Science supporting the use of puberty blockers in children is of “very low” quality, the report suggests

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Science supporting the use of puberty blockers in children over gender identity concerns is of ‘very low’ quality, report suggests

  • Evidence supporting the use of puberty blockers is low quality, review says
  • Studies on the subject were small and “subject to bias,” the analysis found
  • Puberty blockers stop the rise of sex hormones that lead to the onset of menstruation

Evidence supporting the use of puberty blockers in children struggling with their gender identity is of “very low” quality, according to a review of the health authorities.

The National Institute of Health and Care Excellence (Nice) said the few studies on this topic were small and “subject to bias and confusion.”

Puberty blockers stop the rise of sex hormones that lead, for example, to the development of breasts and menstruation.

Evidence supporting the use of puberty blockers in children struggling with their gender identity is of 'very low' quality, according to a health authority review

Evidence supporting the use of puberty blockers in children struggling with their gender identity is of ‘very low’ quality, according to a health authority review

The analysis looked at studies comparing use of the blockers with psychological support, social transition to preferred gender through changing pronouns or wearing different types of clothing, or no intervention at all.

But Nice found that it was difficult to draw conclusions from existing studies because of the way they were designed.

Most had few subjects and had no groups undergoing no treatment at all – which is usually used to determine the true effect of a drug.

The analysis is part of NHS England’s study of gender identity services for young people.

The Nice review says, “The aim is to alleviate the distress associated with the development of secondary sex characteristics, allowing time for ongoing discussion and exploration of gender identity before deciding whether to take fewer reversible steps.”

The existing studies were ‘all small’ and did not include control groups, which are used to directly compare the effect of different treatments.

Some have not described the other physical and mental health problems a young person may have in addition to gender dysphoria.

Experts have argued that conducting higher quality controlled studies can be difficult because of the potential impact that withholding treatment from a group can have on their mental health.

Nice accepted this, but said offering psychological support could “reduce ethical concerns in future studies.”

Nice also considered the use of cross-sex hormone, which people can use to initiate the physical transition to their identified gender.

The quality of the evidence showing their clinical effectiveness and safety was also of ‘very low’ quality.

Nice said, “Any potential benefits of sex-confirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.” The documents were prepared by Nice in October 2020 and will aid in Dr Hilary Cass’s independent investigation into the NHS’s gender identity services for children and young people.

Neither assessment contains recommendations, and both constitute advice rather than formal guidelines.

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