NHS to Tighten Rules on Puberty Blockers, Social Transitioning of Children’s Gender

The Tavistock Centre in London in an undated file photo. (Aaron Chown/PA)

Puberty blockers will only be given to children under a formal research protocol, new draft guidelines published on Thursday by National Health Service (NHS) England said.

The draft “interim service specification for specialist gender dysphoria services for children and young people” also restricted the encouragement of using “social transitioning”—such as using pronouns inconsistent with one’s biological sex and adopting the appearance of the opposite sex.

It is part of NHS England’s transition from having a single gender identity development service (GIDS) centre to multiple regional centres as the existing GIDS at the Tavistock and Portman NHS Foundation Trust is set to close by next spring after an official report in February found issues around safety.

The interim review on Tavistock GIDS was carried out by top British paediatrician and past president of the Royal College of Paediatrics and Child Health Dr. Hilary Cass.

At the time, Cass expressed deep concerns about the affirmative model, concluding that primary and secondary care staff have had to adopt an “unquestioning affirmative approach.”

Two Phase 1 services will be set up to replace the Tavistock center, one in London and one in the Northwest.

They will operate under the interim service specification until new service specification is formed in 2023/24 after Cass publishes her final report.

NHS England said it will collect feedback on the draft guidelines until Dec. 4.

In the draft (pdf), NHS England clarified that social transition should “only be considered where the approach is necessary for the alleviation of, or prevention of, clinically significant distress or significant  impairment in social functioning and the young person is able to fully comprehend the implications of affirming a social transition.”

NHS England said the change is in line with Cass’s recommendation that “early social transition” should be viewed as an “active intervention” rather than “a neutral act” because “it may have significant effects on the child or young person in terms of their psychological functioning.”

The guidance added that “gender incongruence” in young children, which it defines as “a discrepancy between birth-assigned sex and gender identity,” does not persist into adolescence in most cases.

Regarding hormone treatment, NHS England said it’s developing proposals for prospectively enrolling children and adolescents into a formal research programme “with adequate follow-up into adulthood,” and that it will only commission GnRHa (gonadotropin-releasing hormone agonist), a type of puberty blocker, in the context of a formal research protocol.

Four “substantive” changes are included in the draft.

Experts in paediatric medicine, autism, neurodisability, and mental health will be added to the clinical team currently comprised of specialist social workers, family therapists, psychiatrists, psychologists, psychotherapists, paediatric and adolescent endocrinologists, and clinical nurse practitioners.

The new draft guidance also specified that the clinical lead for the service will be a medical doctor, while current guidance doesn’t make such specification.

Changes are made to the progression through the clinical pathway to make it more “structured,” and GPs and NHS professionals will have to be involved in the referrals to GIDS.

Owen Evans contributed to this report.