The government aims to evaluate the evidence surrounding puberty blockers and assess their risks versus benefits. This issue has sparked fierce debate. NHS England proposed in June 2023 that these drugs would only be prescribed through clinical research.
Health Secretary Wes Streeting has pledged to establish a clinical trial. Funding from the National Institute for Health and Care Research is expected soon. However, key questions remain: How should the trial operate, and is it ethical to test this on children?
A Rapid Increase in Referrals
The Gender and Identity Development Service (GIDS) was established in 1989 at London’s Tavistock Clinic. Initially, children referred to GIDS received psychological and social support. However, over the past decade, referrals surged, particularly among people assigned female at birth.
Puberty blockers, known scientifically as gonadotropin-releasing hormone (GnRH) analogues, halt the rise in sex hormones during puberty. These were initially prescribed to patients with gender dysphoria. However, in March 2024, NHS England banned routine prescribing for under-18s due to insufficient evidence of safety and effectiveness.
The Cass report criticized GIDS for shifting focus from psychological support to medical interventions. Other European countries, such as Scotland, Finland, and Sweden, have paused or re-examined the use of these drugs. Despite this, some countries maintain their support for the treatment.
The Ethical Dilemma
The ethics of conducting a trial on children remain contentious. Some argue that existing evidence suggests puberty blockers benefit mental health. This has led groups like the World Professional Association for Transgender Health (WPATH) to oppose clinical trials. They believe the trial would deprive children in gender distress of vital, evidence-based treatments.
Conversely, other researchers highlight that studies supporting these drugs are limited and inconclusive. There are concerns about side effects like reduced bone density and impacts on brain development. Dr. Louise Irvine, co-chair of the Clinical Advisory Network on Sex and Gender, cautions against prioritizing political motives over scientific inquiry.
Professor Gordon Guyatt supports clinical trials, arguing that without rigorous testing, the debate will remain polarized. Many studies lack strong evidence, and randomized trials are crucial to answering fundamental questions about safety and efficacy.
How Will the Trial Work?
The trial is expected to recruit participants in 2025. Its design is still under discussion. Possible models include:
- Placebo vs. Intervention: Randomly assigning participants to either receive puberty blockers or a placebo.
- Delayed Administration: Giving drugs to one group after a delay while the other group receives psychological support.
- Observation of Specific Groups: Some participants might socially transition while participating in the trial to isolate other variables.
The goal is to evaluate how these drugs impact mental health, social factors, and physical development. Side effects like changes in bone density and cognitive effects must also be factored into the analysis. Researchers may study brain scans and other metrics to assess outcomes.
Parent and Community Perspectives
Parents are closely monitoring the trial’s development. Annabel (not her real name), a parent in the Bayswater Group, expresses concerns about the trial’s design and its potential outcomes. She worries that the trial might not provide sufficient evidence to guide medical decisions.
Natacha Kennedy, a lecturer at Goldsmiths, University of London, highlights that some parents may not be willing to enroll their children in placebo groups. Desperation and concerns over access could lead parents to find other ways to obtain these drugs.
The trial’s ethical implications and research design will likely continue to prompt intense debate. Many parents, carers, and researchers are eager to see whether this trial will clarify the long-term effects of puberty blockers.
The Future of Puberty Blockers
The trial will take time, and its conclusions will significantly influence the debate. Questions about how these drugs impact mental health, fertility, and overall development will likely remain unanswered for years. For now, the trial remains a crucial step toward understanding the effects of these medications.
Annabel and other parents believe that long-term follow-ups are essential. The effects of puberty blockers on children’s mental and physical health must be fully understood. Many families await the trial’s findings and its implications for their children’s future medical decisions.
