Puberty blockers: healthcare decisions should be made by healthcare professionals

These medications have been used in New Zealand for the past 20 years and are well established as life-saving treatment. This ban disrupts a healthcare norm for a population which already vulnerable and the sudden removal of this medication is violation of these young people’s human rights. 
 
This decision is based on imported ideology which will only take us backwards, making this group more susceptible to mental health challenges. The UK provides us with evidence of the consequences of removing access to puberty blockers. There are reports of increased suicidality, self-harm and social isolation. We can expect the same here. It’s essential to understand the wider, societal knock-on effects of this decision; such a ban will likely lead to less acceptance of transgender people and young people who are gender questioning. We cannot afford to backslide into social norms and policies which discriminate against transgender people.”

Read the following expert commentary on this decision from the Science Media Centre, reproduced with permission.  

The Government is halting new puberty blocker prescriptions for youth with gender dysphoria.

From 19 December, new regulations under the Medicines Act will prevent new prescriptions for this purpose, pending completion of a publicly-funded clinical trial in the UK.

In November 2024, the Ministry of Health released an evidence brief saying puberty blockers should only be prescribed by a clinician experienced in gender affirming care, and supported by an interprofessional team including mental health support.

The New Zealand Science Media Centre asked experts to comment.

Dr Anna Ponnampalam, reproductive biologist, University of Auckland, comments:

"The [UK] Cass report has been primarily cited as the evidence base for this decision. This report has been criticised by experts and professional bodies around the world for many issues including methodological and conceptual errors. The report has number of inconsistencies including: 1. recommending psychosocial interventions while admitting no evidence of the benefits; 2. recommending against puberty blockers while noting that some young people benefit from it. The report is incomprehensive, including selective studies while ignoring others, and also has many incorrect reports of those studies.

"Over a decade of research has shown that puberty blockers are safe and effective. Withholding puberty blockers to treat gender dysphoria will very likely have serious adverse effects on the health and well being of young people going through gender dysphoria and transgender youth."

No conflict of interest.

Dr Sue Bagshaw, Senior Clinical Lecturer, Christchurch School of Medicine, University of Otago, comments:

"I am saddened to hear of more problems with assisting young people with the help they need to have time to work through the issues they might have with gender identity.

"Safeguards are important but to ignore the protective effect on mental health is not a safeguard.

"Resources to undertake research into the effects of gonadotrophin releasing analogues would be welcome and necessary before any further actions from the government are undertaken."

Conflict of interest statement: “I was a Doctor at Te Tahi Youth one stop shop until the beginning of this year.”

Dr Rona Carroll, General Practitioner; and Senior Lecturer, University of Otago, comments:

"The Government’s announcement that new patients seeking treatment for gender dysphoria or incongruence can no longer be prescribed gonadotropin-releasing hormone (GnRH) analogues from December 19th is a shockingly inappropriate overreach of politics into healthcare. Prescribing decisions should remain between clinicians, patients and their whānau.

"GnRH analogues are used by a very small number of young people to prevent irreversible and distressing bodily changes. They are prescribed with great care by interdisciplinary teams with expertise and experience in providing healthcare for young people experiencing gender incongruence and distress. Their use is supported by major medical bodies including the Endocrine Society and the Royal Australasian College of Physicians.

"There is evidence to show the benefits of GnRH analogues for people experiencing gender incongruence, however, the challenges and ethical considerations of conducting randomised controlled trials in this field mean that the available evidence has limitations. This is common in many areas of medicine, particularly paediatrics and is not unique to transgender healthcare. Other medications with similar levels of evidence continue to be prescribed. No other area of paediatric medicine is held to this standard.

"The Government media release states that “Cabinet has agreed that the Ministry of Health will review the settings for the prescribing of gonadotropin-releasing hormone analogues for the treatment of gender dysphoria or incongruence once the results of the United Kingdom clinical trial are available.” The UK trial is expected to run until 2031, and then there will presumably be a considerable time until the results are published. Whilst the results are likely to be helpful and will add to the body of existing evidence, there is no justification to ban this care while they are being awaited.

"The UK clinical trial will only monitor young people on GnRH analogues for 2 years. It is hard to see what evidence this will provide that is not already available. The benefits of preventing an unwanted puberty may not be seen for many more years as people grow older and go into adulthood. Given that GnRH analogues are often initiated at the start of puberty, after 2 years on this medication patients will not yet have experienced the benefits of preventing unwanted physical changes in adulthood. The more longitudinal arm of the UK study is observational, so will also not provide the high-quality level of evidence which the Government claim is needed.

"The Government announcement states that GnRH analogues can still be prescribed for other indications. This ban only applies to those being prescribed GnRH analogues for gender incongruence or dysphoria. This discriminatory approach shows that this decision isn’t about medication safety concerns but instead is politically motivated to prevent transgender people from accessing gender affirming medical care. Health professionals have decades of experience in using these medications. There are no concerns around the reversibility or safety of these medications when they are used in these other situations.
When considering the balance of the potential benefits and low level of identified risks, banning GnRH prescribing for people experiencing gender incongruence or dysphoria is unjustified, unethical and cruel.

"If the wellbeing of children and young people was truly at the heart of this, the Government would be supporting accessible, high-quality healthcare, and support for young people and their families to make their own informed decisions about their body and their health with the support of experienced healthcare professionals. Young people have a right to access the healthcare they need."

Conflict of interest statement: "I am a member of the PATHA executive committee, and a GP working in gender affirming healthcare."

Dr Massimo Giola, sexual health physician, comments:

"In my work, I see gender diverse youth after the age of 16. I am very worried about the state of their mental health at that point, and I'm worried that they might have significantly self-harmed because of allowing biological puberty to happen, rather than pausing it using these medications.

"While these medications were never subject to a randomized control trial, that is the case for many other interventions in medicine, and particularly for young people, when it's really, really hard to perform a 100% 'scientific' randomized, controlled trial.

"The announcement was essentially a big surprise that we did not see that coming yesterday. There is no reference to any consultation with professionals in the press release I see. And so I'm really worried that this seems to be a purely political decision without any consultation with experts. I would really like to ask the question: what kind of consultation was undertaken before reaching this decision? Particularly because there was a technical report provided by the officials at the Ministry of Health to the minister. The recommendation in that report was that the prescription of puberty blockers should happen in a multidisciplinary context, with the involvement of all the relevant professionals, including mental health professionals. What happened to that advice?"

Conflict of interest statement: "I am a sexual health physician providing gender affirming care to over 16s. I do not prescribe medications in the context of pausing puberty."