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On 12 March 2024, following a review of a public consultation and in the face of the many unknowns and concerns raised by an independent study, the British health service (NHS) officially announced that puberty blockers would no longer be routinely dispensed as treatments for gender dysphoria in minors*. At present, "there is insufficient evidence of the safety or clinical effectiveness" of these treatments, said the NHS.
In 2021-2022, there were more than 5,000 referrals to the Gender Identity Development Service (GIDS) run by Tavistock and Portman NHS Foundation Trust (compared with 250 in 2011-2012). In response to this increase in cases, the NHS has asked Dr Hilary Cass, former President of the Royal College of Paediatrics and Child Health, to conduct an independent review of gender services for minors. In 2022, an interim report from this study warned of the dangers of systematically prescribing puberty blockers, as their long-term effects on the physical and mental health of minors are unknown.
The report mentions in particular the fact that these treatments, by hindering the usual process of psychological and sexual development, could lock minors into an impossible decision, leaving them with no choice but to continue with heavy medical treatment. A study carried out in the Netherlands and quoted in the report shows that almost all children and young people taking puberty blockers continue with sexual hormone treatment (96.5%). By cutting them off from the psychological, physiological, neurochemical and sexual environment that accompanies hormone surges in adolescence, these treatments could have an impact on the maturation and cognitive development of children and adolescents. This raises the question of whether these minors can make a truly free and informed choice. Finally, among the side effects of puberty blockers, the study mentions a short-term reduction in bone density. As for the long-term musculoskeletal impact, data is still lacking.
In response to these findings, the UK health service has called for the closure of the gender identity development service at Tavistock and Portman NHS Foundation Trust by 31 March 2024. The NHS has also commissioned a clinical study focusing on children with gender dysphoria in order to offer them better care. This study will also help to inform the decision-making of minors and their families when it comes to interventions that may have lifelong consequences.
*In England, triptorelin is used for minors who want to change their gender. This hormone originally had marketing authorisation for the treatment of prostate cancer, endometriosis and precocious puberty. In 2014, this hormone began to be given to children and adolescents suffering from gender dysphoria, although its efficacy and safety for this type of condition have not been clinically demonstrated. The treatment prevents the spontaneous release of two puberty-inducing hormones, follicle stimulating hormone (FSH) and luteinising hormone (LH), from the pituitary gland in order to delay the development of secondary sexual characteristics (notably deepening of the voice and hair growth in boys, and breast development and menstrual cycles in girls).