Use of puberty blockers on transgender children to be investigated by Lucy Bannerman in The Times 26.07.19

The original article is here.

Paediatricians are to investigate the controversial drug therapies used to halt the puberty of children who want to change gender.

The Royal College of Paediatrics and Child Health has asked its committee of experts to look at the ethics around the rapid increase in the use of hormone blockers to treat under-16s who identify as transgender.

It is the first time the issue has been formally addressed by the ethics and law advisory committee of the Royal College, which sets professional standards.

Puberty blockers are promoted by transgender lobby groups as a way of offering “breathing space” or a “pause button” to youngsters who are considering changing gender and may be distressed by the unwanted changes in their body.

Groups such as Mermaids and Gires, which support transgender people and their families, have claimed that delaying a young transgender person’s access to hormone blockers may increase their risk of suicide.

The claim is disputed by health professionals who have warned there is no robust evidence on the long-term safety of the drugs, which are only licensed in the UK to treat children who start puberty abnormally early, not to treat adolescents who wish to switch gender.

Their off-label use — using the drug in a way different to that described in the licence — to treat young people with gender issues was likened by one expert to “an unregulated live experiment on children”. Carl Heneghan, director of the Centre of Evidence-based Medicine at the University of Oxford, told The Times that there was a “paucity of evidence” for the “off-label use of drugs” in gender dysphoria treatment.

Blockers are physically reversible, in that natural puberty will resume if the drugs are discontinued, but their long-term effects on the teenage brain remain unknown. The vast majority of children who begin blockers go on to take cross-sex hormones, which will compromise their fertility, once they reach 16.

Mike Linney, registrar and chairman of the Royal College’s ethics and law advisory committee, said that the use of hormone blockers in this area of child health was a complex and important subject. “The Royal College of Paediatrics and Child Health’s ethics and the law advisory committee looks at a wide range of issues — new services, changes in scientific knowledge, new therapies and treatments for example — which impact paediatric care from an ethical position.

“The committee has been asked to review the topic of gender dysphoria from an ethics standpoint, looking at knowledge, management and the ethical thinking behind current approaches. This includes discussing the issue of puberty blocking.”

The move by the Royal College follows a Times investigation in April, which highlighted the ethical concerns of clinicians who had resigned from the Gender Identity Development Service (Gids), the NHS’s only specialised clinic for transgender children.

It also comes amid growing pressure on Gids which is run by the Tavistock and Portman NHS Foundation Trust, to release the results of a study it began in 2011, tracking the effects of blockers on 44 youngsters wishing to change gender. The findings have yet to be published. Meanwhile, the clinic has referred thousands of children for hormone therapies.

Critics have accused the clinic of suppressing negative results but the clinic says it was waiting for the last patient in the study to make a decision about moving on to cross-sex hormones.

It says it is finalising the data, which will soon be published in a peer-reviewed journal.

A Tavistock spokesman said: “The Gid service is a thoughtful and safe service, caring for vulnerable young people and their families and our commitment is to them at all times. The Care Quality Commission, our care standards regulator, and our national commissioners monitor our service very closely. Our service specifications are set nationally by an expert group.

“All young people considering the puberty blocker or cross-sex hormones are repeatedly made aware of the known potential impacts of these medical interventions, as described above, as well as the areas of impact that remain to some extent unknown. This allows young people and parents to take time to weigh up and think about their options.”