NHS adviser to review hormone use on young The Times 04.04.21

The original article is here.

A warning over the health impacts of giving puberty blockers and cross-sex hormones to young people struggling with gender identity has prompted a call for a review of their use in Scotland.

The National Institute for Health and Care Excellence (Nice) said that existing studies of the drugs were small and “subject to bias and confounding”.

It follows research published in the British Medical Journal that described how children prescribed puberty blockers experienced reduced growth in height and bone strength by the time they finished their treatment at age 16.

The Scottish Intercollegiate Guidelines Network (Sign), which issues clinical advice to the NHS, is being asked to conduct a review amid concern that children as young as eight could be given the drugs.

“This should be a national scandal and we hope the upcoming election will focus the minds of our politicians on their responsibilities and a halt is called immediately on this medical experiment, pending a full review,” said Trina Budge, director of For Women Scotland, a campaign group.

A concerned woman who was told that her daughter was experiencing gender dysphoria, said: “The conclusions are pretty damning, making it clear this is all experimental. Anyone can suggest a topic to Sign for investigation so I’m going to ask them to look at the Nice review.”

Puberty blockers, known scientifically as gonadotrophin-releasing hormone (GnRH) analogues, are prescribed to some young people with gender dysphoria — distress caused by a discrepancy between a person’s gender identity (how they see themselves regarding their gender) and their sex at birth.

They work on the brain to stop the rise in sex hormones — oestrogen and testosterone — that accompanies puberty.

The effects of the drugs have been promoted in Scotland as “fully reversible” but NHS Greater Glasgow and Clyde withdrew a pamphlet on gender dysphoria last year and apologised after receiving a complaint that the potential long-term effects were not made clear.

The Nice findings, published last week, were commissioned by NHS England to assist an independent review by Dr Hilary Cass, a paediatric consultant, into gender identity services for children and young people.

Nineteen separate studies were reviewed, including nine that examined the impact of puberty blockers on gender dysphoria, mental health issues — such as depression, anger and anxiety — and the recipients’ quality of life. Nice, which provides guidance and advice to improve health and social care, said: “The quality of evidence for these outcomes was assessed as very low certainty.”

It found that evidence for the clinical effectiveness and safety of cross-sex hormones was also of “very low” quality, adding: “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”

Neither review includes recommendations and both constitute advice, rather than formal Nice guidance.

In February, however, a study published in the BMJ cautioned that children aged 12-15 who were prescribed puberty blockers experienced reduced growth in height and bone strength by the time they finished their treatment at age 16. The findings were based on a study of 44 children treated at the Tavistock and Portman NHS Trust, which runs a gender identity development service.

Last December, in a case brought by Keira Bell against the Tavistock and Portman NHS Trust, the High Court ruled that under-16s could only consent to puberty blockers if they could “understand the nature of the treatment”.

But in a move regarded as partly undoing that ruling, the court decided last month that parents can consent to their child being given puberty blockers without applying for a court’s approval.