healthcare gives young people time to consider and understand their feelings and think about what comes next for them during their transition at a complex but pivotal time.

Dr Hilary Cass, the author of one of the independent reviews that led to the banning of puberty blockers said that they proposed significant risks and that their benefits were unproven. Now, as we discussed briefly previously, her review has been subjected to strong, widespread criticism due to the methodology (the methods she used to research these risks were questionable) and the fact she was unable to draw strong conclusions based on her findings (she basically guessed as her research didn’t prove anything significant). So, as the government has decided to base a strong decision that is a step back for transgender rights on this, it is important to look at other forms of research. When you look up proven benefits on mental health of puberty blockers online, lots of news outlets (BBC, The Guardian) have posted the same study, which was a study of 44 children. This is not a large enough sample size to prove any real data and would need to be conducted on a larger scale. However, the original study showed no evidence of any mental impact, whether good or bad. When they re-analysed they found 34% had a decline in mental health, while 29% found their mental health has improved. However, they categorised mental health decline as needing mental health support, and improvement as no longer needing any mental health intervention. Anyone that has dealt with mental health knows it is not like a cold; it doesn’t just go away – it will always be chronic; it just gets more manageable. So, based on the flawed methods and sample size of this study, we can argue that it is insignificant and only seeks to establish the false narrative that puberty blockers to not help to alleviate any mental health struggles. However, new research that was published in JAMA Network Open reveals that puberty blockers, as well as other gender-affirming hormones do help to reduce the rates of depression and suicide in transgender and non-binary young people. This study has 104 participants, over double the UKs most quoted study and followed the lives of these young people over 1 year as they received gender affirming treatment at Seattle Children’s Gender Clinic. The results of this trail were that 60% of those who received gender-affirming care or puberty blockers had lower odds of depressions, and a massive 73% had lower odds of self-harm or suicidal thoughts. Diana Tordoff, one of the researchers said that this study only added to an already robust and expansive amount of evidence that gender-affirming care is critical for young people in the transgender community.

As previous research has overwhelming indicated, transgender and non-binary youth experience higher rates of depression, anxiety and suicidal thoughts, which will continue to worsen due to this ban. Now the government is aware of this and has said that young people will have access to mental health services if this ban has affected them. The question is how are they going to provide these services when mental health services across the UK are already extremely overwhelmed. Based on a review of NHS England by April 2024 there were 343,000 referrals for children and young people under 18 waiting for mental health services, including 109,000 referrals who had been waiting for more than a year to receive any mental health treatment. So, with the NHS mental health services for young people already extremely overwhelmed, where are we going to fit in the young transgender and non-binary community?

Another question that crops up when discussing puberty blockers is who decides? Many people feel that children should not be making decisions about their gender or about gender affirming care when they are below the age of eighteen – which is a valid concern. Anyone over twenty-one will tell you the decisions they made at eighteen were not the best, and puberty happens long before eighteen, what sort of decisions were you making then? Surely not ones this big. Whilst we can’t completely discard this concern, it does bring up the question of bodily autonomy and consent. What is the age that you can tell someone they can or cannot make decisions about their own body and what happens to it? Should everyone, no matter how young, get to decide what happens to their own body? Many transgender people say that they knew from a very young ages that they were in the wrong body, and having to wait to late adulthood to get gender affirming care led to more struggles with identity and mental health – and actively advocate for puberty blockers as they wished they had had them. Additionally, puberty blockers used to have to be prescribed by a doctor who believed that they would do more good than harm – regardless of the side effects. This should give us some insight into the fact that this isn’t a childish whim, this is long thought-out choice, made with a doctor by a child that has been medically evaluated. At that point, several people, including the child’s parents or guardians have to be pretty sure that this is the right choice. If we also add on that 97% of all transgender people, young and old, have no regrets about their choice to transition which an extremely positive sign that when making these choices, it is never done lightly.

Many people have questioned, in light of this ban, whether anyone that was involved in the choice to ban puberty blockers should be allowed to attend Pride parades and events? Based on all the information – it is a tough question. Yes, there are positives to the ban, but there are seemingly much more negatives. This choice will directly affect the mental health of the young transgender community with little to no help from already overwhelmed mental health services, so why should people that have knowing made this decision, who have knowingly chose to worsen their lives ever get to stand on a float with a flag and pretend for a day to be woke? Perhaps there is something in the hidden independent study that we arn’t seeing, that we don’t know yet. In that case, should the study be released and prove that puberty blockers do cause more harm than good – then we can welcome them for protecting a young and vunerable group. Maybe, we should have left it to the Doctors treating these children, understanding them personally and making a medical decision alongside them to do what is best for the person, for the individual. Every body is different, they have different needs, different risks and need different lengths of time to figure it out – a blanket ban does not and cannot account for this.

CREDIT: Megane Herrick