The care and treatment of children and adolescents in relation to their gender identity in the UK (2021)

Background Paper

Exploratory project

A transfeminine non binary person and transmasculine gender nonconforming person looking at a phone and laughing

Section 3: Research evidence

There are differences of opinion as to what the existing evidence base on the use of puberty blockers (gonadotropin-releasing hormone agonists (GnRHas)) and cross-sex hormones means for clinical practice. Some believe that the existing evidence and clinical experience provides an ethical justification for the use of puberty blockers and cross-sex hormones in care, pointing to the literature which shows the potential risks of not providing that treatment (i.e. increased psychiatric morbidity, self-harming behaviours and suicide). They reject the claim that the use of these treatments is ‘experimental’, or argue that it is similar to other areas of paediatric practice where there are no licensed treatment options.

Others believe that the current state of research evidence provides an insufficient basis for treatment, and that puberty blockers should be considered experimental treatment and prescribed only in the context of a research study. This was the conclusion of the High Court in the recent Bell v Tavistock and Portman NHS Foundation Trust case, on the basis of the uncertainty over the short- and long-term clinical and life-course outcomes and ambiguity over their purpose.

6. In your view, does the available evidence support medical interventions in gender diverse children and adolescents? Please expand on your comments.

7. Does the use of puberty blockers in this context warrant a different standard of evidence to support decisions about treatment compared to other paediatric interventions? Please expand on your comments.