Puberty blockers: Why are they so contentious?

Puberty blockers have become a huge talking point recently.

Given the intensity of the debate, Derry Now sought a wide range of opinions for a timely and considered feature on the issue.

Puberty blockers are commonly prescribed, for short-term use, for children diagnosed with precocious puberty, the development of pubertal changes at too young an age, before eight in girls and nine in boys.

These children are taken off the medication when they reach the age when typical puberty starts, so they can experience normal puberty.

There were calls at Derry’s recent Pride celebrations, and Pride celebrations throughout Ireland this summer, for improved transgender health care. This includes what is described as ‘gender-affirming care’ and can involve the prescription of puberty blockers for people diagnosed with body dysphoria.

Body dysphoria is a state of severe distress or unhappiness caused by feeling one’s gender identity does not match one’s sex.

The purpose of puberty blockers for children with body dysphoria is to postpone the onset of natural puberty, which they will never go through because they may subsequently go on to cross-sex hormones.

However, current NHS policy states: “Puberty suppressing hormones are not recommended to be available as a routine commissioning option for the treatment of children and adolescents who have gender incongruence or dysphoria”.

Paradoxically, in spite of widespread calls for children with body dysphoria to have access to the treatment, public discussion about puberty blockers is fraught. People expressing any concern about puberty blockers have found themselves vilified in the media.

Just this month, Irish singer-songwriter, Róisín Murphy had an interview about her new album ‘Hit Parade’ and her music cut from BBC 6 Music because she wrote on Facebook page she had reservations about the effects of puberty blockers.

In a statement, former Derry City and Strabane District councillor, Rachel Ferguson (Alliance) said: “The prescription of puberty blockers, as with any medical issue, is a decision for that individual, their families and medical professionals to take.”

Former People Before Profit councillor Maeve O’Neill said: “Trans healthcare hasn’t been funded properly. The waiting list for a first appointment at the gender identity clinic is five years, which is far too long for young trans people in particular.

“Trans healthcare in many cases is life saving. Too many trans people are having to access hormones online or privately, which can increase vulnerability and risk.”

Sinn Féin Mid Ulster MLA Emma Sheerin recently called for the introduction of legislation to make puberty blocking drugs available to pre-teens in the North diagnosed with body dysphoria.

However, a spokesperson for Derry Sinn Féin told Derry News: "Clinical and health care is best determined by doctors and clinicians - not politicians - and needs to be informed by the clinical and scientific evidence."

Ulster Unionist Party (UUP) leader Doug Beattie said the discussion around puberty blockers was “important”.

He added: “However, it is also complicated. The original purpose for this medication was to assist young children who enter puberty at a very early age and on that count it is designed to delay puberty.

“Where the complication lies is when puberty blockers are designed to stop, delay or alter the normal path of puberty due to body dysmorphia and in later years assisting with gender reassignment. This may happen to children who are as young as eight and that in itself is concerning.

“The most recent National Institute of Health and Care Excellence (NICE) guidance found that the evidence for using puberty blocking drugs to treat young people struggling with their gender identity is ‘very low’. The NICE review said existing studies of the drugs were small and ‘subject to bias and confounding’.

“It is absolutely vital that the health and wellbeing of our children and young people is paramount and to that end it must be clear to all that this is an issue between the doctor and their patient and it is for those who are experts in this area to make the final decisions.”

Chaired by Derry doctor Tom Black, a spokesperson for British Medical Association NI said it did not have a policy on the use of puberty blockers.

They said: “Our policy is more to do with ensuring individuals have access to healthcare considered on a case-by-case basis, not clinical decisions about one type of drug.”

Colin Mangan, a member of the schools and safeguarding working group of The Countess, a human rights groups which advocates for women and children, explained: “Puberty blockers essentially prevent the release of oestrogen and testosterone, which drive pubertal change.

“Richard Nergårdh, a Swedish clinician who treats children with gender dysphoria described GnRH (Gonadotropin hormone-releasing hormone) puberty blockers as chemical castration. These are the drugs used to chemically castrate sex offenders. They are now being used on gay and autistic children.

“Regardless of what your understanding of trans identification is, there are some children who undergo puberty suppression, cross-sex hormones and even surgery, who later detransition saying they were led down this path by clinicians or they realised they weren’t ‘trans’, they were just gay all along. There are some gay and autistic children getting caught up in this who should not be prescribed these drugs.

“In the referrals to the Tavistock Institute in the UK and generally in children presenting with gender dysphoria, autistic children are way over-represented. 35% of referrals to Tavistock were on the autistic spectrum compared to 2% in the general population.”

He added that puberty blockers halted the natural development of young children into adults. “Whichever way you want to look at it, it is pretty severe.”

“The use of puberty blockers to treat gender dysphoria is unlicenced and and it is off-label,” said Colin Mangan. “They have not been subjected to any kind of rigorous testing for this use.

“According to Tavistock figures, of anyone who starts on puberty blockers, 98% go on to cross-sex hormones. The long term effects of puberty blockers are unstudied and unknown and the claim of reversibility doesn’t stand up.

“In addition, in December 2020 the UK High Court said in its ruling on the Keira Bell case: ‘It is highly unlikely that a child aged 13 or under would be competent to give consent to puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long term risks and consequences.’”

Mr Mangan said the long term effects of puberty blockers have not been studied.

“The shorter term effects are that there are issues with bone density. Puberty blockers cause osteopenia, which leads to osteoporosis. They also affect sexual function and fertility.

Derry Now also contacted the following for comment, but received no response: Colum Eastwood (SDLP leader); MLAs Mark H Durkan (SDLP); Sinéad McLaughlin (SDLP), and Gary Middleton (DUP), and Professor Siobhan O’Neill, the North’s Mental Health Champion.

In addition, Derry News reached out to the Rainbow Project which facilitates Transderry, a social support group for adults who are transgender or non-binary.

The group did not respond, however on its website Rainbow Project said: “Due to ongoing issues within these services, as of the time of writing, KOI [Knowing Our Identity] has suspended the provision of puberty blockers and hormone replacement therapy to any new patients referred.

“We are working with them to urgently resolve this issue and ensure that every trans young person can access the care they need.”