Silke Mayr The government has promised to examine evidence and determine if puberty blockers’ benefits outweigh their risks for children questioning their gender. This issue remains one of modern medicine’s most sensitive and divisive topics.
In June 2023, NHS England proposed that puberty blockers should only be prescribed as part of clinical research. Now, with a new government and Health Secretary Wes Streeting at the helm, efforts are underway to establish a trial. The National Institute for Health and Care Research is expected to confirm funding soon. However, many questions remain about how the trial will proceed.
Ethical Dilemma and Research Challenges
The trial has no clear plan. Experts must determine if the drugs will harm participants physically or psychologically. There is also debate over whether it is ethical to conduct this trial on children at all.
Some scientists argue that puberty blockers improve mental health, making it unethical to deny them in a controlled trial. The World Professional Association for Transgender Health (WPATH) opposes the trial for similar reasons. They believe restricting access during a study could harm children suffering from gender distress.
Others argue there is insufficient evidence proving any mental health benefits. They highlight risks such as changes in brain development and reduced bone density. Dr Louise Irvine of the Clinical Advisory Network on Sex and Gender warns of the risks associated with disrupting natural puberty.
Professor Gordon Guyatt supports conducting trials. Without robust evidence, “philosophies, attitudes, and politics will dominate the debate.” He stresses that randomized trials should address these questions scientifically to end the ongoing controversy.
Dr Hilary Cass has criticized the lack of quality research and long-term studies. She also highlighted that many children may transition to other treatments after starting puberty blockers, complicating research conclusions.
How Will the Trial Work?
Recruitment for the trial is expected to begin in 2025, later than anticipated. Several trial designs are being explored:
- Randomized groups comparing those who receive blockers versus those given a placebo.
- A delayed treatment approach, where one group receives blockers later and first receives psychological support.
- Creating a “matched” control group not using blockers or a placebo for comparison.
The goal is to study both the potential benefits and harms, including impacts on mental health, education, self-esteem, and physical health risks like changes in bone density or brain development.
Parents are expressing concerns. Annabel, a member of the Bayswater Group of parents, questions whether the trial will answer their concerns or add more uncertainty. Her daughter rejected puberty blockers, wary of their physical and mental health implications.
Many parents fear that their children may refuse to participate if given only a placebo. Natacha Kennedy from Goldsmiths, University of London highlights parental desperation and skepticism about the ethics of placebo trials.
There is also concern about long-term effects. Annabel points to fertility risks and other unknown consequences. The Cass report suggests that detransition numbers are increasing, adding complexity to the trial’s findings.
The debate surrounding the trial is ongoing, and its results could shape how puberty blockers are prescribed to children questioning their gender in the future. For now, parents, scientists, and policymakers await its outcome.