Last night we learnt that the failing-fast UK government, in one of its very last actions, did something unprecedented, just to make life more un-liveable for transgender children and adolescents in the UK.
They enacted a very rare government power to block access to the only two remaining routes to doctor-prescribed UK-pharmacy-dispensed puberty blockers.
They used an emergency legal power that as far as I can see has only been used once before. That was in 1999 for a barely-known drug that had caused a number of deaths. Even then they went through several steps to gain medical authority scrutiny and approval of government use of emergency powers to enforce a ban, also considering the likely impacts on existing users of the substance (there was no significant use of the 1999 substance that was considered highly toxic).
Yesterday afternoon the UK government used this same rare power to place an immediate (starts 3rd June) emergency ban on puberty blockers a) from overseas prescribers and b) from NHS GPs in primary care.
Let’s start with the second one. The UK government has enacted draconian emergency powers to ban the medical prescribing of NHS GPs in primary care. GPs in primary care already only have ever prescribed puberty blockers as a harm minimisation strategy – where they know a trans adolescent is accessing from a source (eg grey market without any monitoring) and they recognise their duty of care to minimise harms and where the threat to that adolescent’s life is considered severe (adolescents who cannot conceive of living through the wrong puberty). The UK government has made this harm reduction care from NHS GPs illegal. This has now closed literally the last route to UK-prescribed puberty blockers.
The UK establishment has systematically closed every single UK route to puberty blockers. The GMC (the UK regulator of medical doctors) has used its powers against a series of trans positive doctors since the early 2000s (thereby deterring any other doctors from stepping forwards). The CQC has denied approval to any UK private practices seeking to support trans adolescents under the age of 16, meaning the UK registered private providers do not offer support to trans adolescents at the point of puberty. The NHS gender clinics maintained a tight monopoly, with one English and one Scottish clinic for under 18s. The former was closed in March 2024, and the latter has currently blocked routes to puberty blockers. The new English service (also covering Wales) has no route to access to puberty blockers. Every door has shut.
The primary target of the draconian emergency ruling is those who currently receive a prescription for puberty blockers from an overseas doctor. Currently, the vast majority (I would guess 98%) of UK trans adolescents on puberty blockers receive them from an overseas doctor’s prescription, that is dispensed in a UK high-street pharmacy. There must be high hundreds or low thousands of trans adolescents currently receiving puberty blockers via this route. This route will now stop working on the 3rd of June. High hundreds or low thousands of trans adolescents will be without any route to receiving their prescription in a UK pharmacy.
What are those adolescents meant to do? Now they cannot even go to their GP as an emergency and harm-reduction route. Those who cannot or will not consider grey market routes will literally be medically detransitioned, something known to be an actual medical and well-being risk, by the edict of a transphobic government. This will not be safe. This was never about safety.
The power to take this step is based on emergency measures that can only be enacted where there is a critical threat to immediate safety. The government waved this through with the claim “the Cass Review…”.
The Cass Review was a shambles of transphobic medical policy. The Cass review approach to puberty blockers was based on one clever trick.
If the Cass review had asked these two questions, the answers would have been very clear. 1. Are puberty blockers effective at blocking puberty (Yes, very clearly). 2. Are they safe at blocking puberty (Yes, very clearly, used since the 1960s for precocious puberty in children who are 6 or 7, used since the 1980s for trans adolescents, NO EVIDENCE OF HARM).
The trick played by the Cass Review is that they didn’t ask these questions. They instead asked, 1. Are puberty blockers effective at treating gender dysphoria? Shifting to this question allowed them to ignore the very clear evidence that they are extremely effective at blocking puberty. They claimed that effective puberty blockers should improve well-being which has never been the case. Puberty blockers are intended to maintain well-being, in stark comparison to trans adolescents without puberty blockers whose mental health, well-being, wish to live, and ability to succeed at school and socially tends to nose-dive at puberty). Unless you have an unethical study watching the kids who fall off a cliff in mental health without blockers then how do you prove they help prevent a decline in mental health? Shifting the question to whether they ‘treat gender dysphoria’ allowed the Cass Review to state the evidence of effectiveness was ‘inconclusive’.
Secondly, instead of asking whether the medicine is ‘safe’, they asked a narrower question, is it ‘safe in treating gender dysphoria’? This allowed them to disregard decades of studies that puberty blockers are safe when used in cis children. The drug is very clearly safe. It is still today (and next week) prescribed by the NHS for younger children who are not trans. There are no safety concerns. The medication is clearly safe.
The only way that the Cass Review was able to raise any safety concerns at all, was through transphobic speculation. They speculate, with zero evidence, that perhaps puberty blockers may ‘change the outcome’, keeping a trans child as a trans adolescent, when all they need is a good dose of their endogenous hormone and then they would turn out normal (cis). (See my recent podcast transcript that dives into this). The severe safety risk that the Cass Review speculates about, is the risk of still being trans. There are some other speculations, that are only proposed for trans adolescents (not for cis youth receiving the same medication for any other purpose, including endometriosis or early puberty). None of the speculations are evidenced. The Cass Review also references things like bone density, which is a minor risk that endocrinologists are well aware of and can be easily managed by a) monitoring bone density b) taking vitamin supplements c) not being on blockers without hormones for more than a couple of years. There is no evidence of actual risk or actual harm at all of trans adolescents using puberty blockers.
The actual risk is, of course, the opposite. There is a very real risk to trans adolescents who need puberty blockers and are denied them. In the last week I’ve spoken to two parents whose children no longer wanted to be alive because of starting to be pushed through a puberty that is distressing and humiliating for them. For adolescents who are deeply distressed by puberty, instead of being offered a safe and effective medication that can stop those changes, they are being offered a big pile of nothing. They are being offered the suggestion that perhaps they are not really trans, and perhaps the changes that they find traumatic are just want they really need to grow up cis. That is where we are with trans healthcare in the UK today. Trans children and young teens are being told, ideally you should convert yourself into a cis person, or we literally do not care for you, your life, your safety, your well-being.
High hundreds or low thousands of trans adolescents who are on puberty blockers, happy and healthy, will be forceably detransitioned by government edict, without medical supervision or support, starting on the 3rd of June. Some of these will turn in desperation to grey market sources, finding every route to UK pharmacy dispensing closed. There are risks to youth who are forced onto grey market sources, both in terms of ensuring the quality of medication that does not come from UK pharmacy, and perhaps even more so in terms of the risks associated with healthcare avoidance. Trans adolescents who are accessing grey market medication, having had every other route banned, will be reluctant to go to their GP for other health issues. There is a real risk of a whole generation of trans adolescents losing out of mainstream healthcare, and becoming at higher risk of the health impacts that occur when a portion of society is afraid of talking to their GP or health service. Communities who are afraid of talking to their healthcare providers (see undocumented immigrants) are likely to go to healthcare providers late when they have a routine health concern, are likely to wait until minor healthcare concerns become major, are likely to have significantly worse general healthcare outcomes. This is where we are heading today for trans adolescents in the UK. It is an absolute oppression. It is not about safety. It was never about safety.
The emergency legislation lasts for only 3 months, as the UK government is enacting an emergency power intended for a new and unexpected threat to life, not a power intended for a medication safely used since the 1960s. This temporality does not reassure me. Let’s look at the Labour Government’s reaction – are they going to condemn this transphobic intervention as dangerous and abusive government overreach into healthcare? I bet they will not. And if they do not, then I have no confidence that they will not extend this if they are in power come September.
In the name of ‘safety’ the UK government is making the UK more unsafe for trans adolescents. Transphobia is the biggest safety threat to trans adolescents, as to trans people of all ages. Trans children and adolescents can have a happy and safe and secure childhood and adolescence. But the UK government and the NHS is trying its utmost to take that happiness and safety and security away. We need to do better for trans young people. #TransRights #TransKidsShouldThrive #TransHappinessMatters
Growing Up Transgender 