How puberty blockers for teenagers became normalised in the NHS

Trusted organisations turned over leadership on gender identity to an American group with little evidence to back its ‘gold standard’ claims

Lucy Bannerman Thursday March 14 2024, 6.00pm, The Times

Whistleblowers have been warning about the dangers of puberty blockers for years, but how did the experimental use of such controversial drugs become so quickly embedded at the heart of NHS policy?

As a newly emerging and poorly understood area of medicine, the treatment of issues related to gender identity should have demanded more scientific interrogation, not less. Yet British health authorities appear to have outsourced leadership in this area to lobby groups that are accused of being more interested in activism than evidence.

The “gold standard” that never was

Time and time again, documents from the past ten years show that trusted organisations, from the NHS, the British Medical Association and the General Medical Council to the Royal College of Psychiatrists, deferred to guidelines issued by an American organisation called the World Professional Association of Transgender Health (Wpath).

This group styles itself as the global authority on all matters related to transgender health. It may sound a bit like the World Health Organisation, but that’s about where the similarity with the UN agency ends. It is not a solely professional body — many of its members are activists. One of its former presidents, for example, was Stephen Whittle, a transgender activist and legal professor from Cheshire who describes himself as a “woke, anti-growth, lefty lawyer”. He has no medical background.

What was the role of Mermaids?

Susie Green, the campaigning mother of a transgender child who became the chief executive of Mermaids, had no medical or scientific training either. The charity began as a support group for young patients undergoing treatment at Gids, the NHS’s largest gender identity service for young people, and ended up casting a controversial shadow over the whole service. She resigned in 2022, after six years in the post.

Mermaids has campaigned for greater access to puberty blockers but insists it never interfered in clinical decisions or pushed young people down a particular medical pathway. Yet its alleged influence over the country’s leading gender clinic became a divisive issue among staff. Senior clinicians claimed they felt under increasing pressure from Mermaids and the families the charity supported to make puberty blocker referrals for any young person who asked for one.

Susie Green resigned after six years as chief executive of Mermaids

Susie Green resigned after six years as chief executive of Mermaids


How far did Wpath’s influence reach?

As more and more distressed children joined the Gids waiting list, referred by overstretched mental health services and desperate for the drugs they believed would solve their problems, so began an exodus of senior clinicians, who claimed that normal clinical standards were being abandoned in favour of a dangerously unquestioning approach, promoted by campaign groups.

Repeatedly, organisations referred to Wpath guidelines to justify their approach to treatment.

In 2015 a report by MPs on the women and equalities committee, assessing the state of healthcare for people who identify as transgender, revealed the influence of Wpath on Gids. It said: “Bernadette Wren, head of psychology and associate director at Gids, told us that its treatment protocols are based on Wpath guidelines which are almost universally observed in Europe.”

In its advice for young people considering transitioning to the opposite sex, a leaflet from the Sandyford Clinic, which is Scotland’s main clinic for young people in crisis over their gender, tells patients: “Your treatment will be monitored and run in accordance with the guidelines set out in the ‘Standards of Care’ as laid down by the World Professional Association for Transgender Health (Wpath).”

Dr Hilary Cass found “gaps in the evidence base” in all aspects of gender care for children

Dr Hilary Cass found “gaps in the evidence base” in all aspects of gender care for children

Similar references to Wpath as setting the gold standard in this area of medicine also appear in 2022 guidance by the British Medical Association and 2013 guidance by the Royal College of Psychiatrists.

The trouble was, there was little evidence to back up Wpath’s claims. In truth, there was no global consensus on the best course of treatment for vulnerable young people seeking to change gender.

The Cass review

When Dr Hilary Cass did the most comprehensive review of all the medical evidence in this field she found “gaps in the evidence base regarding all aspects of gender care for children and young people from epidemiology through to assessment, diagnosis, support, counselling and treatment”.

Her careful and thoughtful analysis, commissioned by NHS England, could not have been in starker contrast to the cavalier tone of Wpath members as they discussed putting vulnerable, mentally ill and even homeless patients on irreversible medical pathways in conversations on an online forum, which were recently leaked to the American activist Michael Shellenberger and the campaign group Sex Matters.

The power of euphemism

Language matters in this debate. No one says “sex change” any more. Perhaps, they should. For a long time, the question was framed as, “Should children be allowed to be their authentic selves?”

On the surface, that is difficult to argue against. Parents, teachers and carers who said “no” risked being vilified as bigoted and transphobic.

However, one wonders how much quicker the ban on puberty blockers would have come into effect had the question been: “Should the NHS give sex changes to vulnerable kids?” Or even: “Will sex changes bring happiness to troubled children, a disproportionate number of whom are autistic and/or have histories of trauma, abuse and foster care?”

What has been the impact on families?

For many parents of children who have been in crisis over their gender, the ban is welcome — but comes too late.

A spokeswoman for the Bayswater Support Group, which represents more than 650 family members of children seeking to transition, said: “We’re pleased this has happened but for kids who have been told for the past four, five years that these drugs are safe, it’s too late.

“It has destroyed families. No one is ever going to say sorry.

“It has really messed kids up. They have missed years of their childhood because of this. They won’t get those years back.

“There has been a lot of estrangement between children and their families. We have seen cases where parents are divorced and one parent supports going to a clinic [for puberty blockers] and the other does not.

“We’re seeing 18-years-olds who have the emotional development and maturity one might expect from a 15-year-old.

“We have watched our children wait for these interventions because they have been told to believe that’s when their lives will begin. All we can do is wait for them to grow up and hopefully realise what has happened, but it would be much better if the schools, NHS and the government could acknowledge they made a mistake.

“It is useful the NHS has said this but for the kids who get their information from TikTok instead of the media, who is going to tell them?”