Public NHS consultation on puberty blockers open

[WarriorN]

www.engage.england.nhs.uk/consultation/puberty-suppressing-hormones/

NHS England commissions gender incongruence and dysphoria services and the purpose of this consultation is to seek views on a proposed interim clinical policy on puberty suppressing hormones (sometimes referred to as ‘puberty blockers’ or ‘hormone blockers’) for children and adolescents who have gender incongruence or dysphoria.

The policy proposition is that 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.

This public consultation will run for 90 days from 3 August to 1 November 2023.

Obviously the fetishists don’t need psychotherapy

If it's gone so far that you are getting breast implants then I think that's debatable.

Just bumping. Deadline 1 Nov.
Transgender Trend have just done guidance.

www.transgendertrend.com/nhs-interim-clinical-policy-public-consultation-submission-guide/

Clear, well supported ,and beautifully worded comments from Transgender Trend.

Agreed - that's an excellent response from TT. It appears that the NHS is proposing to continue to experiment on children below the age of consent with drugs that will result in their sterilisation & lack of sexual function as part of clinical trials. Not as part of life saving treatment (eg cancer, critical illness).

Unbelievable that this is being proposed.

Are we able to largely copy and paste the text from TT?

Just bumping again deadline 1st Nov.

Generally speaking, it's best to personalise if you can. But if you're pressed for time it's definitely useful to use resources that articulate your own position.

Sad, as it will create a two-tier system. Those who can afford to go private or source blockers from overseas, and those who cannot and watch their child go through the "wrong" puberty and all the risks that brings. May also mean an exodus, ala Florida to more positive climates for trans people.

I saw Abigail Thorn (trans person) had written a piece on twitter as an alternative view - for those interested in the other perspective for balance.

Not interested in debating it. I'm not that heavily invested in either side. But I do know genuine trans kids, and the thought of having no NHS support for them, as is the current situation, saddens me greatly.

The NHS should be sponsoring the clinical trials they mentioned in Cass to obtain the evidence one way or another as they had proposed. Seems they have just concluded that these are bad. So if you are a "cis" child - yeah go for it. "trans" child, nope, nothing for you. The very best of luck if you make it through!

Abigal Thorn Piece on Blocker Ban

You can only go through one puberty - that for your sex. The biggest ‘risk’ for a ‘trans’ child going through puberty is that they will come to terms with their sex (as happens in the vast majority of cases). I wonder why TRAs might want to avoid that? 🤔

’transitioning’ hugely increases the risk of suicide. Studies claiming high suicide risk are actually post transition in adults not children.

It is a two tier system; the NHS belatedly ensuring children with gender dysphoria receive evidence based medicine vs overseas drug dealers plying children with dangerous drugs from the safety of unregulated markets where they cannot be sued.

There is a two tier system for opiate drugs in the UK too - a closely regulated one via the NHS to ensure only those who benefit from them receive them, in doses that do minimal harm and limit risk of dependency.

Then there is the heroin dealer who doesn’t care if his product kills you and for whom dependency is a good thing. He may even consider the occasional overdose death due to purity of his product a good marketing tool.

@MishyJDI The NHS needs to conduct those trials BEFORE giving unproven experimental treatments to children whose health will be permanently damaged by them. There may be a small number of children who will suffer harm if puberty blockers are limited -but there will be a considerably larger number whose health will be saved.

There are two people in my family (young relative and their partner) whose health has been damaged, one to the point where one cant work full time. They are same sex attracted young people who could have been living together happily had pressure groups not encouraged them to trans away the gay. It was a safeguarding failure by the NHS.

So I know the arguments -and could express them more logically and coherently than your twitter person. I did try to read that but what a load of incoherent tripe. To take one simple point- if this is not a medical condition you dont need medical treatment. If medical treatment is needed it goes through the normal process of assessing safety and value for money. Anything else is both quackery and grossly unfair on people whose medication is far closer to passing those tests than puberty blockers.

There may be a small number of children who will suffer harm if puberty blockers are limited

There is currently no evidence that any children benefit from puberty blockers.

British medicine is supposed to be evidence based. This is not.

I'm not that heavily invested in either side

And yet you decided to come and tell us that some children most be given access to dangerous drugs off label because otherwise they'll just buy them from dodgy sources? Should we have that system for other dangerous drugs too, or are these somehow different? Or are the patients somehow different, and therefore not entitled to evidence based healthcare?

Protect trans kids indeed.

Giving this one another bump with the deadline coming up in 2 days.

Hopefully the recent re-evaluation of the original data on puberty blockers (~70% either no benefit or mental health worsened) will help to focus the decision on whether or not it's ethical to continue this experiment on children with the trial.

Also, the impact on brain development (which the NHS already says is unknown) is slowly getting sharper focus in the public discourse. Even Jazz Jennings' parents are openly wondering about whether Jazz's asexuality is linked to the use of puberty blockers. Given the fact that cross sex hormones don't actually lead to opposite sex puberty, meaning that any child who has them as early as Jazz will go through no puberty EVER, I would suggest they might be right. There is no way that this trial is ethical.

To take one simple point- if this is not a medical condition you dont need medical treatment. If medical treatment is needed it goes through the normal process of assessing safety and value for money.

Excellently put Anyolddinosaur

I've just been reading the article on the link that you sent @MishyJDI . Thank you for sharing.

It's interesting that you say you're not heavily invested either way. That surprises me, given your comments on other threads.

My thoughts on reading the article are as follows:

1. This is in incredibly disingenuous representation of the needs of children who experience gender dysphoria, the Interim Report, the Cass Review itself and the current (lack of) evidence.
2. No "hate groups" were consulted during the Cass Review. I presume this refers to Transgender Trend, Genspect and others who are advocating for evidence-based care. They aren't hate groups.
3. Transgender people's voices and groups were considered. The full list of those who were consulted is available
4. It relies on an assumption that gender identity is recognised as a truth i.e. that we all have a gender identity. It's not a universal truth, it's a belief. Any pathway of neutral care would need start with a differential diagnosis to understand why someone is distressed about their body. Not from a gender affirming start point that they "are trans". Instead comorbidities need to be looked at without the lens of gender identity. Thankfully, this has mostly been addressed with the new proposal, but not completely and it's very clear that there are several people (from the old Tavistock clinic) who are working very hard to circumvent this key part of the Cass Review.
5. That's quite a bold and divisive move to donate money from the article publication to Palestine.
6. There is still reliance on the misrepresentation of suicide (no consideration for comorbidities or for post-transition suicide rates). Unfortunately the recent positioning of the awful Alice Littman coroner's report (there is a separate thread on this) lends itself very well to pushing the narrative that "gender affirming care" is "life-saving".

Anyway, still very helpful to read and to see the spin that is being put on everything. I really do hope that a proper approach to medical and mental health care prevails on this one.

We have concluded that there is not enough evidence to support the safety or clinical effectiveness of PSH to make the treatment routinely available at this time. NHS England recommends that access to PSH for children and young people with gender incongruence/dysphoria should only be available as part of research.

On an exceptional, case by case basis any clinical recommendation to prescribe PSH for the purpose of puberty suppression outside of research and in contradiction to the routine commissioning position set out in this policy must be considered and approved by a national multidisciplinary team.

Christ. This is huge. They've finally done the evidence review we've ask for over the last decade and the powers that be actually listened to the findings. This could be the death knell of kids getting PBs as a sticking plaster for the complex MH difficulties they have.

I've taught children this would have really helped. I'm genuinely quite emotional that it's finally (hopefully) here.

Anyone with first hand experience of the 'treatment' of kids who describe themselves as having GD please, please take the time to write a considered and detailed response.

Did you not read that NIHCE have concluded PBs are not an efficatious treatment for GD?

If you did, why the hell would you want to give kids a treatment that doesn't work?

I'm genuinely trying to work out whether your are ignorant or malicious?

Yes and no on it being huge....

They haven't set any limits on the size of the research group, so that means that every person referred to the service (and those on the waiting list) is eligible. The only qualifier is that they need to consent to their data being used for research purposes.

So sadly, it's just one giant live experiment.

I still think that the fact it's research rather than treatment will make a big difference:

• Much more emphasis on informed consent.
• They specify that a single multidisciplinary team has to sign off on each candidate. That's a much better safeguard than has been in place.
• Better follow up.

I don't want the medical profession to bin PBs just because we think it's wrong. I want proper evidence to show (or not) that these treatments have been harming people.

As long as the evidence isn't there these quack treatments will keep being available privately.

I don't want the medical profession to bin PBs just because we think it's wrong. I want proper evidence to show (or not) that these treatments have been harming people.

This is arse about face. There have been no actual studies showing throwing people out of aircraft at 20,000 feet is harmful so should we perform studies to prove it?

Many clinicians would like research to be like that but it isn’t. They will need to get research ethics committee approval and clinical trial authorisation. There seemed a gross failure of these during the Tavistock trial but one hopes that with all the attention a REC and MHRA would be a lot more careful this time about ensuring trial protocols are up to scratch and followed.

Also children under 16 year old are unable to consent to take part in this research - the parents must consent for them (so parents must be given sufficient information and have sufficient understanding of that information). Under 16s just need to assent so may not be given the same amount of information about risks.

Given what we now know, I fail to see how any trial could be ethical.

I don't want the medical profession to bin PBs just because we think it's wrong. I want proper evidence to show (or not) that these treatments have been harming people.

The trouble is that it's not ethical to experiment on physically healthy children, not with drugs that risk damage to their physical health or cognitive abilities, or that put them on a pathway to those kinds of damage. And we already have evidence that puberty blockers do both. Even for precocious puberty (a physical condition with physical consequences) there are still measurable risks.

Now that the suicide narrative has been debunked I don't see how a trial would be ethical either.

Kathleen Stock has investigated this - she talks about the ethics in this interview - about 15 minutes in.

It sounds as if she's written something about it, but I don't know where.