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Evidence of a blockage

It’s been reported [see page 12] that the Ministry of Health [MoH] has delayed the release of its long-promised review of the scientific evidence around the use of ‘puberty blockers’ in New Zealand for the treatment of transgender children and teenagers.

This latest delay comes just eight days after MoH announced it would be releasing the review this week, after having previously reneged on its undertaking to release it in November last year, which was in itself a delay of its initial aim to make it public in the first half of 2023.

Puberty blockers are hormone suppressing drugs that stop the physical changes of puberty and were first used to treat what’s known as ‘precocious puberty’, which is marked by breast development before age eight or testes growth before age nine. Although studies have suggested this therapy is generally safe, it’s also been noted there’s little data on long-term impacts on cognitive development, fertility, and the risk of cancer and metabolic disease.

Much more recently – and much more controversially – they’ve been used ‘off label’ [ie, prescribed for a use other than what is stated on the label] in a number of countries in the treatment of children and adolescents who have gender dysphoria and, as a result, believe they’ve been born in a body that is the opposite sex to the one they feel they really are [what’s commonly referred to as being ‘trans’]. The purpose has been “to buy time for patients to explore their gender identity and to hold off potentially distressing sexual maturation”.

Proponents of their use have pointed to studies suggesting improvements in recipients’ mental health, while critics of their use – who have typically been denounced as “transphobic” for their trouble – have pointed to other studies that indicate negative outcomes, including adversely affecting the development of bone density.

Until September last year, the MoH’s published advice regarding the use of puberty blockers in the treatment of young people suffering from gender dysphoria was that they “are a safe and fully reversible medicine that may be used from early puberty through to later adolescence to help ease distress and allow time to fully explore gender health options”.

It then removed the words “safe and fully reversible” from its description and added a line noting that the drugs are used under the guidance of a clinician who specialises in their use.

When asked about the alteration, MoH issued a statement saying that “while puberty blockers are currently considered safe, all treatments have risks and benefits” and that it had made the tweaks to make it clear it wasn’t providing specific clinical advice for patients, as the suitability of any treatment should be assessed by a clinician.

In announcing this latest delay in releasing its evidence review, MoH chief medical officer Dr Joe Bourne referred to “a considerable amount of new material was published in the UK last week”.

That “new material” is the report – four years in the making – by leading paediatrician Dr Hilary Cass into ‘gender affirming care’ in the UK that found young people had been given life-changing treatment despite “remarkably weak” evidence for this approach.

On the strength of Cass’s interim findings, the UK banned the routine use of puberty blockers in March.

No doubt there are many in NZ who await the MoH’s eventual release of its evidential findings with great interest.

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