Puberty blockers for trans kids under fresh scrutiny as NHS issues ban

Australia’s children’s hospitals are increasingly being left as international outliers as Britain’s NHS moves to ban the routine prescription of puberty blockers in trans children.

The Tavistock and Portman NHS Foundation Trust is due to close this month.

Australia’s major children’s hospitals have distanced themselves from the growing questions over the prescription of hormone drugs to children in the wake of a ban by UK health authorities on the routine prescription of puberty blockers to young teenagers.

The Royal Children’s Hospital in Melbourne - despite being the setters of quasi-national standards of care that incorporate the prescription of hormone blocker drugs to children in the early stages of puberty - refused to respond to the English National Health Service’s move to restrict the prescription of puberty blockers to clinical trials, the move mirroring growing doubts over the safety and clinical effectiveness of the hormone drugs in a host of European countries.

The NHS released a statement saying “we have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time” and announced the drugs will only be able to be prescribed as part of clinical trials. The decision is in line with a central recommendation of pediatrician Hillary Cass following an extensive examination of the care being provided to children at London’s Tavistock clinic in the wake of clinical governance concerns raised by doctors and patients.

The RCH had no response to the development when asked, but the Premier’s department said via a spokesperson that it backed the gender service’s model of care absolutely.

“Our gender clinics offer some of the most vulnerable young people in our community the support they deserve – we’re fiercely proud of the important work they do,” a department spokesperson said.

Queensland health minister Shannon Fentiman also declined to engage with the questions raised by the NHS ban, issuing a statement saying that the Queensland Children’s Gender Service - which is currently under review - “is considered one of the best in the country, based on the best available evidence”.

“All trans young people deserve access to high quality and timely healthcare and that is something we are committed to continue providing,” Ms Fentiman said.

NSW Health Minister Ryan Park said NSW Health “continues to monitor developments in the evidence”.

One of the nation’s most experienced child psychiatrists, George Halasz, who has become increasingly alarmed at the growing prevalence of the prescription of puberty-blocking drugs in young teenagers amid a model he does not believe sufficiently explores psychological complexities in patients, has now demanded the RCH publish its data on patient outcomes to inform debate.

“We’re not about ideology here, we’re talking about medical evidence,” Dr Halasz said. “There are great gaps that are appearing in all of the scientific studies emerging over the past year. In this climate I would question why are hospitals in Australia or state health departments refusing to disclose the data that should be available to support its case. That’s the way science proves its efficacy and safety and the risk benefit ratio for any treatment.”

The Cass review found that an ideologically-driven approach at the Tavistock had essentially transplanted usual clinical governance and that children were being rushed onto the drugs and placed on a medical pathway that almost invariably progressed to the later prescription of cross-sex hormones and sometimes surgery.

International evidence has mounted since the interim findings of the esteemed pediatrician were handed down in Britain, with several progressive countries that had wholly embraced gender-affirming care instituting greater restrictions and safeguards and launching reviews into the model’s evidence base. Some of the original Dutch researchers who published the first papers on puberty blockers in the treatment of gender-questioning children – that provided the evidence upon which the gender-affirming model is based, including in Australia – have now questioned their own findings, prompting the Netherlands parliament to commission fresh research.

There are concerns around the drugs’ impact on children’s brain development, bone mineral density, and potentially their future fertility and sexual function especially when the patients progress onto cross-sex hormones.

Last year Norway’s independent healthcare investigator, the Norwegian Healthcare Investigation Board, declared gender-affirming care “experimental” and a major Finnish study found gender-affirming care did not change suicide outcomes for patients with clinical gender dysphoria. Westmead’s published research has questioned whether the gender-affirming care pathway results in better mental health outcomes for those who progress to transition at all.

In a response to the interim findings of the Cass review 18 months ago, Royal Children’s Hospital Melbourne doctors Ken Peng and Michelle Telfer wrote in the British Medical Journal, that Dr Cass had ignored international consensus around the prescription of puberty blockers, noting it would “take many years to obtain these long term data” and that it was legitimate to proceed on the basis of “professional consensus”.

Australia’s peak psychiatry body has also recently also put forward an increasingly cautious view.