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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.