Prescription of puberty blockers paused for children in Scotland following Cass Review

The Sandyford Clinic in Glasgow said new patients under 18 will no longer receive the treatment

Ministers have welcomed the decision to pause the prescription of puberty blockers for children who identify as transgender in Scotland.

SNP health secretary Neil Gray said the move was “based on the best evidence available”. The Sandyford Clinic in Glasgow, which offers gender services, said new patients aged under 18 will no longer receive hormone treatments.

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It follows recommendations made by the Cass Review – named after its head, Dr Hilary Cass – for the NHS in England. The landmark report criticised the lack of evidence around the use of puberty blockers and other medical interventions.

The Sandyford clinic in Glasgow is Scotland's only facility for trans young people (Picture: John Devlin)The Sandyford clinic in Glasgow is Scotland's only facility for trans young people (Picture: John Devlin)
The Sandyford clinic in Glasgow is Scotland's only facility for trans young people (Picture: John Devlin)

The Scottish Government had been under pressure to rule out the routine use of puberty blockers, as has been done in the NHS down south.

In a statement posted on its website, the Sandyford said: “Referrals from the Sandyford sexual health services to paediatric endocrinology for the prescription of puberty suppressing hormones have been paused for any new patients assessed by our young person’s gender service.

Patients aged 16 to 17 years old who have not been treated by paediatric endocrinology, but who are still seeking treatment for their gender incongruence, will no longer be prescribed gender affirming hormone treatment until they are 18 years old.”

The clinic said those already being treated will not be affected, adding: “This service update follows research from NHS England and the publication of the Cass Review while we work with the Scottish Government to engage in research with NHS England that will generate evidence of safety and long-term impact for therapies.”

The Cass Review – named after its head, Dr Hilary Cass – was released last weekThe Cass Review – named after its head, Dr Hilary Cass – was released last week
The Cass Review – named after its head, Dr Hilary Cass – was released last week

The facility said it would continue to give young people “the psychological support that they require”.

NHS Greater Glasgow and Clyde (NHSGGC) and NHS Lothian deferred starting new patients on the treatment in mid-March, following the decision taken down south. Patients were informed before the move was made public. NHS Lothian provides care to those aged 17 and over at its Chalmers gender identity clinic.

Dr Emilia Crighton, director of public health at NHSGGC, said: “The findings informing the Cass Review are important and we have reviewed the impact on our clinical pathways. The next step from here is to work with the Scottish Government and academic partners to generate evidence that enables us to deliver safe care for our patients.

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“We echo the views of Dr Hilary Cass that toxicity around public debate is impacting the lives of young people seeking the care of our service and does not serve the teams working hard to care and support them.

“We understand the distress that gender incongruence can cause and while all referrals to endocrinology are paused, we will continue to give anyone who is referred into the young people gender service the psychological support that they require while we review the pathways in line with the findings.”

Tracey Gillies, executive medical director at NHS Lothian, said: “The Cass Review is a significant piece of work into how the NHS can better support children and young people who present with gender dysphoria. Patient safety must always be our priority and it is right that we pause this treatment to allow more research to be carried out.”

Mr Gray said it was right for the decision to be made by clinicians rather than politicians, adding the Government and boards were considering the recommendations of the Cass Review.

He said: “The Scottish Government welcomes the joint statement from NHS Greater Glasgow and Clyde and NHS Lothian confirming their change in clinical policy on prescribing puberty hormone suppressants and cross-sex hormone medication to young people.

“We have been clear it is for clinicians and health boards to make decisions about clinical pathways, and that these decisions should be made carefully and based on the best evidence available. This is what both health boards have done and their position is supported by the chief medical officer.

“More broadly, the Cass Review’s final report and findings are being closely considered by both the Scottish Government and health boards, in the context of how such healthcare can be best delivered in Scotland.”

He went on to lament the “toxic” debate around gender issues – mentioned by Dr Cass in her review – saying those in receipt of care should be “at the centre of our thoughts when we discuss this issue”.

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The Tavistock Clinic in London, which offered gender services, was closed this year, but Humza Yousaf previously said the Sandyford would not suffer the same fate.

Speaking during First Minister’s Questions in Holyrood, he said: "It was absolutely right to allow clinicians to have conversations with the young people that they treat compassionately before the government came forward with any further statement.

"Now that we've had that confirmation, of course the health secretary or ministers will come to this chamber with the agreement of the parliamentary bureau next week or in the coming weeks to give an update on the Government's position. There is a process of review that is very much under way."

Scottish Tory deputy leader Meghan Gallacher said the decision to pause the use of puberty blockers should have been taken “weeks ago”. Ms Gallacher had repeatedly pushed for a statement to be made in Holyrood on the Cass Review, which ministers rejected.

“This long overdue decision should have been taken weeks ago when NHS England put a pause on the prescribing of puberty blockers,” she said after the decision was announced.

“The SNP Government have been dragged kicking and screaming towards taking the necessary action to safeguard vulnerable youngsters after days of shameful silence and dithering in response to the Cass Review – presumably to placate the gender zealots in the Scottish Greens.

“Humza Yousaf repeatedly passed the buck – insisting it was up to clinicians to decide on the efficacy of puberty blockers and saying he wouldn’t be rushed into responding to Cass – when it was clear decisive action was required.”

Scottish Labour deputy leader Dame Jackie Baillie said she was “pleased” at the decision and urged the Government to lay out what changes would be made to treatment in the wake of the Cass Review.

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“The guiding principle for all actions must be to ensure that young people with gender dysphoria get safe treatment,” she said.

But two Scottish charities said the decision was wrong. The Equality Network and Scottish Trans said they were concerned about the impact the decision could have on transgender young people, whom they said were rarely prescribed the drugs.

“We’re saddened that this change will result in some young people being unable to access the care they need at all, or having to wait even longer for it,” Scottish Trans manager Vic Valentine said. “We want every child or young person to get the individualised care that’s right for them at the time that’s right for them. We don’t think this decision will make that possible.”

The charities called on health boards and the Scottish Government to “urgently prioritise” research required to “make sure that no child or young person is denied the care they need”.



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