The government has promised to determine if puberty blockers are safe and effective for children questioning their gender. This remains one of the most debated issues in modern medicine. The focus is whether these drugs, which delay puberty, offer more benefits than potential harms.
A Complex Issue Under Investigation
In June 2023, NHS England proposed restricting puberty blockers to children as part of clinical research. Now, Health Secretary Wes Streeting has pledged to set up a trial to gather evidence. The National Institute for Health and Care Research is expected to confirm funding soon. However, questions remain about how the trial will function and its ethical implications.
The idea has raised significant debate. Some experts question whether conducting a trial on children is even ethical. Additionally, there is no consensus on how to structure the study, and experts must determine the risks involved.
Rising Referrals and Controversies
The Gender and Identity Development Service (GIDS) opened at the Tavistock Clinic in 1989. At first, children received psychological and social support. Over the past decade, the number of referrals has risen sharply, primarily among those assigned female at birth. Alongside this, treatments like puberty blockers began to be prescribed.
Known scientifically as gonadotropin-releasing hormone (GnRH) analogues, puberty blockers suppress the rise in sex hormones like testosterone and estrogen. These drugs were originally prescribed for young people with gender dysphoria. However, in March 2024, NHS England halted routine prescribing under 18s due to insufficient evidence about their safety and effectiveness.
The recent Cass report criticized the shift away from psychological support toward medical interventions. Dr. Hilary Cass pointed out the lack of robust evidence supporting these drugs’ long-term effects. Other countries, such as Finland and Sweden, have re-evaluated their use, highlighting international uncertainty.
Ethical Concerns and Views on the Trial
The ethical debate centers on whether a clinical trial would harm or help vulnerable children. The World Professional Association of Transgender Health (WPATH) argues that trials may be unethical. They believe the drugs are medically necessary and potentially life-saving. Conversely, other clinicians worry about risks like bone density reduction and brain development changes.
Dr. Louise Irvine, co-chair of the Clinical Advisory Network on Sex and Gender, expresses concerns about political influences overshadowing science. She argues that these trials must justify their risks with proven benefits.
Professor Gordon Guyatt suggests that randomized trials are essential to provide evidence in areas with uncertainty. Without more research, debates will remain polarized, fueled by opinions rather than facts.
How the Clinical Trial Could Work
The trial’s design remains undecided. Recruitment is expected to begin in 2025, though delays are likely. Participants would undergo a full assessment by specialist clinicians before joining. The goal is to compare mental health and quality of life in groups receiving and not receiving puberty blockers.
Some researchers suggest using randomized groups. For instance, one group would receive blockers while the other would take a placebo or delay their treatment. Others oppose placebo groups, arguing that participants would drop out or seek other sources of blockers.
Professor Guyatt proposes a trial comparing groups with delayed versus immediate drug intervention. This could show if timing matters or if psychological support can reduce gender distress on its own.
Parents Express Unease
Many parents are watching these developments closely. One mother, part of the Bayswater Group, shares concerns about medical interventions. Her daughter chose not to use puberty blockers, citing insufficient evidence about the risks and long-term effects. Parents like her fear that trial results may continue to lack clarity.
Natacha Kennedy, a researcher at Goldsmiths, University of London, points out that many parents may not accept participation in a placebo group. She believes parents might seek alternative pathways if trials fail to meet their expectations.
Long-Term Questions Remain
While the trial could eventually answer critical questions, much remains unknown. Will it provide clear evidence on the physical and mental health effects of puberty blockers? Will it show which children benefit most and which are at risk? Furthermore, how many might later detransition, as some studies suggest?
Parents and researchers emphasize the importance of long-term follow-up. They argue that children cannot fully understand the implications of fertility changes or other side effects resulting from these treatments.
As the trial nears, families and clinicians alike await answers. The ethical, medical, and personal stakes remain high.