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Britain limits use of puberty-blocking drugs to research only

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Britain limits use of puberty-blocking drugs to research only

By Azeen Ghorayshi

June 9, 2023 4:40 p.m. ET

In the news

Britain's National Health Service announced on Friday that it would restrict the use of puberty-suppressing drugs to children enrolled in clinical trials. The move comes as the agency's pediatric gender services struggle to keep up with growing demand.

A document explaining the NHS's reasoning stated that "there is insufficient evidence to support their safety or clinical efficacy as a commonly available treatment".

The NHS had published a draft of this policy change in October, but Friday's announcement officially instituted the new approach after months of public comment. The policy will come into effect later this year.

The NHS announced last year that it would close the Tavistock Gender Identity Development Service in London after the clinic experienced a surge in referrals.Credit...Peter Nicholls/Reuters

Why it matters: Other countries have also restricted drugs

The move is part of a wider initiative in several countries to restrict gender-related medical treatment for young people. Following reviews of the evidence, Finland has begun to restrict access to sex-related treatments, and Sweden has restricted the use of puberty blockers and hormones to clinical trials. A Norwegian health organization and the French National Academy of Medicine have also called for caution.

In the US, more than 20 Republican-led states have passed laws banning the use of puberty-blocking drugs and hormones, some making it a crime for doctors to prescribe them. Hundreds of clinicians across the country - including some who have raised concerns about which teens should receive gender-based treatments - have denounced the bans, saying such decisions should be made by patients, their families and their doctors. Background: Data on the effect of blockers is scarce

Last year, the NHS announced it would close the country's only gender clinic for young people after an external review showed that Tavistock's Gender Identity Development Service had been unable to provide appropriate care for the growing number of teenagers seeking gender treatment. The clinic has seen a sharp increase in referrals, from 250 young people in 2011 to 5,000 by 2021.

Puberty blockers, which work by suppressing estrogen and testosterone, were first tested on children with gender dysphoria in the Netherlands in the 1990s. Dutch researchers published their first study on 70 children in 2011, finding that adolescents reported a reduction in depression and anxiety after taking the drugs.

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Apple knows you didn't mean to type 'dodge' But a British study of Tavistock patients published in 2021 showed that blockers had no effect on children's scores on psychological tests. The study revealed that 43 of the 44 participants subsequently chose to start testosterone or estrogen treatments. One interpretation of the data is that all were good candidates for hormone therapy. But the figures raised concerns in the NHS about whether the drugs were serving their purpose of giving teenagers time to think.

"The most difficult question is whether puberty blockers actually offer valuable time for children and young people to consider their options, or whether they effectively lock "children and young people into a treatment pathway," wrote Dr Hilary Cass, a paediatrician overseeing the independent review of the NHS gender service, last year.

Britain to start trial of children taking blockers

The NHS is organizing a clinical trial for all children receiving puberty blockers from the health service, with recruitment due to begin in 2024.

Although the Tavistock clinic has been closed, regional centers are opening across Britain to extend gender-related services for young people. The NHS said the new system for treating minors with gender-related problems will establish standardized assessments and incorporate much more mental health support.

"The main aim is to alleviate the distress associated with gender incongruence and promote the overall functioning and well-being of the individual," said NHS guidelines.

Azeen Ghorayshi covers the intersection of sex, gender and science for The Times.



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