Reform use of puberty blockers

The question facing Australia’s health ministers is whether vulnerable young people distressed about their gender are entitled to care based on high-quality scientific evidence. This is an internationally urgent question and now we have a clear answer from the UK Health Secretary, Wes Streeting, who has announced an indefinite ban on puberty-blocker drugs, apart from a proposed clinical trial.

The rationale for that ban – and for England’s landmark 2020-24 Cass Review of care for gender-distressed minors – is that the evidence for puberty blockers is too weak and uncertain to be confident that minors taking these drugs will do so safely and with beneficial outcomes.

Puberty blockers are hormone-suppression drugs used with regulatory approval for other conditions such as precocious (or premature) puberty and prostate cancer. The Dutch pioneered their use with gender dysphoria, whereby the naturally timed puberty of children as young as age 10-12 is suppressed, supposedly to give them time to consider what was thought to be the more momentous decision to proceed to cross-sex hormones.

But the data now suggests puberty blockers may lock in gender distress and be a one-way path to lifelong medicalisation. There is increasing concern, too, about the effect of blockers on the still-developing adolescent brain.

The unprecedented and rapid increase in gender-distressed teenagers – chiefly girls, many with pre-existing mental health problems – has been driven by puberty blockers internationally, and Australia is no exception. Multiple systematic reviews of evidence for this off-label use of puberty blockers – in the absence of regulatory approval – have been undertaken independently in Finland, Sweden and the UK since 2019.

All concluded the evidence for hormonal treatment of minors with gender distress is weak and uncertain. There is no dodging the international relevance of Mr Streeting’s remarks in the House of Commons: “It is a scandal that medicine was given to vulnerable young children without the proof that it is safe or effective or through the rigorous safeguards of a clinical trial.” Before deciding upon an indefinite ban he consulted the UK Commission on Human Medicines, and was advised that prescribing puberty blockers for gender dysphoria was “an unacceptable safety risk”.

Health Minister Mark Butler should bring his state counterparts together to discuss an urgent review. It should interrogate failings that have led to children being exposed to experimental hormone treatment. It would drive more accurate media coverage, so Australians can fully understand the imperative for reform. Gender-nonconforming minors deserve better; they need high-quality care.