Prescription of puberty blockers paused for new patients in Scotland

Prescribing puberty blockers to new patients has been suspended in Scotland after a major review into gender care found the drugs were “built on shaky foundations”.

This comes after Prime Minister Humza Yousaf said the government would consider all recommendations of the Qas Review, which was released last week.

The study found there is a lack of evidence on gender care for young people and that children are being let down by “harmful” public discourse.

The Scottish Government is under pressure to rule out the routine use of puberty blockers, as is done in England’s NHS, but the review said there was “not enough evidence”.

Scottish Government officials met with Dr Cass on several occasions during the review process “to share information” about improving care in Scotland.

In response to NHS England’s position, NHS Greater Glasgow and Clyde (NHSGGC) and NHS Lothian have announced that they will not be able to start these treatments for new patients until March 2024, pending publication of the Cass Review. It was postponed to mid-year.

Following the publication of the Cass Review, the health board, with support from Scotland’s Chief Medical Officer Sir Gregor Smith, formally suspended the treatment.

The suspension has now been formally communicated to patients while NHSGGC works with the Scottish Government and NHS England on research to “generate evidence of the safety and long-term effects of the treatment”.

Existing patients currently receiving hormone suppressants or gender-affirming hormones will not be affected by the suspension, the health board said.

Dr Emilia Crichton, NHSGGC Director of Public Health, said: The next step from here is to work with the Scottish Government and academic partners to generate evidence that will enable us to provide safe care to our patients.

“We believe that the toxicity surrounding public debate is impacting on the lives of young people seeking care in our services and is not serving the teams working hard to care for and support them. I agree with Dr. Hilary Cass.

“We understand the distress that gender non-conformity causes. All endocrinology referrals have been suspended, but those referred to youth gender services will be provided with the psychological support they need. We will continue to explore the legal path forward.” ”

Tracey Gillies, Executive Medical Director at NHS Lothian, added: “The Cass Review is an important initiative into how the NHS can better support children and young people with gender dysphoria. Patient safety must always be our priority and we encourage further research. It is right to pause this treatment so that it can be carried out.”

The Scottish Government’s Health Secretary said: “We welcome the joint statement from NHS Greater Glasgow and Clyde and NHS Lothian.”

Neil Gray said: “It is clear that clinicians and health boards make decisions about clinical pathways, and these decisions should be made carefully and on the basis of the best available evidence.” have done so, and their position is supported by the Chief Medical Officer.

“More broadly, the final report and findings of the Cass Review are being closely considered by both the Scottish Government and health committees in terms of how health care can best be delivered in Scotland.

‘The ‘increasingly toxic, ideological and polarizing public debate’ highlighted by Dr Hilary Cass has implications for young people in this care, their families and the NHS staff working hard to care for them. We agree with your point that it is of no use. I am clear that it is right that those most affected by these changes hear about these changes first, sensitively and from the services that care for them. They should be at the center of our thinking as we discuss this issue. ”

Scottish Youth Gender Services, based in Sandyford, Glasgow, has announced it has suspended referrals for prescriptions for puberty-suppressing hormones.

An update to the service states: ‘Referrals from the Sandyford Sexual Health Service to Pediatric Endocrinology for prescriptions of puberty suppressing hormones have been suspended for new patients assessed by the Youth Gender Service.

“Patients ages 16 to 17 who are not receiving pediatric endocrinology care but are seeking treatment for gender nonconformity will no longer be prescribed gender-affirming hormone therapy until they are 18 years old.”

It added that patients already receiving treatment and prescribed medication have been contacted directly to inform them that there will be no change to their treatment.

The clinic added: “This service update follows NHS England research and the publication of the Cass Review, and we are working with the Scottish Government to continue working with NHS England to provide evidence of the safety and long-term effectiveness of the treatment. We are working on research to create this.”

“We understand the distress that gender nonconformity can cause and are committed to providing the best possible clinical care to the young people we access. While this suspension is in place, While we consider pathways in line with our findings, we will continue to provide all those referred to our Youth Gender Services with the psychological support they need, including through a number of support networks: can. Mental Health Support (sandyford.scot).”

People waiting to book an appointment for the service were told that the update would not affect their standing on the waiting list.

Transgender Scotland said it was “saddened” by the move, saying it “will cause harm to transgender children and young people”.

Transgender Scotland said in a statement: “This decision comes at a time when the reality of trans people’s experiences and lives is being questioned on an almost daily basis in some media and in some political circles. It was done.” This makes me worry that this decision was not made solely with the best interests of transgender children and young people in mind, but was influenced by their context.

“Currently, it is extremely rare for children and young people to be prescribed puberty blockers. Between 2011 and 2023, 87 children and young people were prescribed them, with an average of seven new cases per year. The prescription was given.

“From my experience speaking to families who help young people access gender identity services, as well as people who have used youth services, they paint a picture of services being very sensitive. Many Some believe the investigation and evaluation process has been too slow, and some feel that its cautiousness has had a negative impact on them and their children. Getting endocrine treatment as part of that was all positive, hopeful and fun, but the journey to get there took longer than was appropriate for them, and there were some painful moments along the way.”

It added that waiting times for the service have increased so children and young people who book for the first time today will have to wait around four years.

“Of course, for young people, four years can feel like a lifetime, and these delays mean that for many, puberty ends before they can make their first appointment with gender services, or they don’t get an appointment at all until they join elective services. “This means that you may or may not be able to get it when you turn 18 on the list,” the charity said.

“The extremely rare and deliberate choice to prescribe puberty blockers, made for a small number of people after an enormous amount of waiting, is seen as a matter of course for some and a rush. It must not be different from the truth.

“We regret that these changes will mean that some young people will not receive the care they need at all, or will have to wait longer for it. We want all children and young people to receive the care they need. We want to receive appropriate, individualized care at the appropriate time, and we do not believe this decision will allow us to do so.”

More to come…