Express & Star

What is the situation with puberty blockers across the UK?

The Cass Review into children’s gender services has prompted a change in approach.

The Cass Review

The prescription of puberty blockers to under-18s has been paused to new patients in Scotland.

Here, the PA news agency takes a look at what the situation is with puberty blockers across the UK.

– Scotland

On Thursday, two health boards – NHS Greater Glasgow and Clyde (NHSGGC) and NHS Lothian – said the prescription of puberty blockers to new patients has been paused.

Puberty blockers pause the physical changes of puberty such as breast development or facial hair.

NHS Scotland announced an update into gender care for young people (Alamy/PA)
NHS Scotland announced an update into gender care for young people (Alamy/PA)

NHSGGC covers the Sandyford clinic – Scotland’s only gender clinic for under-18s.

NHS Lothian provides care to those aged 17 and over at its Chalmers gender identity clinic.

Both boards had already deferred starting new patients on puberty suppressants – commonly known as puberty blockers – and gender affirming hormones, such as oestrogen and testosterone, in mid-March.

These treatments have now been “formally paused”, the boards said, with the support of Scotland’s chief medical officer and in the wake of the Cass Review – which found a weak evidence base for medical treatments in the gender care of young people – published in England last week.

Patients already on puberty blockers or gender-affirming hormones will not be affected by the change, the boards said.

– England

In March, NHS England confirmed children will no longer be prescribed puberty blockers at gender identity clinics.

Dr Hilary Cass
Dr Hilary Cass carried out the review into the use of puberty blockers (Yui Mok/PA)

They will only be available to children as part of clinical research trials, which NHS England has said it aims to have in place by December.

The decision to stop the routine use of puberty blockers was taken on the basis that “there is not enough evidence to support (their) safety or clinical effectiveness”.

Gender-affirming hormones are currently still available to patients aged 16 and above but NHS England, in response to the Cass Review’s publication on April 10, said it will also review their use “similar to the rigorous process that was followed to review the use of puberty suppressing hormones”.

Dr Hilary Cass had urged such a review, recommending “extreme caution” on their use, saying there should be a “clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18”.

– Wales

There are no gender clinics for under-18s in Wales. Anyone needing treatment is referred to clinics in England.

A Welsh Government spokesperson said: “We commission gender identity services for young people from NHS England and NHS Wales is represented on the gender dysphoria services transformation programme board in England.

“In line with the commitments in our LGBTQ+ plan, we are committed to improving the gender identity development pathway and the support available for young people in Wales.”

– Northern Ireland

Puberty blockers have only been available on NHS prescription for under-18s in Northern Ireland for those young people who had been accepted into the regional gender identity service, Knowing our Identity (KOI), at the Belfast Trust before March 2020.

Northern Ireland health minister Robin Swann (David Young/PA)
Northern Ireland health minister Robin Swann (David Young/PA)

Following the decision in England to stop the routine use of puberty blockers last month, Health Minister Robin Swann said he welcomed the “clarity provided by NHS England” and that the decision would be “carefully considered in relation to services provided across the UK including Northern Ireland”.

– Private providers

In her review, Dr Cass said she “understands and shares the concerns about the use of unregulated medications and of providers that are not regulated within the UK”.

This week, Health Secretary Victoria Atkins indicated the Government could legislate to ban young people accessing prescriptions to gender-blocking drugs from private clinics and online.

She told Parliament on Monday she would work to close any loopholes which could see online providers prescribe hormones to gender-questioning children as she hit out at the “morally and medically reprehensible” practice.

The MP insisted “nothing is off the table” when it comes to ensuring private and online providers cannot “get around the rules” following publication of the Cass Review.

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