As a result of a public consultation by the National Institute for Health and Care Excellence, NHS England has recently announced that it will cease to prescribe puberty blockers to children with gender dysphoria.
Here, Maya Born, McAlister Family Law Paralegal, explores what this new legislation means and how it will impact children with gender dysphoria.
Gender dysphoria describes ‘a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity’ and Puberty Blockers are medicines which may be prescribed to prepubescent or pubescent children to temporarily slow down puberty. The objective being to provide children with gender dysphoria with more time to consider their gender and receive professional support before undergoing permanent gender reassignment surgery.
In recent years, there has been a significant increase in children questioning their gender. Between 2021-2022, 2585 referrals were made to the UK’s Gender Identity Development Service. At the same time, there has been an increase in research on the long-term consequences of blockers with many arguing that suppressing puberty can result in long term psychological and physical harm.
What are the disadvantages of puberty blockers?
Perhaps the most prominent reason for the NHS decision to stop prescribing blockers is due to the lack of research and longitudinal studies that have been undertaken on the use of such medicines to slow down puberty.
Further, the studies that have been completed show, that blockers can have several serious physical impacts such as weight gain, decreasing bone mineralization and impacting brain development. There are also links between taking blockers and the development of mental health issues such as anxiety and depression. Additionally, the association between those with gender dysphoria and autism is particularly high.
What are the advantages?
Other studies have found that hormone blockers can significantly improve the mental health of children struggling with their gender identity, helping reduce their anxiety surrounding puberty and giving them time to consider their options. Further, many argue that blockers are reversible and that once children stop taking blockers, their bodies will develop as usual.
The Gillick competence test is the medical principal used by medical practitioners to establish whether children (under 16) have capacity to consent to medical treatments. It consists of several aspects that practitioners must consider when assessing a child’s competence to understand the medical decision at hand, such as the nature and implications of the treatment and the implications of not pursuing the treatment.
In accordance with NHS England and English Law, until now the Gender Identity Development Service used the Gillick competence test to establish whether the child has necessary capacity to consent to blockers.
However, perhaps the new NHS regulation suggests there is growing uncertainty over whether the NHS agree that the Gillick competence test is sufficiently robust in relation to puberty blockers and suggests that Gillick is not applicable to assessing children’s capacity in all medical dilemmas.
What does this mean for children with gender dysphoria?
As a result of this new regulation, puberty blockers will no longer be routinely prescribed until more research is done into their long-term impact on children. Only children who partake in clinical research will be able to receive puberty blockers.
However, those who are already receiving puberty blockers will not have their treatment withdrawn. Similarly, blockers may be available via private healthcare gender clinics.
For Parents and Carers of children with gender dysphoria
For those Parents and Carers who have a child who is suffering with gender dysphoria, there are many ways you can support them without the use of puberty blockers.
Educate yourself – research gender dysphoria and puberty blockers to understand what your child is going through. It would be helpful to find out what support is available from local services and the child’s school. Young minds and Barnardo’s are both great charities which offer information and advice to young people and families. You can also read through and familiarise yourself with Dr Hillary Cass’ Review commissioned by NHS England.
Ask your child their pronouns and use them when addressing your child – show your child that you respect them
Seek professional support –children with gender dysphoria often feel especially distressed when preparing or undergoing puberty as their body undergoes drastic physical changes that may not align with how they feel inside. It is important to make an appointment with your GP who then may make referrals to gender identify clinics.
