Puberty blockers: Can a drug trial solve the big debate?

The BBC has learned details about the arguments going on around the concept of a trial and how it could look. Some argue that there is already evidence that puberty blockers can help with mental health, and that in light of this it would be unethical to perform a trial at all because this would mean some young people experiencing gender distress would not be given them.

The World Professional Association of Transgender Health (WPATH) has expressed their concern about the trial for this reason. They support the use of puberty blockers, cross-sex hormones and surgery. WPATH, who have faced increasing criticism of their guidelines from some clinicians, say that it is ethically problematic to make participation in a trial the only way to access a type of care that is “evidence based, widely recognised as medically necessary, and often reported as lifesaving.”

Meanwhile other clinicians believe there is no good evidence that puberty blockers can help with mental health at all. They also point to research that questions the negative impact that the drugs might have on brain development among teenagers, as well as evidence around the negative impact on bone density.

Dr Louise Irvine is a GP and co-chair of the Clinical Advisory Network on Sex and Gender which says it is cautious about using medical pathways in gender dysphoric children. She says: “Given that puberty blockers by definition disrupt a crucial natural phase of human development, the anticipated benefits must be tangible and significant to justify the risk to children.

“In pushing ahead with a puberty blockers trial, we are concerned that political interests are being prioritised over clinical, ethical and scientific concerns, and over the health and wellbeing of children.”

The NHS adult gender services holds data that tracks 9,000 young people from the youth service. Some argue that this should be scrutinised before any trial goes ahead as it could provide evidence on, among other things, the potential risks of taking puberty blockers.

But there is a third view held by some others, including Gordon Guyatt, a professor at McMaster University in Canada, who points out that randomised trials are done in “life-threatening stuff all the time” where no-one can be sure of the long-term effects of a treatment. In his view it would be “unethical not to do it”.

“With only low quality evidence, people’s philosophies, their attitudes or their politics, will continue to dominate the discussion,” he argues. “If we do not generate better evidence, the destructive, polarised debate will continue.”