Scotland halts prescription of puberty blocking hormones for minors as gender identity service faces scrutiny

April 18, 2024
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London — The only gender identity clinic in Scotland has paused prescribing puberty blockers to new patients under 18 years old, mirroring action taken by England’s health authorities after a landmark review found young people had been let down by “remarkably weak” evidence backing medical interventions in gender care

The report, commissioned by Britain’s National Health Service, also found that the “toxicity” of the debate around gender identity meant physicians were operating in fear.

Dr. Hillary Cass, who led the review that produced the 388-page report published earlier this month, said “we don’t have good evidence” that puberty blockers are safe to use to prevent changes that come during puberty.

“It is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood, and that’s been a particular problem, that we haven’t had the follow-up into adulthood to know what the results of this are,” Cass told CBS News partner BBC News.

Puberty blockers suppress the release of hormones that cause puberty. They can be prescribed to children who are questioning their gender in order to stop physical changes such as the growth of facial hair or breasts.


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“The next step from here is to work with the Scottish government and academic partners to generate evidence that enables us to deliver safe care for our patients,” Emilia Crighton, the director of the public health service for the Glasgow region, said in a statement. “We echo the views of Dr. Hilary Cass that toxicity around public debate is impacting the lives of young people seeking the care of our service and does not serve the teams working hard to care and support them. We understand the distress that gender incongruence can cause and, while all referrals to endocrinology are paused, we will continue to give anyone who is referred into the young people’s gender service the psychological support that they require while we review the pathways in line with the findings.”

Scottish Trans, an advocacy group, said it disagreed with the decision to pause prescriptions of puberty blockers for minors, which it said “has been taken within the context where the reality of trans people’s experiences and lives is questioned almost daily in some of the media and some political circles.”

“This makes us worry that the decision has been influenced by that context rather than solely through consideration of the best interests of trans children and young people,” Scottish Trans said in a statement, adding that between 2011 and 2023, only 87 young Scottish people were prescribed puberty blockers.

“The exceptionally rare and cautious choice of puberty blocker prescription, made for a small number after huge waits, is being wrongly painted by some as though it was commonplace and rushed. Nothing could be further from the truth. We’re saddened that this change will result in some young people being unable to access the care they need at all, or having to wait even longer for it,” Scottish Trans said.

Ahead of the Cass review’s publication, the NHS said in March that it would stop prescribing puberty blockers to under-18s at gender identity clinics in England. New young patients in the U.K. can still get a prescription for hormone blockers, but only as part of a clinical trial.

Cass’ review called for better research into the medications and their long-term effects, as well as the characteristics of children seeking treatment.

“The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” she wrote in the review.

She encouraged a holistic assessment of patients, taking into consideration issues that may not relate to their gender identity, including screening for conditions such as autism to address “diagnostic overshadowing” that could occur when issues of gender are brought up.

“What’s unfortunately happened for these young people is that, because of the toxicity of the debate, they’ve often been bypassed by local services who’ve been really nervous about seeing them,” Cass told the BBC. “So, rather than doing the things that they would do for other young people with depression or anxiety, or perhaps undiagnosed autistic spectrum disorder, they’ve tended to pass them straight on to the GID (Gender Identity Disorder) service.”

The Cass review was commissioned following a sharp rise in referrals to gender identity services in the U.K., from around 250 a year to more than 5,000 in 2022.

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