‘Wes Streeting’s Regressive Ban on Puberty Blockers is a Betrayal of Trans People’

“First, children’s healthcare must always be led by evidence. Medicines prescribed to young people should always be proven to be safe and effective. Secondly, evidence-led, effective and safe healthcare must be provided to all who need it, when they need it. Thirdly, this Government believe in the dignity, worth and equality of every citizen, and recognise that trans people too often feel unsafe, unrecognised and unheard, and that must change.”

With those words, the Health Secretary, Wes Streeting MP began his announcement that overseas and private prescriptions of puberty blockers for trans children would be permanently banned when the current ’emergency’ ban expires at the end of December.

Yet while there may be little for most people to disagree with in the words that he chose, things start to change once you dig into the uncomfortable details of what they actually mean.

First a quick explanation. Puberty blockers, or gonatrophin-releasing hormone agonists, basically block the receptors for estrogen and testosterone. These are the hormones which help the body develop secondary sex characteristics, such as breasts or facial hair. They have been used for almost 40 years to pause puberty where it is unwanted, for example in early or ‘precocious’ puberty, or when a teenager starts the “wrong” puberty because of a hitherto undetected intersex condition, or when a trans teenager starts puberty and finds it distressing.

As part of a concerted and alarmingly well-funded campaign to roll back trans people’s rights and inclusion in our society, the provision of puberty blockers as part of the NHS’s care package started to come under scrutiny about six years ago. A handful of people who worked at the GIDS clinics alleged, among other things, inappropriate and hasty prescriptions of puberty blockers.

A case in the High Court in December 2020 ruled that those aged under 13 could not have the competence to agree to be prescribed these drugs, and questioned whether those aged under 16 had competence. For under 18s it strongly suggested that courts should be involved before puberty blockers were prescribed. Within hours NHS England changed their policy to ban all new prescriptions of puberty blockers to those under 18s who might be trans.

Despite the case being overturned on appeal nine months later, NHS England didn’t overturn its policy, laying the ground instead for a review – the Cass Review – of healthcare for young trans people.

In April 2024, the Cass Review published its final report, which claimed that the evidence base that puberty blockers were safe and reversible was “weak”, and expressed concern that young people may be harmed by taking them.

The report also claimed that there was no real evidence of benefits, stating that the mental health of recipients had changed little. Hidden in the depths were the statistics that showed that only around one in four were referred for puberty blocker prescriptions, with an average number of six appointments. The data did not support the initial allegations. Yet the report didn’t state this clearly.

I don’t know if you’ve noticed, but the media and policy landscape around trans people has shifted quite considerably since 2018. Six years ago we were talking about moving to a self-declaration model for legal gender recognition, along with most of western Europe, as well as trans-inclusion being on most corporates’ radars.

Since that time, trans people have been systematically excluded from public discourse and policy decisions, suffering substantial reverses.

Self-declaration was dropped in favour of making the application process online and cheaper, but doing nothing to substantially address any of the issues previously identified, such as the requirement for shedloads of documents.

Media coverage shifted so that trans people and trans women in particular, were continually linked to violent crime, without any real right of reply.

Waiting lists for first appointments with psychiatrists, already overlong before the pandemic, absolutely ballooned.

Companies started rowing back on trans-inclusion, suffering huge social media backlashes for anything seen as portraying trans people in a positive light.

Discussions about whether trans people and trans women in particular, should be allowed to use single-sex spaces escalated.

Kemi Badenoch boasted on X that she had placed gender-“critical” people in key places in education and health, with the ability to impact policy for years to come.

Even the census figures were eventually “downgraded” after months of lobbying. It feels like they don’t even want to count us now, and if you aren’t counted, you don’t count.

So it’s entirely unsurprising that trans people’s mental health has suffered over recent years. We are now relentlessly portrayed as monsters hoovering up vast quantities of public money, making unreasonable demands, causing physical danger to women and girls – none of which has any basis in reality.

When the dying act of the Conservative government was to implement an emergency ban on overseas and private prescriptions of puberty blockers, trans people across the country hoped that an incoming Labour administration would reverse what they saw as a discriminatory decision.

Emergency bans can only be made under the Medicines Act in order to remove a “serious danger to health”. In the rare cases this has been used before, it’s always been to ban medication which could cause death. Suddenly it was being used, but only for a subgroup of trans people – those who were young and acquiring the drug through private or overseas prescriptions.

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A One Way Street

Within days of coming into office, instead of reversing it, Wes Streeting announced the Conservative Government’s ban would continue. When it needed to be renewed in August, he actively enhanced it by closing down routes of access through Northern Ireland.

The High Court found that the Minister was allowed to take the Cass Report as sufficient evidence. By that time many academics in the UK and overseas had highlighted a number of flaws with it.

Also, almost all jurisdictions which had undertaken a similar review of healthcare for young trans people found that affirmative care involving puberty blockers was both safe and beneficial. Cass was becoming an outlier, while being used by those hostile to trans people to try to ban healthcare and inclusion of young trans people across the world.

When the court found the initial emergency ban lawful, the judge required NHS England to put in place adequate safeguards for those adversely affected by the ban. This turned out to be an A4 letter sent out to parents, of which half of one side listed mental health or suicide watch helplines. A tacit admission that they know they’re doing harm while pretending to act in people’s best interests.

The workaround? Cass suggested a mandatory trial run through the NHS, whereby those requesting puberty blockers had to agree to be part of a study into their effects. This study has been proposed for a number of years now, and there is still no start date. Moreover, it is not clear what the study will be looking for, nor how long it will last. And that’s before you get on to questions about coercion, or the impossibility of doing a gold-standard clinical trial, or how the “optimal age” for prescribing this drug should be determined.

Making a ban permanent requires a consultation, which was done by invitation. Remarkably, groups actively working against trans inclusion were invited to submit evidence. This included groups where a spokesperson had been found by an Australian court to have no relevant expertise, and where a leader had admitted that they had met only around a dozen young trans people in the two years they had led their organisation campaigning against inclusion of young trans people.

Despite this apparent rigging of the input, the majority of the participants disagreed with making the ban permanent. The organisation I head up, TransActual, presented a bunch of evidence that Cass disregarded because it was either published after the cut off date or was in a foreign language. We also showed evidence of benefit, while pointing out that huge numbers of drugs are used off-licence in pediatric medicine, without evidence from clinical trials, in hospitals across the country.

We also asked a more fundamental question. If these drugs have been used by thousands of people in the UK over almost 40 years, where is the evidence of actual harm? In order to justify any restrictive measure, it ought to be easy to find examples. We cannot find one, and none have been cited. Instead, it’s all about fear – again.

Nevertheless, Streeting stood up in the House of Commons on 11 December and started his statement with the words used at the top of this piece. But it became apparent that they were words only.

Quickly Streeting said it was “a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial”. A scandal implies malice aforethought, rather than medics working to act in their patients’ best interests.

Labour MP Alex Sobel pointed out the inconsistency in the Government’s argument. By saying that these drugs were dangerous, surely they must be dangerous for everyone, and therefore banned for all. At the heart of Sobel’s question is the principle that drugs don’t discriminate, unlike this Government. No, fired back Streeting, because puberty blockers were safe for other conditions.

Somehow, the medication is supposed to know both who it has been prescribed to and how it has been prescribed. If it’s been prescribed privately to a young trans person, it’s supposedly dangerous. However, it’s supposedly safe if the exact same dose of the exact same medicine for the exact same purpose is prescribed to an intersex teen, or at some indeterminate point in the future, prescribed to a young trans person but only through the NHS.

In the preceding week the Council of Europe had raised concerns about whether it was possible to run the proposed study, however poorly defined, in an ethical manner, saying it may breach the “fundamental ethical principles governing research”. Streeting dismissed this saying that he had to take decisions based on clinical evidence. I don’t think the Council disagrees, but are instead stating that it might be impossible to get the evidence Streeting requires in an ethical manner – in which case, what happens then?

Streeting also cited a paper written by suicide expert Dr Louis Appleby dismissing claims that suicides amongst young trans people are increasing. Earlier that morning the mother of a young trans person who had taken their own life received confirmation that her child hadn’t been included in the statistics used by Appleby.  Another study shown to twist data, or only give a partial picture.

The end product is yet another erosion of trust between trans and non-binary people on one side, and the Government and the NHS on the other; another diminution of hope and another fight needed to recover what we once had.

More than this, a Government for which many had high hopes has continued to implement and tighten the policies initiated by their predecessors. All the warm words will do little to make people think things are getting better rather than worse. Rather than people with agency, we become powerless guinea pigs for other people’s observations. And that does nothing for anyone’s mental health.