The Australian Professional Association for Trans Health (AusPATH) was established in 2009 and is Australia’s peak body for professionals involved in the health, rights and wellbeing of all trans people – binary and non-binary. The AusPATH membership comprises over 600 experienced professionals working across Australia.
The NHS England has recently released a Clinical Policy advising that “Puberty suppressing hormones (PSH) are not available as a routine commissioning treatment option for treatment of children and young people who have gender incongruence / gender dysphoria.” In this policy document, it is stated that a Policy Working Group commissioned by the NHS has concluded “that there is not enough evidence to support the safety or clinical effectiveness of puberty suppression hormones to make the treatment routinely available at this time”. They recommend “that access to puberty suppressing hormones for children and young people with gender incongruence/dysphoria should only be available as part of research”.
AusPATH has significant concerns about this decision by NHS England, and the negative impact that it is likely to have on young gender diverse people in the UK. It is our opinion that the NHS England is undertaking an enormous and unprecedented public health experiment on children with no safeguards.
The onset of puberty is a time that can cause significant distress for a young gender diverse or gender questioning person, as their body undergoes changes that may be out of alignment with their identity. The aim of puberty suppressing hormone treatments is to temporarily halt pubertal development, allowing more time for a young person to decide on the gender pathway that is right for them.
Puberty suppressing hormone treatments have been in use for decades in a variety of clinical contexts, including in the treatment of precocious puberty in young children. They are widely considered to be safe, and their effects reversible. When used in the treatment of gender incongruence, PSH are very carefully monitored and only initiated after thorough assessment by a health professional.
AusPATH notes that there is no mention of removing publicly funded access to puberty suppression in other clinical scenarios, such as in the treatment of precocious puberty. This undermines the assertion that restricting access to these medications for young gender incongruent people is purely due to concerns around their safety and efficacy as medical treatments, as any potential risks related to the use of puberty suppressing hormones in gender diverse young people would be similarly present in young people undertaking treatment for precocious puberty.
While AusPATH welcomes further research into all gender affirming medical treatments, it is our position that the current evidence base supports PSH as a safe, effective, and beneficial treatment option for many young gender diverse people.
NHS England’s decision means that, for young gender incongruent people in the UK, there is no longer access to public health funded puberty suppression. For those families that cannot afford private health care, the NHS England is removing the right of those families to access lifesaving care for their children.
AusPATH Vice President, Dr Portia Predny, a GP working with trans young people, said:
“Families with young people who are trans, gender diverse, or gender questioning, are often struggling with increased pressures and stresses as their children approach puberty. On top of all the usual challenges that come with raising kids, these families are also trying to navigate an increasingly hostile social and political climate, whilst doing their best to help their children be happy and healthy, as they grapple with their developing sense of identity.
Puberty can be a time of hugely increased psychological distress for young gender diverse people, as their bodies start to change in ways that they can’t control, and that don’t align with their gender identity. In some cases puberty suppressing treatments can be quite literally lifesaving: buying kids and their families extra time to make really important decisions, with the support of their doctors and health care team.
Often, by the time young people and their families enter into conversations about puberty suppressing treatments with their doctor, they have already been through many challenging conversations and sleepless nights, trying to decide on the best course of action. Doctors who work with these young people and their families want to support them in finding the best treatments for their individual needs.
The decision to start treatment in a gender diverse young person is not made lightly – it is a decision made in a collaborative way, after much discussion and deliberation, with inputs from the young person, their family and loved ones, and their health care team. Not all gender diverse young people want or need puberty suppression or other hormone therapies, but for those that do, it is our ethical duty to help them to access these treatments.”