Govt warn of puberty blocker “scandal” – but have they learnt the lessons?

The prescription of puberty blockers to vulnerable, gender-confused children is one of the greatest medical scandals of our age. It is encouraging that Health Secretary Wes Streeting has woken up to this.

Earlier this month, Mr Streeting announced that the temporary ban on puberty blockers, introduced by the previous Conservative Government, will be made permanent. Addressing the House of Commons, he said: “It is a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.”

The decision follows the recommendation of the Commission on Human Medicines, which determined in the current prescribing environment there is “an unacceptable safety risk”.

It also aligns with advice provided by Dr Hilary Cass earlier in the year. Her landmark independent report into NHS gender services for children stated that a systematic review “found no evidence that puberty blockers improve body image or dysphoria, and very limited evidence for positive mental health outcomes” – some of the main reasons cited for prescribing the drugs.

This is welcome news. But it’s deeply concerning that some children will still be able to access the experimental drugs through a clinical trial, the scale of which is yet to be determined.

This must not be the end of the matter. There must be an urgent inquiry to establish exactly how we ended up in a situation where children were, without clear evidence, being prescribed drugs which studies have suggested could cause damage to bone density and brain development.

We need to learn the lessons.

What is clear is that, at least in part, this scandal occurred because medicine was allowed to become ideologically driven rather than evidence-led. Believing in the inalienable right of a gender-confused child to access puberty blockers became a shibboleth – with those taking a more questioning approach branded ‘transphobes’.

Mr Streeting admits that the political culture created a situation where young people and their families were led to believe that puberty blockers were the “gold standard” treatment. As a result of this assumption, the Commission on Human Medicine found that children and families were not given enough time and information to give their full and informed consent.

And according to Dr Cass, clinicians working in gender services have been afraid of “what colleagues might say if they speak up” in favour of a more “cautious or exploratory approach”.

Nevertheless, despite the move to ban puberty blockers, the Government stands on the brink of continuing all the same mistakes. Its proposed law on conversion therapy would simply cement the ideological culture that led to the scandal in the first place.

A law would have a chilling effect on those who want to take a more cautious approach.

In the Australian State of Victoria, official guidance on their ‘conversion therapy’ law initially stated that parents “refusing to support their child’s request” for puberty blockers could be guilty of an offence. Whilst this sentence was removed after significant pushback, the codification of an affirmative-only approach to gender treatment remains.

The UK Government say they want to create exemptions for clinicians exploring gender treatment. But that misses the point. A law would embed a culture of fear.

Dr Cass has already sounded the warning. Speaking to The Guardian, she explained: “all I can say is you absolutely have to avoid anything that’s going to frighten people more”.

She said she had been “really clear with the Government that any legislation would have to take inordinate care to not make workforce problems worse than they are”.

New fault lines are already beginning to emerge. During Mr Streeting’s statement, some MPs were already pressing the Government on broadening access to clinical trials for puberty blockers.

It is clear where this may go. Could clinicians or parents sceptical about encouraging children to participate in any trials be accused of ‘conversion therapy’?

Labour say they want to learn the lessons and are “committed to the full implementation of the Cass review”. But unless they drop their ‘conversion therapy’ proposals, there is a real risk that another scandal is just around the corner.