Puberty blockers now completely inaccessible for trans youth after NHS trial paused

Trans youth are now incapable of obtaining new prescriptions for life-saving puberty blockers through the NHS after it has temporarily paused a trial on the treatment.

NHS England’s upcoming PATHWAYS trial was put on hold last week after the Medicines and Healthcare products Regulatory Agency (MHRA) voiced concerns regarding its methodology.

Headed by King’s College London (KCL), the £10million study, which will analyse the effects of puberty suppressants on transgender adolescents, was commissioned after health secretary Wes Streeting indefinitely extended a ban on new prescriptions for the medication.

In a letter published on 20 February, the MHRA recommended pausing the trial to discuss “potential amendments” which included expanding the withdrawal criteria for participants with certain health risks.

The trial, which was the only way to access the treatment via the NHS, will now remain on hold for an indefinite period until discussions between the MHRA and researchers have concluded.

According to a statement from the Department of Health and Social Care (DHSC) shared with PinkNews, puberty blockers are now completely inaccessible for trans youngsters.

“Children with gender dysphoria will still be able to receive care through new regional Children and Young People’s gender services, which provide holistic care, centred on psychosocial support. This includes thorough mental health support,” a DHSC spokesperson said. “As the evidence is now being interrogated by clinicians, preparations for the trial have been paused while the MHRA and clinical leaders work through these concerns.

“We have always been clear about the red lines regarding this trial – ensuring the safety and wellbeing of the children and young people involved and always being led by the clinical evidence.”

Leading gender-care doctor says he is ‘disappointed, but not surprised’

The statement was met with condemnation from Dr Aidan Kelly, a clinical psychologist and director of Gender Plus, who said he was “disappointed but not surprised”.

“They keep talking about young people’s safety and well-being as the primary importance, but it’s never felt that way,” he said. “It’s felt more and more like these moves have been motivated by other desires or other priorities.”

Dr Kelly argued that NHS England’s approach to treatment had been “poorly thought out”, claiming that officials had conceded to the “anti-trans lobby” and left trans youngsters without the support they need.

“This is a medication that’s offered in most other countries to those for whom it’s appropriate, like trans youth, and it works well,” he added. “So the premise for the trial was flawed in the first place, and now it’s running into problems because the NHS has conceded so much ground to the anti-trans lobby.”

While the trial was formerly the only way to access the treatment through the public health body, critics and health experts argued that clinical trials don’t and shouldn’t count as a method of accessing care.

The World Professional Association for Transgender Health (WPATH) expressed concern alongside its European (EPATH) and US (USPATH) counterparts that the trial could violate clinical standards on informed consent.

Others have noted that puberty blockers are regularly prescribed to cisgender youngsters for issues such as precocious puberty.

Dr Kelly criticised the NHS and the MHRA for failing to justify the contradiction in allowing cisgender youngsters experiencing precocious puberty to access the blockers, and denying trans adolescents the same thing.

“They always ignore the fact that this medication is also used in this developmental stage by cis children. They don’t have a response to it. They always ignore it,” he claimed. “They seem to somehow think it’s okay in that instance, but not for trans youth.

“If puberty blockers are used in a proportional way to suspend and pause puberty while working out what to do as the child gets older, then it’s the right way to use it. If you misuse the medication, of course you can cause harm, but that shouldn’t stop us from trying to use it in the right way and knowing the limits and parameters for when it can be used safely.”

In its letters, the MHRA argued that, because trans adolescents are “biologically healthy”, unlike those with precocious puberty, the NHS needed further justification for using the medication.

However, Dr Kelly argued that this was simplifying the “complex” nature of medication and the human body in a way that is reductive and harmful.

“If you run enough tests, you will find anomalies and outliers and things will show up. It doesn’t always mean what you think it will mean, so you need to have a good rationale and reasoning for running an investigation,” he said. “I don’t think they have it here … I think this is an overreaction in response to this anti-trans hysteria, this moral panic.”

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