Puberty blockers: Can a drug trial solve one of medicine's most controversial debates?

Deborah Cohen
BBC
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It is among the most delicate and controversial challenges in modern medicine - how to determine whether the benefits of puberty blockers (or drugs that delay puberty) outweigh the potential harms.

This question came to the fore in June 2023 when NHS England proposed that in the future, these drugs would only be prescribed to children questioning their gender as part of clinical research.

Since then, a new government has arrived in Westminster and Health Secretary Wes Streeting has said he is committed to "setting up a clinical trial" to establish the evidence on puberty blockers. The National Institute for Health and Care Research is expected to confirm soon that funding is in place for a trial.

The dilemma that remains is, how will such a trial work?

Eighteen months since the announcement there is still a lack of consensus around how the trial should be conducted. It will also need to be approved by a committee of experts who have to decide, among other things, whether what's being tested might cause undue physical or psychological harm.

But there is a second unanswered question that some, but by no means all, scientists have that is more pressing than the first: is it right to perform this particular trial on children and young people at all?


A rapid rise in referrals


When the Gender and Identity Development Service (GIDS) was established at London's Tavistock Clinic in 1989, it was the only NHS specialist gender clinic for children in England, and those referred there were typically offered psychological and social support.

Over the last 10 years, however, there has been a rapid increase in referrals - with the greatest increase being people registered female at birth. In a separate development, around the same time the approach of typically offering psychological and social support moved to one of onward referrals to services that prescribed hormone drugs, such as puberty blockers.

Known scientifically as gonadotropin-releasing hormone (GnRH) analogues, puberty blockers work on the brain to stop the rise in sex hormones - oestrogen and testosterone - that accompany puberty. For years, they were prescribed to young patients with gender dysphoria (those who feel their gender identity is different from their biological sex). But in March 2024, NHS England stopped the routine prescribing of puberty blockers to under 18s, as part of an overhaul of children's gender identity services.

NHS England said in a policy statement: "There is not enough evidence to support the safety or clinical effectiveness of PSH [puberty suppressing hormones] to make the treatment routinely available at this time."

The ban was later tightened to apply to private clinics as well.

PA
Dr Hilary Cass published her final report in April 2024

In April 2024, a review of gender identity services for children and young people, led by Dr Hilary Cass, a past president of the Royal College of Paediatrics and Child Health, published its final report, which called out the "field of gender care" for not taking a cautious and careful approach.

She also reported that the change in practice at GIDS away from one primarily relying on psychological and social support was largely based on a single study that looked at the effect of medical interventions such as puberty blockers on a very narrowly defined group of children and there was a lack of follow up in the longer term.

Elsewhere, some other countries were re-examining puberty blockers too. Scotland paused the use of them while Finland, Sweden, France, Norway, and Denmark have all re-evaluated their positions on medical intervention for under 18s - including puberty blockers - to differing degrees. In other places there is still support for the use of puberty blockers.

In medicine, when there is genuine uncertainty as to whether the benefits of a treatment outweigh the harms - called equipoise - some ethicists argue there's a moral obligation to scientifically study such treatments. But there are some from across the debate who don't think there is equipoise in this case.

The ethical dilemma at the heart of the trial


The BBC has learned details about the arguments going on around the concept of a trial and how it could look. Some argue that there is already evidence that puberty blockers can help with mental health, and that in light of this it would be unethical to perform a trial at all because this would mean some young people experiencing gender distress would not be given them.

The World Professional Association of Transgender Health (WPATH) has expressed their concern about the trial for this reason. They support the use of puberty blockers, cross-sex hormones and surgery. WPATH, who have faced increasing criticism of their guidelines from some clinicians, say that it is ethically problematic to make participation in a trial the only way to access a type of care that is "evidence based, widely recognised as medically necessary, and often reported as lifesaving."

Meanwhile other clinicians believe there is no good evidence that puberty blockers can help with mental health at all. They also point to research that questions the negative impact that the drugs might have on brain development among teenagers, as well as evidence around the negative impact on bone density.

Dr Louise Irvine is a GP and co-chair of the Clinical Advisory Network on Sex and Gender which says it is cautious about using medical pathways in gender dysphoric children. She says: "Given that puberty blockers by definition disrupt a crucial natural phase of human development, the anticipated benefits must be tangible and significant to justify the risk to children.

"In pushing ahead with a puberty blockers trial, we are concerned that political interests are being prioritised over clinical, ethical and scientific concerns, and over the health and wellbeing of children."

The NHS adult gender services holds data that tracks 9,000 young people from the youth service. Some argue that this should be scrutinised before any trial goes ahead as it could provide evidence on, among other things, the potential risks of taking puberty blockers.

But there is a third view held by some others, including Gordon Guyatt, a professor at McMaster University in Canada, who points out that randomised trials are done in "life-threatening stuff all the time" where no-one can be sure of the long-term effects of a treatment. In his view it would be "unethical not to do it".

"With only low quality evidence, people's philosophies, their attitudes or their politics, will continue to dominate the discussion," he argues. "If we do not generate better evidence, the destructive, polarised debate will continue."

- Dr Cass found the existing research in the field was poor quality and that there was not a reliable enough evidence base to base clinical decisions on. Young people involved in many of the existing studies may have also had interventions including psychological support and other medical treatments and so it was not always possible to disentangle the effect of each different treatment.

- When it comes to suppressing puberty by using drugs, the rationale for doing so "remains unclear", Dr Cass said. One of the original reasons given was to allow time to think by delaying the onset of puberty. But the evidence suggests the vast majority who start on puberty blockers go on to take cross-sex hormones - oestrogen or testosterone. It is not clear why but one theory, the Cass report suggests, is that puberty blockers may, in their own right, change the "trajectory" of gender identity development.

• - Clinicians "are unable to determine with any certainty" which young people "will go on to have an enduring trans identity", Dr Cass wrote. In other words, there's a lack of clarity about which young people might benefit in the long term and which may be harmed overall by the process.

How the trial could look


Recruitment for the trial is due to start in 2025, months later than originally anticipated. Young people will likely be referred after a full assessment by specialist clinicians. A lot is still to be determined, including how many participants there will be.

Ultimately the scientists running the trials will need to establish whether people who get an intervention are better off than those who do not. In this case, do the puberty blocking drugs and their effect make the young people better off?

"Better off" in this instance includes the extent to which a young person's mental health may be improved if they are happy with their body. Quality of life is determined by various factors including self-confidence and self-esteem. As well as getting the personal views from the young people and parents, the trial could measure actual real life changes, such as time spent in education and time spent with family and friends.

But there are potential harms to study too, such as the possibility of reduced bone density. Some scientists suggest examining the impact on learning using a form of IQ test.

Normal brain development is influenced by both puberty and chronological age, which usually act in tandem during adolescence. It's not clear how this is affected when puberty is suppressed. Brain scans are one way of understanding any effect.

Some scientists believe it may be possible to simply randomly assign trial participants into two groups where one gets puberty blockers, the other gets a placebo and nobody is aware which group they're in.

But others believe a placebo group is impossible. They say the placebo group would go through puberty, realise they weren't on puberty blockers and potentially drop out of the trial or even find other ways to obtain puberty blockers. Either scenario would reduce the validity of the results.

Professor Gordon Guyatt and others have outlined a potential trial where the group of patients not receiving drugs would be made up entirely of children who are keen to socially transition, such as by changing how they dress and altering their name and pronouns. Researchers could then monitor the difference between the groups.

A second possibility is that both trial groups are given puberty blockers but one group gets them after a delay, during which time they receive psychological and emotional support. This would help researchers determine, among other things, whether their gender-related distress subsides during that delay while receiving the support.

Alongside this there would be a "matched" control group that doesn't take a placebo or puberty blockers, whether for health reasons or because they don't want to, that get similar tests and scans.


The Gender and Identity Development Service (GIDS) was established at London’s Tavistock Clinic in 1989


Puberty occurs in stages when different bodily changes occur. A third proposal could involve a second group being given drugs at a later stage in puberty than the first.

This would allow researchers to explore when the right time to give puberty blockers might be. For example, it would enable the researchers to see if starting the drugs early improves wellbeing by reducing gender-specific body changes. They would also be able to see whether starting the drugs earlier has a greater negative impact on bone density and brain development.

Children referred to GIDS also experienced higher rates of anxiety, depression, eating disorders, and autism compared to the general child population. Trial participants would continue to receive treatment related to these conditions but - so we know any differences in the results from the groups are down to the drug - they will need to be balanced for the above conditions.

All these considerations demonstrate the complexity of trying to obtain evidence in this area that is reliable and definitive.

What parents say


Many parents are watching closely to see how it will play out. Annabel (not her real name) is one of them. She is part of the Bayswater Group, a collection of parents with children who are questioning their gender who say they are "wary of medical solutions to gender dysphoria". She began looking into puberty blockers when her own daughter began questioning her gender in her early teens, an option put on the table by GIDS.

Ultimately her daughter decided not to take them. Annabel was not convinced there was enough evidence to show they were beneficial and she was unsure what it would mean for her daughter's long-term physical and psychological health.

Today, she still has unanswered questions - including some further ones around the trial. "A big concern for me is will this new trial, if it gets approval, give us the evidence that we want? Or will we end up with more weak data that Dr Cass said undermined decision making in this area?"

Natacha Kennedy, a lecturer at Goldsmiths, University of London who researches transgender issues, has examined the results of a survey of 97 parents of young people with gender-related distress that took place following the puberty blockers ban. She believes that puberty blockers should be an option available for young people questioning their gender and that many will not accept being part of a placebo group in a trial.

"These parents are desperate and if [they] get to a trial and it turns out their child is not being given the actual puberty blockers, then there is no point in them being there," she says.

"There may be some parents who would… find another way [to obtain the drugs]."

Whatever trial format is settled on, more scrutiny will follow. And there will no doubt be fierce debate about the merits of the trial and what it can tell us, as many scientists around the world are watching to see what happens in the UK.

But inevitably, there will be a long wait to fully understand the longer term effects on physical and mental health of those who take puberty blockers - and the long-term effects on those with gender-related distress who don't. Nor do we know how many people detransition, though the Cass report says, "there is suggestion that numbers are increasing".

"We really need to have long-term follow up," argues Annabel. "Can a child possibly understand what that means to their fertility and a loss of sexual function and what that will mean for their future life?"

For now, she and the scores of parents, carers and young people, can only watch and wait for the trial to begin and for its verdict - and what that means for whether puberty blockers will be prescribed to children once again in the future.


Deborah Cohen is a former BBC Newsnight health correspondent and is a Visiting Senior Fellow at LSE Health.

Top image: Getty

LA REVUE GAUCHE - Left Comment: Search results for Tavistock

Analysis
Debunking myths about puberty blockers for transgender children

Chloe Kent

10 September 2020 (Last Updated August 25th, 2020 17:03)

Puberty blockers are drugs that may be given to young people with gender dysphoria, to prevent them from going through a puberty that doesn’t match their gender identity. They’re a physically reversible intervention, and if a young person stops taking the blockers their physical adolescence will continue to develop as it had done previously – but the drugs have proven controversial and there’s a lot of misinformation out there. Chloe Kent reports.

What are puberty blockers and why might a young person want to be prescribed them? Credit: Shutterstock.

In January, papers were lodged at the British High Court against the Tavistock and Portman NHS Trust, which runs the UK’s only gender identity development service (GIDS).

The claimants against the Trust want to establish a legal minimum age of 18 for puberty blocking hormone therapy for young people diagnosed with gender dysphoria, with their lawyers arguing that it is illegal to prescribe the drugs to anyone younger as they cannot give informed consent to the treatment.

The case has been brought about by the parent of a 15-year-old on the GIDS waiting list known as Mrs A, who does not believe children can understand the ramifications of taking puberty blockers. Alongside her is a 23-year-old woman named Keira Bell, who transitioned to male as a teenager but has since detransitioned and believes she should have been challenged more by GIDS during the process.


So-called puberty blockers, known formally as gonadotropin-releasing hormone (GnRH) antagonists, are medications that cause the body to stop producing sex hormones. They are delivered either as leuprorelin injections, which are administered by a healthcare worker every three months, or via a histrelin implant, which needs to be replaced annually.

The GnRH antagonists bind to receptors in the pituitary gland, blocking the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the anterior pituitary. This leads to suppression of testosterone production in the testes or the suppression of estradiol and progesterone production from the ovaries, depending on the anatomy of the individual taking them.



For young trans people, taking these drugs will prevent things like breast tissue development and periods, or the growth of facial hair and a deepening voice. The effects of drugs are completely reversible, and if a person stops taking them their body will resume sex hormone production as it had done before they started.

As well as being used to suppress puberty in gender-questioning youth, they’re used from the age of six onwards for the management of precocious puberty, when a child’s body enters adolescence too early. GnRH antagonists are also used to treat prostate cancer, as part of IVF fertility treatment and for the management of uterine disorders such as endometriosis or fibroids. They’re even being investigated as a treatment for women with hormone-sensitive breast cancer, as a treatment for benign prostatic hyperplasia and as a potential contraceptive.
Why might a young person want puberty blockers?

Gender dysphoria – the sense of unease arising from one’s physical sex characteristics not aligning with one’s gender identity – can be just as unpleasant for young people as it is for adults.


Pacific University Oregon co-director of child psychology Dr Laura Edwards-Leeper says: “The impact of going through the wrong puberty for a child who is transgender can be devastating, as their body feels as if it is out of their control and changing in a way that is incongruent with their gender identity. This can lead to a host of psychological problems, most often depression, anxiety, low self-esteem, self-harming behaviours and suicidality.”

When puberty blockers are used to delay or prevent these changes, they’re essentially used to buy time. They’re primarily intended to give young gender-questioning people a few years to weigh up their options before going through any permanent bodily changes, whether those are through hormone replacement therapy (HRT) to induce a puberty which corresponds with their gender identity, or discontinuing the blockers altogether and allowing puberty to proceed as it would have done without any intervention.

“It is important that the young person fully understands that they can change course at any time and that no one will be disappointed in them or feel that they made ‘a mistake’ or ‘didn’t know who they were’ when they made the decision to start blockers,” says Edwards-Leeper.

“Parents, other family members, providers, friends and peers and school staff need to understand this as well, so that the young person does not feel boxed in. Just as we do not want trans youth to feel pressured into being cis, we don’t want gender diverse youth to feel pressured into being trans if they ultimately feel that this does not fit for them.”
How are puberty blockers prescribed in the UK?

While many people who oppose the use of blockers maintain that drugs are given out too readily, most patients actually face a lengthy waiting period. In November 2019, doctors in the UK GIDS were beginning initial consultations with patients who had been referred in September 2017, more than two years beforehand. Even then, puberty blockers won’t be prescribed immediately.

Val, a 19-year-old transfeminine student, came out at 13 and had her first appointment with the UK GIDS soon after, but didn’t receive puberty blockers until she was 17.

“I think the thing I find really distasteful is all the things in the media about how they’re fast-tracking trans people,” she says. “I’m like, ‘they’re not!’. During that process you have to put your life on hold. It’s like an axe that’s hanging above your head all the time and you don’t know when it’s going to drop and it’s terrifying. Puberty blockers allow trans teenagers to finally get back to living their lives. They just give you peace of mind.”

More than 5,000 young people are currently on the GIDS waiting list, and according to a BBC investigation only 267 people under the age of 15 started using blockers between 2012 and 2018. While things differ internationally, the UK GIDS will not prescribe HRT to a young trans person unless they have spent 12 months on blockers and are at least 16 years of age.
Related Report



While it’s important to acknowledge that detransition does happen, what’s vital is that cases like Keira Bell’s are rare. Most recent studies estimate the overall detransition rate for trans people to be less than 4%.

“Far more trans kids live with lifelong impacts of decisions that we seem to be making based on one cis kid who gets referred accidentally,” says Val.
Do puberty blockers have any serious side effects?

Puberty blockers are safe as far as can be determined from the experience of non-transgender children who take them or women undergoing fertility treatments who take them,” says Mount Sinai Center for Transgender Medicine and Surgery executive director Dr Joshua Safer.

Like all medications, the blockers are still known to have some side effects, including weight gain, hot flashes, headaches and swelling at the site of injection. There also may be more long-term effects on bone density, which is part of the reason the drugs aren’t supposed to be prescribed for too long.

Safer explains: “The primary concern is that bones might be at greater risk of osteoporosis because bones depend on sex hormones for maintenance. That need is part of the reason that women typically are at risk for osteoporosis earlier than men, as women go through menopause and suffer a loss of sex hormones while men don’t typically have a similar significant hormone change. But the risk is hard to see when only taking puberty blockers for a year or two.”

It’s also worth noting that there is a relationship between puberty blockers and fertility. Sperm production typically begins between 13 to 14, and egg maturation between 12 to 13, and the vast majority of trans children will begin puberty blocker treatment after these processes have already occurred.

In these cases, sperm or eggs can be frozen before treatment and may be used to conceive a child in later life. If a young person decides not to transition after all and ceases puberty blocker treatment, the Endocrine Society advises that no studies have reported long-term, adverse effects on ovarian function. For people with testicles, sperm numbers can fall below the normal range in some cases.

Things are slightly different for the small number of trans children who may undergo puberty blocker therapy before sperm or egg maturation occurs and then immediately begin HRT. As they will be unable to have a sperm or egg sample frozen, they don’t have the same fertility preservation options that children who start taking blockers when they’re slightly older would have.

“The concern is hormone treatment would have to be stopped in order to restore fertility later were it desired – perhaps for many months,” says Safer. “The concern is part of the reason for puberty blockers – to allow time to have the conversations that will allow reasoned choices being made regarding hormone therapy.”

Of course, any medical decision which could have an impact on fertility is one that requires a lot of time and care to consider. However, many trans people find the way the impact on fertility is used to argue about the ethics of trans healthcare inherently problematic.

Val says: “It’s something that gets brought up and is very much rooted in the idea that if you are infertile that is somehow lesser and you are lesser of a person, which is not at all correct.”
Gillick competence and the future of trans healthcare

In England and Wales, the term ‘Gillick competence’ is used in medical law to decide whether a child under the age of 16 is able to consent to their own medical treatment, without the need for parental permission or knowledge.

It means that the legal authority for parents to make medical decisions on behalf of their children is revoked when the child reaches sufficient maturity to make their own decisions. There is no hard-and-fast age at which a child can be considered ‘Gillick competent’, and it is something decided on a case-by-case basis.

The claimants in the ongoing UK court case against Tavistock and Portman believe that Gillick competence should not apply when it comes to gender reassignment, with their solicitor telling The Guardian: “We say it is a leap too far to think that Gillick as a judgment could apply to this type of scenario, where a young person is being offered a treatment with lifelong consequences when they are at a stage of emotional and mental vulnerability. It simply doesn’t compute, and therefore whatever medical professionals say is consent is not valid in law.”

Yet, a study published this year in the journal Pediatrics found that access to puberty blockers can be life-saving, reducing the chances of suicide among young trans people, who are at much greater risk of this than the general population. It’s hard to see how revoking Gillick competence for a reversible, life-saving treatment stands up from a medical ethics standpoint.

While many parents and carers of transgender children understandably worry about what the future holds for their kids in a world that isn’t especially kind to gender nonconforming people, that worry should never be allowed to become so overwhelming that they seek to strip away essential health services out of fear.

A representative of UK trans children’s charity Mermaids says: “The important thing to remember is that all journeys and identities are valid, and by supporting your child, they will be able to continue along this journey knowing you love and care about them, whoever they are and whatever they choose to do.”

https://www.pharmaceutical-technology.com/features/debunking-myths-about-puberty-blockers-for-transgender-children/

Lone dissenter calls Texas Supreme Court transgender ruling ‘cruel, unconstitutional’

Matt Keeley, The New Civil Rights Movement
June 29, 2024

Texas Supreme Court (AFP)

The lone justice to dissent called the Texas Supreme Court ruling to uphold the ban on gender-affirming care for minors "cruel" and "unconstitutional" Friday.

The Texas Supreme Court, currently made up of all Republican justices, decided 8-1 to uphold a ban on providing gender-affirming care, including puberty blockers, to transgender people under the age of 18. The Court said that it did "not attempt to identify the most appropriate treatment for a child suffering from gender dysphoria," claiming it to be a "complicated question" for doctors and legislators.

The Court ruled that even though "fit parents have a fundamental interest in directing the care, custody, and control of their children free from government interference," that interest is bound by "the Legislature’s authority to regulate the practice of medicine."

READ MORE: Republican Gov. Mike DeWine Vetoes Anti-Trans Bill After Talking to Families With Trans Kids

"[W]e conclude the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment and the Legislature’s express constitutional authority to regulate the practice of medicine," Justice Rebeca Aizpuru Huddle wrote.

Justice Debra Lehrmann, the only justice to dissent, was clear in her disagreement. She wrote that the decision means "the State can usurp parental authority to follow a physician’s advice regarding their own children’s medical needs." Lehrmann identified that gender-affirming care can be "lifesaving."

She also mocked the idea that the Court's ruling didn't "deprive children diagnosed with gender dysphoria of appropriate treatment." Lehrmann pointed out that by upholding the law, it "effectively forecloses all medical treatment options that are currently available to these children ... under the guise that depriving parents of access to these treatments is no different than prohibiting parents from allowing their children to get tattoos."

"The law is not only cruel—it is unconstitutional," she wrote, calling the ban a "hatchet, not a scalpel."

Lehrmann also put the lie to the claims by anti-LGBTQ activists that surgery is common for transgender minors.

"Indeed, the leading medical associations in this field do not recommend surgical intervention before adulthood. Without a doubt, the removal of a young child’s genitalia is something that neither the conventional medical community nor conscientious parents would condone," she wrote. "Moreover, medical experts do not recommend that any medical intervention ... be undertaken before the onset of puberty."

Lehrmann is correct. Prior to puberty, transgender care is basically limited to social changes. For example, wearing gender-affirming clothing and using appropriate pronouns, according to Advocates for Trans Equality.

Puberty blockers can be prescribed for those who are starting puberty. Puberty blockers are safe, according to Cedars-Sinai, and are not only used for transgender youth. A common purpose is to stop precocious puberty, which affects 1 in 5,000 children, including children as young as 6. For both transgender youth and kids going through precocious puberty, puberty blockers are known to improve patients' mental health, according to the Mayo Clinic.

Puberty blockers are also fully reversible. However, in terms of trans youth, a study published in The Lancet found that 98% of those on puberty blockers went on hormone replacement therapy upon turning 18. But even for those few teens who realize after being on puberty blockers that they aren't trans, all they have to do is stop taking them, and their puberty will progress as normal.

THE LANCET
Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands

Maria Anna Theodora Catharina van der Loos, MD
Sabine Elisabeth Hannema, PhD
Daniel Tatting Klink, PhD
Prof Martin den Heijer, PhD
Chantal Maria Wiepjes, PhD

Published:October 20, 2022

DOI:https://doi.org/10.1016/S2352-4642(22)00254-1
VOLUME 6, ISSUE 12, P869-875, DECEMBER 2022

Summary

Background

In the Netherlands, treatment with puberty suppression is available to transgender adolescents younger than age 18 years. When gender dysphoria persists testosterone or oestradiol can be added as gender-affirming hormones in young people who go on to transition. We investigated the proportion of people who continued gender-affirming hormone treatment at follow-up after having started puberty suppression and gender-affirming hormone treatment in adolescence.

Methods

In this cohort study, we used data from the Amsterdam Cohort of Gender dysphoria (ACOG), which included people who visited the gender identity clinic of the Amsterdam UMC, location Vrije Universiteit Medisch Centrum, Netherlands, for gender dysphoria. People with disorders of sex development were not included in the ACOG. We included people who started medical treatment in adolescence with a gonadotropin-releasing hormone agonist (GnRHa) to suppress puberty before the age of 18 years and used GnRHa for a minimum duration of 3 months before addition of gender-affirming hormones. We linked this data to a nationwide prescription registry supplied by Statistics Netherlands (Centraal Bureau voor de Statistiek) to check for a prescription for gender-affirming hormones at follow-up. The main outcome of this study was a prescription for gender-affirming hormones at the end of data collection (Dec 31, 2018). Data were analysed using Cox regression to identify possible determinants associated with a higher risk of stopping gender-affirming hormone treatment.

Findings

720 people were included, of whom 220 (31%) were assigned male at birth and 500 (69%) were assigned female at birth. At the start of GnRHa treatment, the median age was 14·1 (IQR 13·0–16·3) years for people assigned male at birth and 16·0 (14·1–16·9) years for people assigned female at birth. Median age at end of data collection was 20·2 (17·9–24·8) years for people assigned male at birth and 19·2 (17·8–22·0) years for those assigned female at birth. 704 (98%) people who had started gender-affirming medical treatment in adolescence continued to use gender-affirming hormones at follow-up. Age at first visit, year of first visit, age and puberty stage at start of GnRHa treatment, age at start of gender-affirming hormone treatment, year of start of gender-affirming hormone treatment, and gonadectomy were not associated with discontinuing gender-affirming hormones.

Interpretation

Most participants who started gender-affirming hormones in adolescence continued this treatment into adulthood. The continuation of treatment is reassuring considering the worries that people who started treatment in adolescence might discontinue gender-affirming treatment.

Funding
None.

U.S. Supreme Court will rule on trans treatment bans, a decision expected to impact Florida law

The closely watched case is almost certain to affect similar laws in Florida and more than a dozen other states


By Dara Kam, News Service of Florida 

on Tue, Jun 25, 2024 

Photo by Matthew LehmanThe U.S. Supreme Court on Monday agreed to decide whether a Tennessee law restricting puberty blockers and hormone therapy for transgender children is unconstitutional, in a closely watched case that is almost certain to affect similar laws in Florida and more than a dozen other states.

Justices will hear the case in the fall, with a decision likely coming in June or July 2025.

The Biden administration in November filed a petition asking the court to consider whether the Tennessee law, which blocks doctors from ordering puberty blockers and hormone therapy for minors with gender dysphoria, violates equal-protection rights and is sex-based discrimination because the treatments are available for other purposes.

The “court’s intervention is urgently needed because Tennessee’s law is part of a wave of similar bans preventing transgender adolescents from obtaining medical care that they, their parents, and their doctors have all concluded is necessary,” U.S. Department of Justice lawyers wrote in the petition.

Monday’s decision to take up the case, known as United States v. Skrmetti, comes amid conflicting lower-court decisions over similar restrictions enacted in Republican-led states, including Florida.

U.S. District Judge Robert Hinkle this month ruled that a 2023 Florida law and regulations prohibiting the use of puberty blockers and hormone therapy to treat children for gender dysphoria and making it harder for trans adults to access care are unconstitutionally discriminatory and were motivated by “animus” toward transgender people.

Hinkle permanently barred Florida health officials from enforcing the law, which also carried heavy sanctions and potential jail time for doctors who violated the restrictions.

In a 101-page ruling, the judge wrote that “gender identity is real” and likened opposition to transgender people to racism and misogyny.

“The state of Florida can regulate as needed but cannot flatly deny transgender individuals safe and effective medical treatment — treatment with medications routinely provided to others with the state’s full approval so long as the purpose is not to support the patient’s transgender identity,” Hinkle’s June 11 ruling said.

Lawyers for the state last week asked the 11th U.S. Circuit Court of Appeals to put a hold on Hinkle’s ruling while Florida’s appeal plays out. A June 18 notice of appeal, as is common, did not detail arguments the state will make at the Atlanta-based appeals court. But the motion for a stay raised a series of arguments, including that putting the ruling on hold would prevent “irreparable harm” to the state and be in the “public interest.”

The state’s motion also pointed to debate about transgender treatment for minors at appellate courts in other parts of the country.

“At the very least, all must agree that the legal issues aren’t clearcut,” the motion said.

Shannon Minter, an attorney who represents plaintiffs in the Florida lawsuit, called the Supreme Court’s decision to rule on the issue a “huge victory.”

“They don’t take very many cases. It’s an indication of how important this issue is, and it should give hope to families across the country. Our nation’s highest court recognizes the significance of this issue. Now is our chance to let them hear from these families,” Minter, legal director for the National Center for Lesbian Rights, told The News Service of Florida in a phone interview.

The Florida lawsuit, filed last year by the parents of two transgender children and a transgender man, almost certainly will be put on hold until the Supreme Court decides the Tennessee case, Minter predicted.

The Tennessee law, which focuses only on children, prohibits all medical treatments intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”

U.S. District Judge Eli Richardson, who was appointed to the bench by former President Donald Trump, last year blocked the part of the Tennessee law that banned puberty blockers or hormone therapy. Richardson found that the ban violates constitutional guarantees of equal protection for people in similar situations, because it prohibits treatment for transgender adolescents that would be allowed for other adolescents.

But a split 6th U.S. Circuit Court of Appeals reversed Richardson’s ruling and reinstated Tennessee’s law and a similar prohibition in Kentucky. Plaintiffs in both cases, which the appeals court consolidated, and the Biden administration asked the Supreme Court to take up the issue.

The Supreme Court’s review “will bring much-needed clarity to whether the Constitution contains special protections for gender identity,” Tennessee Attorney General Jonathan Skrmetti said in a prepared statement.

"We fought hard to defend Tennessee's law protecting kids from irreversible gender treatments and secured a thoughtful and well-reasoned opinion from the Sixth Circuit. I look forward to finishing the fight in the United States Supreme Court,” he said.

The court’s decision to consider the case immediately drew widespread attention. But the pending review also created divisions within the LGBTQ legal community, especially among people wary of the conservative-leaning court.

Alejandra Caraballo, a transgender attorney who teaches at the Harvard Law School Cyberlaw Clinic, posted on X, that she thinks asking the Supreme Court to take up the issue “will turn out to be a generationally bad strategic mistake akin to Bowers v Hardwick,” referring to a 1986 Supreme Court ruling that said sodomy is not a constitutionally protected right and allowed states to outlaw it.

But Minter, who also represents plaintiffs in Kentucky’s lawsuit, said the issue is urgent and needs to be settled.

“We can’t let these incredibly harmful laws stay on the books, so really there’s no choice about the timing,” Minter told the News Service. “These laws are so damaging, so extreme, we have to challenge them and we’re doing so all across the country, generally with a lot of success, and when those victories are reversed by these appellate courts, we have to seek review.”

Minter also pointed to a 2020 decision by the Supreme Court in a case known as Bostock v. Clayton County establishing that discrimination against LGBTQ workers is unconstitutional.

“I am extremely optimistic about our chances in the Supreme Court. Yes, it is a conservative court. They have done many alarming things. At the same time, this is essentially the same court that decided the Bostock case very recently, and Bostock recognized that discrimination because a person is transgender is sex discrimination, and that is the main issue in this case,” he said.

South Dakota doctors who offer transgender kids hormone treatments and puberty blockers could face jail time if lawmakers pass a new bill

Canela López

ANGELA WEISS / Getty Images

South Dakota lawmakers voted Wednesday on a bill that would make it criminal for doctors to provide puberty-blockers, hormones, or any gender-affirmation surgeries to anyone under the age of 16. 

The bill is supported by social conservatives in the state's Republican-controlled legislature who say that transgender people under 16 are "too young" to make medical decisions about their gender identity. 

A recent study found that trans kids have a firm grasp of their gender identity. Another found gender-affirming care reduces rates of suicide among transgender youth.

On Wednesday, South Dakota's House passed a bill that would penalize doctors for providing gender affirmation treatments — like hormone treatments, puberty-blockers, and gender-affirming surgeries — to anyone under the age of 16.

If passed by the state Senate and ultimately signed by the governor, the bill would punish doctors with up to one year of jail time and a fine of up to $2,000.

Social conservatives in the state's Republican-dominated Congress who support HR 1057, like state representative Fred Deutsch, have said that transgender youth are "too young" to make life-altering medical decisions based on their gender identity.

Similar age-restricting bills have been proposed in seven other states: Missouri, Illinois, Kentucky, South Carolina, Colorado, Florida, and Oklahoma.

Experts say the bill could have grave consequences.

"This bill runs counter to a mountain of medical and social science literature that shows transgender youths' health significantly improve with access to supportive and gender affirming-health care, resulting in a reduction in suicide rates of transgender youth," Shawn Meerkamper and Dale Melchert, senior staff attorney and staff attorney for the Transgender Law Center, wrote in an email to Insider.
The law would ban young people from accessing puberty blockers, which delay body changes that can be traumatic and confusing

Klaus Vedfelt/Getty ImagesSupporters of the bill have likened HR 1057

 to pressing a "pause button" on transgender children receiving gender 

affirmation procedures until after they turn 16, rather than a ban.

Critics say it would do the opposite.

Parts of puberty, like growing breasts or body hair, can be traumatic for teens who do not identify with the gender they were assigned at birth. In many cases, it can trigger something called gender dysphoria, a condition in which a person feels like their body doesn't match their gender identity. Dysphoria has been linked to depression and anxiety and significantly increased risks of substance abuse and suicide.

To prevent or minimize dysphoria, doctors can prescribe puberty blockers, which halt puberty, allowing trans teens to make decisions about whether they want to take hormones to transition later in life, or not.

These procedures are not necessary for all transgender or non-binary people — many opt to not take hormones or have surgery at all. But for many, puberty blockers are extremely important for the mental health and safety of many other transgender and non-binary people. 

Gender-affirming care has been found to reduce rates of depression and suicide among transgender youth

Mark Makela/Getty Images

A study by doctors at Massachusetts General Hospital, published 

January 1 in the medical journal Pediatrics, found that

transgender youth who are able to take hormone blockers when they

 wanted to, rather than going through puberty, had significantly less

 suicidal ideations throughout their lifetimes than those who did not.

"Gender-affirming health care saves lives," Melchert and Meerkamper, who were not involved in the study, told Insider.

"Transgender youth are already up against astronomical rates of bullying, violence, and suicide, and they already face tremendous barriers to accessing health care. They don't need their state legislators piling on."

Keisling said that this kind of ban would prevent families, and their medical practitioners, from making life-saving, private medical decisions.

"These are parents who are just trying to do the best they can," Mara Keisling, executive director of the National Center for Transgender Equality, told Insider. "And this makes that harder. It makes it harder to live in South Dakota. It makes it harder to be a kid."
A recent study debunked the idea that under-16s are 'too young' to make medical decisions about their gender

Klaus Vedfelt/Getty Images

The bill says that transgender children are "too young" to know what their gender identity is for certain.

A recent study by Princeton University researchers, published in PNAS, found that transgender children who are able to "socially transition" — or live as the gender they identify with — develop a firm grasp of their gender identity at the same age their cisgender peers do.

Regardless of how long it had been since a transgender child had socially transitioned, they identified as strongly with the gender they are rather than the one they were assigned at birth as their cisgender peers did.

"We trust kids to tell us what their gender is unless they're trans kids," Keisling told Insider.

Read more:

Beauty YouTuber NikkieTutorials came out as a transgender woman in an emotional video. Here are 4 other trans YouTubers.

15 iconic moments in the LGBTQ rights movement from the last decade

A trans dad underwent $30,000 worth of fertility treatments to have a baby. He says his insurance company refused to pay.

LGBTQ+ organisations respond after UK puberty blocker ban extended to Northern Ireland

Alice Linehan
Fri, 23 August 2024 

This article is about a ban on puberty blockers extended to Northern Ireland. In the photo, the hand of a person holding a blue, white and pink sign that reads 'Protect trans lives' while marching at a protest. Via Shutterstock - Michael Tubi


LGBTQ+ organisations have responded after the puberty blocker ban currently in place in England, Scotland and Wales was extended to Northern Ireland. The news was announced by the UK government’s Department of Health and Social Care on Thursday, August 22.

The government’s statement reads: “The continuation of the ban applies to the sale or supply of these drugs, prescribed by private UK-registered prescribers for gender incongruence or dysphoria to under 18s not already taking them. It also prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland for any purposes to those under 18.”

The puberty blocker ban will come into effect in Northern Ireland from August 27, and BBC News NI reports that the order was signed off by the first and deputy first ministers without wider executive approval.


LGBTQ+ organisations Cara-Friend, The Rainbow Project, HERe, Belfast Trans Resource Centre and Mermaids collectively responded to the announcement, calling it “extremely disappointing” and adding that it “will undoubtedly cause harm to trans young people and their families who require this care”.

“Decisions around puberty blockers, and any other care for trans youth, must be made by young people, their clinicians and their family, not by politicians.

“We are seeking urgent clarification on why this decision was made, and are requesting meetings with Executive parties to chart a path forward where all trans people in Northern Ireland have access to timely, competent and accessible care that meets their needs.” the statement concluded.



Similarly, Trans and Intersex Pride Dublin wrote: “We must look at the ‘evidence’ that’s being used to justify the removal of healthcare for young trans people. The move to ban puberty blockers in the UK came after the Cass Review was published. We must be honest about what the review says and how it is being used.”

In a lengthy post on X, the organisation states that the Cass Review is “deeply flawed” and “disregards over 100 studies that show the safety and effectiveness of puberty blockers for trans youth”.

“The reality is puberty blockers and gender affirming care are life saving for trans youth,” the group continues.

“For the guaranteed protection and liberation of trans people and all exploited people, we need to fight oppression at its root. We need to build a grassroots movement that tackles the capitalist system head-on and fight for a better world for all.”



Up to this point, puberty blockers were only available for minors in Northern Ireland under NHS prescription. To qualify, patients must have been accepted to the Child and Adolescent Mental Health Services Gender Identity Service endocrine pathway prior to March 2020, and it is understood that the young people who remain in that category will continue to receive treatment.

For more information regarding the puberty blocker ban or for support, LGBTQ+ organisations like Cara-Friend, The Rainbow Project, HERe, Belfast Trans Resource Centre, Mermaids and Transgender Equality Network Ireland are here to help.

Gender surgeon says JK Rowling should ‘not comment on stuff that she doesn’t know much about’

Dale Fox
Thu, 22 August 2024 


Mr James Beringer has commented on JK Rowling's views on transgender issues (Image: YouTube/LadBible TV; WikiMedia/Dan Ogren)

A prominent UK gender surgeon has expressed concern over JK Rowling‘s public statements about transgender individuals, saying the author’s comments on trans issues are “somewhat ill-informed”.

In a video interview on LadBible’s YouTube channel, Mr James Bellringer, a consultant urologist specialising in gender affirming surgery in trans women, said he wished Rowling would “stick out of what I do and not comment on stuff that she doesn’t know much about.”

“It seems slightly unfair to use her privileged position to make, I think, somewhat ill-informed comment about this patient group,” he added, also saying, “I’m not going to try and write a children’s book tomorrow.”



Rowling, author of the Harry Potter series, has faced criticism for her stance on transgender issues. She has been critical of some aspects of trans activism, often expressing concerns about the erosion of women’s rights and single-sex spaces. Her comments have sparked accusations of transphobia, which she has denied.
“If you don’t offer them appropriate support, counselling and in the end, surgery, we think about one in five of them commit suicide” – Mr Bellringer on the importance of gender surgery

Mr Bellringer, who LadBible says in one of only four surgeons qualified to perform vaginoplasties in the UK, also noted that many trans individuals are at risk of suicide without appropriate support and surgery.

“If you don’t offer them appropriate support, counselling and in the end, surgery, we think about one in five of them commit suicide,” he explained.

The surgeon also highlighted the significant improvement in quality of life for many patients post-surgery. “Patients literally change overnight,” he remarked. “They report back immensely increased levels of satisfaction and happiness with their lives. It’s a huge, amazing change.”

JK Rowling was recently named in a cyberbullying lawsuit by Olympic boxer Imane Khelif, along with Elon Musk. It alleges “acts of aggravated cyber harassment” around Khelif’s appearance at the Olympic Games Paris 2024 this summer.

Khelif won women’s boxing gold a year after being disqualified from the World Championships, with her Olympic journey giving rise to misinformation and speculation around her gender.

JK Rowling’s team was approached by Attitude, but declined to comment.

The post Gender surgeon says JK Rowling should ‘not comment on stuff that she doesn’t know much about’ appeared first on Attitude.

Julia Malott: Politicizing the transgender debate does a disservice to gender dysphoric youth

Opinion by Julia Malott • 


In the wake of Alberta Premier Danielle Smith’s announcement of comprehensive reforms to the province’s transgender care protocols, a flurry of commentary has erupted, spanning a broad spectrum of opinions on the social and medical treatment of transgender youth.

The polarizing opinions largely align with partisan biases, offering either staunch support for, or vehement opposition to, the proposed policies. Astonishingly, there’s been scant exploration of the complexities inherent in such policies, which is a disservice to gender dysphoric children.

A nuanced understanding seems necessary, given that the irreversible nature of transitioning in childhood is matched by an equally consequential decision to forego such medical interventions until adulthood. Once sexual development has taken hold — whether through natural puberty or cross-sex hormones — irreversible changes happen to the body. The stakes are high with either outcome.

Unfortunately, a lack of nuance is starkly evident in our political discourse. Earlier this month, Conservative Leader Pierre Poilievre broke his silence on Alberta’s policy shift and weighed in on the use of hormone therapies and puberty blockers for minors. Yet his response was marked by contradiction and divisiveness.

He stated that, “We should protect children” and their ability to “make adult decisions when they become adults,” but also that, “We should protect the rights of parents to make their own decision with regards to their children.” Pressed further, he clarified that he is against puberty blockers for children. He then blamed the status quo on Prime Minister Justin Trudeau (who has been equally divisive in his own statements)

Poilievre’s contradictory statements ignore that a decision for a child not to undergo puberty blockers is itself a decision that cannot be undone in adulthood, because it results in profound changes to the body that cannot be completely reversed. It is those changes that lead a transgender adult to stick out in public and receive much of the negative attention they are often subjected to.

He also appeared to stumble on the contradictions inherent in Smith’s recent policy changes, which respect parental rights over social transitioning and sex education, but impose restrictions on hormonal treatments, even when consensus might exist between the child, its parents and medical professionals that such a treatment might be best.

(More recently, Poilievre stated his opposition to transwomen participating in women’s sports and using female-only spaces, such as change rooms and washrooms.)

The Conservative leader’s comments underscore the broader issue of transgender health care moving away from scholarly discussion and being dragged into the arena of partisan politics. As noted by York social work professor Kinnon MacKinnon and Pablo Expósito-Campos, writing in the Conversation , the resulting polarization and spread of misinformation may pose greater risks to gender-diverse individuals than the medical treatments in question.

The direction of our discourse mirrors past debates over abortion, which quickly became mired in political ideology. The abortion discussion became framed in terms that implied stark opposition between the “pro-choice” and “pro-life” camps, as if most Canadians are not broadly in support of both choice and life as guiding principles. In social politics, solutions lie in carefully balancing virtues, not pitting them against one another as though they’re diametrically opposed.


With minds already made up on whether a transition is to be celebrated or condemned, partisan players are all too comfortable making any case that will advance their position, with little consideration for the real-life consequences.

Statements from Conservative politicians continue to overlook Canada’s troubling history of LGBTQ+ abuses, which persist to this day, and are reluctant to recognize that one of the primary benefits of medical transitions in childhood — achieving more seamless post-transition integration as one’s affirmed gender — can significantly mitigate the challenges faced by transgender individuals who are marginalized in a society that’s deeply divided by these political debates.

On the other end of the political spectrum, progressive voices have yet to acknowledge the medical risks and regrets involved in transitioning, acting as though every desire professed by a child is unquestionably flawless. These narratives from progressive quarters have painted medical transitioning as a straightforward, low-risk endeavour with negligible regret rates, framing it moreso as a journey of self-discovery.

Progressive resources have been leaned upon heavily under current policy. Juno Dawson, in her influential work, “This Book Is Gay,” which is considered a top resource for LGBTQ+ youth, addresses this topic directly. Dawson states that, “There is no such thing as ‘sex changes for kids.’ It doesn’t happen. If a young trans or non-binary person wants medical intervention (many do not) … they will have extensive counselling before possibly being prescribed a course of hormone blockers that delay the onset of puberty.

“All this means is that if that individual chooses to make permanent physical changes as a young adult, they won’t then have to counteract the bodily consequences of puberty, ie., breasts, a deeper voice, etc. It basically saves them a lot of time on a surgeons table at a later date.”

While Dawson highlights the benefits of puberty blockers for those who continue their transition into adulthood, her vacuous portrayal simplifies the medical process involved in prescribing these treatments. Contrary to the rigorous medical review one might expect, Canadian health-care providers, operating under an affirmation-first model, often face pressure to prescribe puberty blockers without extensive vetting.

This approach, aimed at avoiding crossing into conversion-therapy practices, relies on the principle that one’s professed gender identity must always be affirmed, even by medical professionals. Dawson’s reassurance that permanent changes are deferred until adulthood also overlooks the significant issue of infertility resulting from the use of puberty blockers, as they prevent the attainment of reproductive maturity.

Our conversation around transgender youth care needs to be more thoughtful and medically grounded, and politicization does not lend well to that endeavour. Several European countries have recognized potential shortcomings in the current standards of gender-affirming care and have embarked on systematic reviews of the medical literature to ensure evidence-based approaches that prioritize the well-being of gender dysphoric youth.

This is a discussion that would be better to have within the medical community, rather than the political sphere. We should follow the evidence of where gender-affirming care yields powerfully positive life-changing outcomes for gender dysphoric youth, while also taking a cautious approach in deference to the profound nature of these interventions.

Wouldn’t that service gender dysphoric youth better than the politicization of their health care?

National Post

 

Hormone therapy reshapes the skeleton in transgender individuals who previously blocked puberty

Bioscientifica Ltd

Skeletal size may be altered by gender-affirming hormone therapy only if puberty has also been suppressed during adolescence, according to research presented at the 62nd Annual European Society for Paediatric Endocrinology Meeting in Liverpool. The findings from this research, carried out by Amsterdam UMC, not only help researchers further understand the roles sex hormones play on the skeleton but may also improve counselling on gender-affirming treatment in transgender individuals.

Skeletons of men and women vary in size and proportion. For instance, men typically have broader shoulders while women have a wider pelvis. Gender-affirming hormones are used to better align an individual’s physical appearance with their gender identity. What’s more, puberty blockers (gonadotrophin-releasing hormone analogues) can be used to delay or prevent the changes associated with puberty in transgender youth. However, how sex hormones affect the skeleton such as the shoulders and pelvis of transgender individuals is still unclear.

To investigate this, researchers from the Amsterdam University Medical Center (UMC) in the Netherlands analysed data on the shoulder and pelvis dimensions of 121 transgender women and 122 transgender men who were either undergoing gender-affirming hormone therapy – with or without previously taking puberty blockers – or had not taken any therapy.  The researchers found that only transgender men who had been treated with puberty blockers from early puberty, followed by hormone therapy, had broader shoulders and a smaller pelvic inlet (upper opening of the pelvis) compared to untreated individuals, while transgender women had smaller shoulders only after treatment from early puberty. In addition, transgender women under treatment had a larger pelvis, but this change was most noticeable in those who started blocking puberty earlier.

“To our knowledge, this is the first study to explore the effect of both gender-affirming hormones and puberty blockers on the pelvic dimensions,” said Ms Lidewij Boogers, a PhD student at Amsterdam UMC who led the study. “Shoulder width is only affected when puberty suppression is initiated in early puberty, while pelvic dimensions may be sensitive to hormonal changes even after puberty has ended.”

Ms Boogers added: “Since skeletal dimensions from individuals who started puberty suppression in early puberty were most similar to those of the affirmed gender, our findings suggest that irreversible skeletal changes occur during puberty.”

The researchers will next assess the extent to which physical changes that occur during puberty suppression and gender-affirming hormones impact body image and quality of life in transgender adolescents. “We are currently conducting a prospective study, with the collected data we aim to further evaluate the relation between physical changes and psychological outcomes in this population. This could help optimise treatment and improve counselling for individuals who seek treatment,” said Ms Boogers.

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Method of Research

Observational study

Subject of Research

People

 

‘What Wes Streeting gets wrong about puberty blockers’

Kaz Self   JULY 17,2024

As I listened to the Human League at Bristol Pride, the words from one of their songs resonated ‘I’m only human, of flesh and blood I’m made’. Those are words that we should all note when we talk about trans people. 

For far too long the trans community have been dehumanised, characterised as mentally ill or a threat to women and children, a similar playbook to that used against gay men many decades ago. The Tories and right-wing media have been responsible for making the lives of trans people a living hell, as I know only too well having changed my gender from male-to-female in 2018. 

With a new Labour Government it’s my hope that the culture wars might end, that NHS waiting lists will come down and that access to NHS dentistry will improve. I made the last two issues part of my campaign to successfully become the first openly elected trans woman councillor in Bristol in May 2024. 

Labour have made some important promises to the LGBT+ community in the manifesto, including a fully trans inclusive ban on conversion therapy and improved access to healthcare for trans people. I’ve been an active campaigner on these issues within my home city, organising protest gatherings and appearing on local TV.

I’ll never forget the time when I had a lesbian woman addressing the crowd right in front of me, recalling how she had lost a young trans friend to suicide – when she finished speaking we hugged with tears streaming from our faces. Nothing is more powerful than personal testimony.

And so it is with dismay that I hear that Wes Streeting has vowed to continue the ban on puberty blockers introduced by the Tories as a parting gift to punch down on the trans community.

Some reality about gender transition

It took me about 40 years to come to terms with my gender issues, throughout all that time I felt a great deal of shame and stayed very much in the closet. When I did finally accept my trans identity I never looked back – it was the best decision for me and I have no regrets. 

As part of my transition I’ve spent thousands of pounds on facial hair removal and private healthcare, as well as having some vocal therapy sessions, all the consequence of a male puberty.

READ MORE: Fresh party trans row as activists launches ‘alternative’ to LGBT+ Labour

I got a referral to an NHS gender identity clinic, but it took them five years to finally give me a first appointment. I regard myself as lucky to be seen, because in some regions the waiting time is much longer than this.

Fortunately we now live in more enlightened times and I find it joyous that people can come out as trans more readily and much younger. When like me you’ve talked to many, many trans people (I ran a trans pride for five years), you know that for some young trans people going through puberty can be a distressing experience.

We must remember that the number of people that identify as trans is very low, and those that identify as trans at an age lower than 16 are a miniscule proportion of the population. And it is because of my lived experience that I wholeheartedly condemn the ban on puberty blockers.

Questions that need to be asked

• Why is it acceptable for the medication used to prevent precocious puberty acceptable for this medical condition and yet unacceptable for trans kids? Do we have some special ‘trans blood’ that means the side effects are worse for us than others? Of course not, because of the same flesh and blood we’re all made. Why is it acceptable to ban puberty blockers on one cohort because of perceived harm without banning them from all?
• The Tories made trans people a wedge issue in their campaign (that went well didn’t it Rishi). People in power appoint people who will sing their tune; witness Trump’s appointment of Supreme Court judges in the USA. There are people like me who look at certain appointments and see the possibility of an inherent bias in decision making. Is the Cass report neutral and unbiased? There are many people that think the report is flawed too, including many experts in the field of trans healthcare.
• Since Victoria Atkins announced the ban on puberty blockers I am hearing more reports of young trans people that are self-harming and, disturbingly, there is also anecdotal evidence of an increase in suicide. From mental health support to improved access to trans healthcare, the new Labour Government has to act quickly to support trans people.
  

The number of trans people that take their own lives is shocking. When we talk about medical intervention it’s done with the intention of doing no harm. But we know that medicines and surgery have an inherent risk. At aged 15 I was advised to have my spleen removed, a huge surgical intervention.

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That operation significantly improved my life but had its own consequences, making me more vulnerable to infection. Covid was a terrifying time for me, so the availability of a vaccine that was relatively untested was a huge relief.

Medicine has to be based on risk and the balance of probabilities when it comes to deciding which path to choose. For most of us a simple aspirin will help with a headache, but this common medicine has its own risks. Whatever the medical intervention, we use our own knowledge to decide what is best, knowing the risks.

Gillick Competence is a clear principle by which medical intervention for under 16s applies. There are many instances where medicines are used ‘off-label’, indeed there are even NHS leaflets for it.  If young trans people and their parents aren’t capable of making decisions based on Gillick Competence then why is informed consent acceptable for some young people’s healthcare but not others?

The way forward

I would expect an incoming Labour Secretary of State for Health to be asking all the questions above.

The very real possibility of poor mental health and increased suicide rates of trans youth due to this unfathomable continuation of a spiteful Tory policy is too much for me to ignore.

The way forward for Wes Streeting isn’t just to blindly carry forward the doctrine from the outgoing Tories and their questionable Cass report, but to ask the basic questions above before making policy. I will continue to hold the Labour Party’s feet to the fire on this issue. Because trans kids’ lives are important to me. 

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Tags: prime Minister / Labour manifesto 2024 / UK Labour Party / general election 2024 / Rishi Sunak / UK politics / Labour Party Manifesto / Labour Government / Trans rights / Transgender / Keir Starmer / House of Commons / Chancellor / Wes Streeting / Trans / Polls / Parliament / Healthcare / Downing Street / Politics / Conservatives / manifesto / Government / Rachel Reeves / Gender / Labour / General Election / MPs / Policy / Elections / Labour Party / NHS

Kaz Self

Kaz Self is a Labour councillor for Southmead ward in Bristol. She is running to be an NEC (CLP) representative.

View all articles by Kaz Self