One of the UK’s biggest health services says it will stop the routine prescribing of puberty blockers to children with gender dysphoria.
In one of the biggest announcements this year, NHS England — a leader in championing change in healthcare for gender dysphoria — said it had carefully considered the evidence review conducted by NICE (2020) and reviewed published evidence.
In its Clinical Commissioning Policy, the service said it had concluded that there was not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones (PSH) to make the treatment routinely available at this time.
“The reason why some people experience gender incongruence is not fully understood and it is likely that the development of gender identity is multifactorial and influenced by both biological and social factors,” the NHS said.
“Gender variant behaviours may start between ages 3 and 5 years, the same age at which most typically developing children begin showing gendered behaviours and interests. Gender atypical behaviour is common among young children and may be part of normal development.
“Children who meet the criteria for gender incongruence / gender dysphoria may or may not continue to experience the conflict between their physical gender and the one with which they identify into adolescence and adulthood.”
From now on, the UK’s treatment of individuals with gender dysphoria will be tailored to the specific needs of individual patients to “ameliorate the potentially negative impact of gender incongruence on general developmental processes.”
“The primary intervention focuses on psychosocial and psychological support; for some individuals, the use of PSH in adolescence to suppress puberty has previously been a treatment option though no NHS clinical commissioning policy has been in place; this may be followed later with gender-affirming hormones of the desired sex,” the NHS said.
“If individuals fulfil additional criteria, they may have various types of gender affirming surgery from the age of 18 years through adult Gender Dysphoria Clinics.”
An initial review of the published research was conducted by the National Institute for Health and Care Excellence (NICE) for the NHS in January 2020, including a review of gonadotrophin releasing hormone analogues (GnRHa).
A follow up review in April 2023 identified nine further studies and overall, NICE concluded that, “there was no statistically significant difference in gender dysphoria, mental health, body image and psychosocial functioning in children and adolescents treated with GnRHa.”
“The quality of evidence for all these outcomes was assessed as very low certainty using modified GRADE. There remains limited short-term and long-term safety data for GnRHa [which] may reduce the expected increase in lumbar or femoral bone density during puberty.”
Puberty blockers will only be approved only for people taking part in clinical research trials, but the new guidance does not apply to children with precocious puberty, or natal males aged 16 or older seeking to transition, as “oestrogen alone is insufficient to suppress testosterone levels into the normal range for natal females.”
The number of young people currently taking puberty blockers in the UK is estimated to be less than 100. A final report from the review is expected in April.