The recent NHSE decision to cease the prescription of puberty blockers to children is a step in the right direction for child safeguarding but ministers must now close the remaining loopholes which allow minors to access puberty blockers through medical trials and private provision. 

The tragic effects of puberty blockers are best illustrated by the case of Keira Bell. When she was just fifteen, Keira was referred to the NHS’s Gender Identity Development Service (GIDS), The Tavistock, where she was diagnosed with gender dysphoria. By the time she was 16 she was put on puberty blockers. A year later she received testosterone shots, and when she was 20 she had a double mastectomy in which her breasts were surgically removed. Shortly after this, Keira realised that she was not in fact a boy, as she had been told by professional clinicians at GIDS, but a lesbian woman.

She began the process of detransition and took legal action against the clinic for their prescription of puberty blockers to her when she was just a child. Four years after the service was first rated “inadequate” by inspectors in 2020, GIDS is finally due to close at the end of the month. Despite this, between 2021-2022 more than 5,000 children have been referred to the service, many of them young girls who developed rapid onset gender distress in their early teens. During this time, children referred to the clinic have been prescribed drugs intended to “pause” or block puberty. They were promised that these interventions were reversible, with no long-term unwanted side effects.

There is very limited evidence of mental health improvements and no data about the long-term impacts of the treatment

The puberty blockers prescribed to gender questioning children have also been used to chemically castrate sex offenders and to treat prostate cancer in men. They are licensed in the treatment of precocious puberty in very young children for a short period. There is almost no research regarding their efficacy in “pausing” puberty in teens. The first children given puberty blockers were part of an early intervention study on the efficacy of the long-term use of puberty blockers to treat gender dysphoria in 2011. Disturbingly, before any data emerged from this study, the decision was made to roll out these experimental medications to children as young as “nine or ten” at the clinic.

Research has now found that puberty blockers can lead to infertility, the loss of future sexual function, profound harms to bone health, and many other unanticipated side effects. There is very limited evidence of mental health improvements and no data about the long-term impacts of the treatment. The drugs have not been shown to allow children to “pause” or “delay” a decision. In fact, 98 per cent of children who take blockers never withdraw from puberty suppression and go on to take cross sex hormones.

In guidance published earlier this month, NHS England have finally announced a cessation of the prescription of puberty blockers to children. They “have found that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available”.

This landmark decision follows extensive work by Policy Exchange on child safeguarding. In “Asleep at the Wheel: An Examination of Gender and Safeguarding in Schools”, Policy Exchange revealed that there is a major safeguarding blind-spot when it comes to the issue of sex and gender. This is jeopardising the safety and wellbeing of children. Decisions about child safeguarding have been made on the basis of contested beliefs about gender identity, not informed by evidence. The decision by NHS England to cease mass experimentation on young children with puberty blockers is a vote in favour of the evidence-based safeguarding Policy Exchange has repeatedly called for. 

While these changes represent a significant intervention, they do not go far enough to protect children. The NHS have acknowledged that there is “not enough evidence” that puberty blockers are safe or effective. Nevertheless, they will still be prescribing blockers to boys aged 16 years or old seeking to transition to become women.

More concerningly still, it is widely understood that the NHS plan to begin a study into the use of puberty blockers on children before the end of this year, pending ethical approval. Puberty blockers have now been prescribed by the NHS for over ten years. The first children to receive blockers did so as part of a study with University College London Hospitals. In this study, 34 per cent of children were found to have deteriorating mental health while only 29 per cent improved. Tens of thousands of children have now been prescribed puberty blockers across the world. Rather than embarking on another potentially harmful study, the NHS should analyse outcomes for these children. The NHS have been experimenting on children with this treatment since 2011. A further study is not needed.

Despite the NHS decision, private clinics are still permitted to prescribe “gender-affirming” hormones to children as long as they are over the age of 16. Gender Plus, a private clinic which employs at least nine former GIDS staff, have already received license to prescribe masculinising and feminising hormones to private patients. 

It is currently legal for private healthcare providers to prescribe hormones for children aged just 16. Private clinics registered outside of the UK may still be able to prescribe puberty blockers to children off label through online pharmacies. Due to a lack of safeguarding many very young children are able to get puberty blockers and hormones over the internet through “unofficial” routes.

Gender GP, an organisation registered in Singapore, continues to offer private prescription of cross-sex hormones and puberty blockers through online pharmacies in the UK. Dr Helen Webberly, who runs Gender GP, states on her website that “GenderGP will not be following the NHS guidance”.

The government has taken a significant step to ensure child safeguarding, but they must ensure that these loopholes are closed, and that no more children are put at risk. Ministers must step in to prevent the NHS from experimenting on children and serious regulations should be brought in to prevent puberty blockers from being prescribed to children under any circumstances.