Puberty blockers: Ban in Scotland unlikely, according to Scottish trans charity, but concerns remain

Scottish Trans has said a puberty blockers ban is unlikely north of the border, despite one being introduced on the NHS in England

A puberty blockers ban is unlikely in Scotland, a Scottish trans charity has claimed, due to the “exceptionally difficult” process patients must go through to acquire gender identity treatment through NHS Scotland.

The waiting times for young people at the Glasgow-based sexual identity clinic are in excess of four-and-a-half-years, with clinicians at the Sandyford facility seeing fewer patients per month than are added to the waiting list. However, the charity still harbours some concerns.

NHS England confirmed last week that children would no longer be prescribed puberty blockers at gender identity clinics south of the border.

Puberty blockers, which pause the physical changes of puberty such as breast development or facial hair, will now only be available to children in England as part of clinical research trials

Vic Valentine, the manager of Scottish Trans, said: “We’re, of course, concerned that developments in NHS England could be followed in Scotland, but we would hope that given that the children and young person’s service up here is run quite differently from the previous service down in England, and also that the Scottish Government is currently supporting the establishment of a nationally commissioned Young Person’s Gender Identity Service, that any decisions around puberty blockers or gender identity services more widely will carefully consider all of the evidence, and be taken with the best interests of trans children and young people in Scotland at their heart.”

The process for acquiring puberty blockers is slow and laborious, according to Vic, and increasingly excessive waiting times for trans healthcare mean young trans people are unlikely to acquire them before finishing puberty anyway.

Vic said: “More people join the lists every quarter than the clinics see. If things stay the same, it’s hard to say how long someone joining the list today would wait – but it would be a very, very long wait. If waits are drifting towards the decade mark, it’s not really an available service anyway.”

Children and young people experiencing gender dysphoria are referred to the Sandyford Clinic in Glasgow. After waiting for years, they then undergo several psychosocial assessments with various psychologists, who may decide that puberty blockers are in the best interest of the patient.

The Sandyford clinic is allocating appointments to young patients who were first referred to the service in June 2019.

They would then be referred to an endocrinologist, who would also have to agree that puberty blockers are the correct course of action. As such, there are fewer than 20 young people in Scotland being prescribed puberty blockers by NHS Scotland for gender dysphoria.

“A very small number of people experience distress around their gender,” said Vic.

“It’s very unfortunate that what should be a conversation between young people, their families and doctors has become a subject of wider national discourse.”

Puberty blockers, which pause the physical changes of puberty such as breast development or facial hair, will now only be available to children in England as part of clinical research trials.

Puberty blockers are already prescribed for a significantly larger number of young people experiencing precocious puberty than for trans children.

The NHS England policy document, published last week, said: “We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time.”

It follows a public consultation on the issue and an interim policy, and comes after NHS England commissioned an independent review in 2020 of gender identity services for children under 18.

However, puberty blockers in England will still be available in private clinics, and young trans people who are already being prescribed them will continue to receive them on the NHS. Transgender people in the UK are already forced to crowdfund for private healthcare not available on the NHS.

On sites such as GoFundMe and JustGiving, pleas for help can be found from both trans men and trans women, driven to desperation by waiting times measured in years, not months.

Young trans people in Scotland and England are also being forced to take out large loans or deplete their life savings to purchase private treatment, due to “completely unsustainable” waiting times for gender-affirming surgery and hormones. This has led to fears that a ban on puberty blockers would drive more transgender people to private clinics at considerable expense.

“Much more than in the past, people are turning to private healthcare,” said Vic. “In the midst of a cost-of-living crisis, we’re hearing of people selling their cars to afford treatment, or having to back out of treatment in the middle. I know that even now there is a bit of a wait for that private clinic.”

A spokesperson for Stonewall said trans young people “deserve access to high quality, timely healthcare”.

“For some, an important part of this care comes in the form of puberty blockers, a reversible treatment that delays the onset of puberty, prescribed by expert endocrinologists, giving the young person extra time to evaluate their next steps,” the spokesperson said.

“We are concerned that NHS England will be putting new prescriptions on hold until a research protocol is up and running at the end of 2024.”

Mermaids, a transgender charity, described the NHS England announcement as “deeply disappointing”.

“There were virtually no first appointments offered in 2023, with ever-growing waiting lists of over five years,” a spokesperson for the charity said. “Those currently prescribed puberty blockers won’t see any changes to their treatment, and this is a pause on prescribing – not a ban.

“It’s also important to note that puberty blockers can be just one possible part of a young person’s gender journey. However, this news still comes as a blow and will deeply affect our communities.”

A Scottish Government spokesperson said: “The Scottish Government and NHS Scotland are engaged with NHS England on its planned study into the use of puberty blockers in young people’s gender identity healthcare, and discussions are ongoing to determine what future engagement is appropriate.”

Vic said: “We are supportive of every young person getting the healthcare right for them. As far as we’re aware, there is ample evidence that some young trans people would benefit from puberty blockers.

“The main thing is that it is completely understandable that people want to be reassured that young people are getting access to well evidenced treatment.”