October 31, 2023
October 31, 2023

Re-analysis of puberty blockers study raises concerns about mental health in transgender youth

Sunila Masih
Waiting room
Sunila Masih

The Tavistock and Portman NHS Foundation Trust Hospital opened the Gender Development Identity Service (GIDS) in 1989. Since then, the centre has worked with around 9,000 children aged 17 and under presenting with gender dysphoria and offered treatments such as prescribing hormone blockers.

In 2011, a study initially found that hormone blockers made ‘no change’ to psychological function, but a reanalysis of the data showed that 34% of participants had a ‘reliable deterioration’ in mental health and that 37% had no significant change, suggesting the need for more individualised approaches to gender-affirming treatments.

Gender dysphoria treatment

Gender dysphoria is when a person experiences distress due to a mismatch between their biological sex and their gender identity. Concerns have been raised that children attending the clinic have been rushed into a diagnosis and treatment with hormone therapy. This hormone therapy treatment can take the form of:

  1. ‘Puberty blockers’ that pause the physical changes of puberty
  2. Feminising or masculinising hormones, otherwise known as gender affirming hormones

Gender dysphoria treatments are provided with the aim of helping people live the way they want to, in their preferred gender identity or as non-binary. Young people with lasting signs of gender dysphoria who meet the relevant criteria can be referred to a Consultant Endocrinologist who decides whether to prescribe hormone blockers as the child reaches puberty.

Puberty and hormone blockers

Puberty and hormone blockers pause the physical changes of puberty by suppressing the physical developments that would otherwise occur during puberty and can be prescribed to children as young as 11.

From the age of 16, teenagers who have been on hormone blockers for at least 12 months may be given cross-sex hormones, also known as gender-affirming hormones. Both puberty blockers and gender affirming hormones are life altering.

Early intervention study

In 2011, a team from GIDS and University College London Hospitals (UCLH) started what became known as the early intervention study. They enrolled 44 children, aged between 12 and 15, over the following three years. The study looked at the effects of taking puberty blockers on children. It used scores from both parent and child questionnaires, which assessed children’s behavioural and emotional problems.

The results were published in 2021, which revealed that blockers had ‘no changes in psychological function’ to those taking them. The overall finding of ‘no change’ was based on a group average of the scores from the questionnaires given at different points in time.

This approach had the potential to miss the extent of any significant variation between the participants: those who did really badly and those who did really well could still produce an overall result of somewhere in the middle when looking at the group as a whole.

Reanalysis of data

Susan McPherson, a professor of psychology and sociology at the University of Essex, and David Freedman, a retired social scientist, have since re-analysed the data according to an article published by the BBC[1]. They looked at the individual trajectories of each of the young people in the early intervention study.

This approach revealed that 34% of young people experienced a ‘reliable deterioration’ in their mental health, while 29% ‘reliably improved’ after 12 months of taking puberty blockers. Another 37% showed no significant change.

The significance of the reanalysis lies in its ability to provide a more nuanced understanding of the impact of puberty blockers on transgender youth. By examining individual responses, researchers were able to identify variations in the participants’ experiences, offering a more comprehensive view of the treatment’s effects. This approach allows for a closer examination of who benefits from the treatment and who may not.

Professor McPherson and Mr Freedman recommended that such individualised analytical approaches should be incorporated into new gender dysphoria services being established in the UK and future research studies. This recommendation aims to enhance the understanding of how gender-affirming treatments impact the mental health of transgender youth.

The findings from this reanalysis have raised questions about the original conclusions of the Early Intervention Study.

Ongoing investigations

The data from the re-analysis has also been submitted to Dr. Hilary Cass, a former President of the Royal College of Paediatrics and Child Health and former Chair of the British Academy of Childhood Disability, who is currently conducting an independent review of gender identity services for children and young people.

In February 2022, Dr Cass and her team published their interim findings. They found that the ‘single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand’ and ‘the clinical approach and overall service design has not been subject to some of the normal quality controls that are typically applied when new or innovative treatments are introduced.’

Staff at GIDS reported they felt a ‘pressure to adopt an unquestioning affirmative approach’, which was ‘at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters’. This was mirrored as the Cass Review found that ‘from the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations.’

The Cass Review found that there was no apparent ‘standardised approach to assessment or progression through the process’. The Review also identified an issue of diagnostic overshadowing. Once adolescents were ‘identified as having gender-related distress, other important healthcare issues that would normally be managed by local services could sometimes be overlooked’.

Since the reanalysis, Dr Cass’s review team has committed to considering the new research findings in its final recommendations, which are expected to be released by the end of 2023.

In conclusion, the reanalysis of the Early Intervention Study highlights the need for a more nuanced approach to the study of the effects of puberty blockers on transgender children’s mental health. As the healthcare community and policymakers continue to evaluate and improve gender identity services, a comprehensive understanding of the impact of these treatments is crucial for the wellbeing of transgender youth.

Pogust Goodhead’s role

We have been at the forefront of holding those accountable for failures in their duty of care towards young children and adolescents at Tavistock and Portman NHS Trust.

Partner and Head of Medical Product Liability, Lisa Lunt, said: “This new analysis suggests that there are more people that have been adversely affected by puberty blockers than those that have experienced a positive effect. Whilst we have to be mindful of the fact that the reanalysis has not been peer reviewed or published in a scientific journal yet, the requirement for more research on the impact of puberty blockers is clearly demonstrated.”

Pogust Goodhead represents clients that have been adversely affected by the failures identified at GIDS to obtain compensation for their life changing injuries. If you, or someone you know, has been affected, please do not hesitate to get in touch with our dedicated team of experienced lawyers.

[1] ‘Children on puberty blockers saw mental health change – new analysis’, 19 September 2023, BBC News

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