Actions speak louder than words. In one of the first tests of his tenure, the Health Secretary Wes Streeting has put clinical evidence and child welfare above ideology and intimidation in pledging to persist with a ban on the use of puberty blockers for children. Streeting confirmed that he intends to retain a ban on the prescription of puberty blockers to under 18s across both NHS organisations and at private clinics. JK Rowling has described the move as ‘humane’ and ‘considered’. She’s right.
There are no shortage of challenges facing the new Health Secretary
‘Puberty blockers’ (known more accurately as gonadotrophin-releasing hormone analogues) can halt the production of sex hormones. Some of the known, possible side-effects range from weight gain to impacting bone growth and density, but the long-term impacts may – for instance – impact brain development and cognition. Fundamentally however, the impact of their use is poorly understood.
Despite a lack of clinical evidence, puberty blockers had been prescribed to gender-questioning children in recent years. The practice was eventually halted by the last government in the wake of the findings of the independent ‘Cass Review’, a comprehensive review of NHS gender identity services, which both the Conservatives and Labour pledged to implement in their manifestos.
Cass concluded that there is a ‘very narrow indication for the use of puberty blockers in birth-registered males as the start of a medical transition pathway in order to stop irreversible pubertal changes. Other indications remain unproven….’
In seeking to maintain the ban on their use, Streeting will uphold the provisions of an emergency order, introduced by the previous health secretary, Victoria Atkins, as part of the ‘wash up’ period, but which runs out in September of this year.
There are no shortage of challenges facing the new Health Secretary. Less than ten days into the job, he has stated that the ‘NHS is broken’, appointed Lord Darzi to divulge ‘hard truths’ about NHS performance and called for the Department of Health and Social Care to ‘end the begging bowl culture’ and focus on ‘boosting economic growth’.
But while in many of these areas there is a degree of consensus, in stating that: ‘I am treading cautiously in this area because the safety of children must come first’, Streeting has acted decisively amidst ongoing division amongst some in his own party on the subject.
As Policy Exchange has previously highlighted however, questions remain over the approach the new government will take to a wider series of questions relating to sex and gender across health and care. Will the new Health Secretary follow through in amending the NHS Constitution for England to protect single-sex intimate care across the NHS (as proposed by the previous government)? Will he go further than his predecessors in stamping out the influence of activist groups pushing ill-evidenced ideological positions within NHS organisations?
The timing of the Health Secretary’s clarification has significance too. It comes just days after TransActual, a trans activist organisation, brought a judicial review of the puberty blocker ban to the High Court. They claim that ‘a partial and unfair consultation process’ was carried out in introducing the emergency legislation during the previous parliament’s ‘wash up’ period.
At a hearing last week, the ban on puberty blockers was alleged by the applicants to be motivated by the former Health Secretary’s ‘personal views’ and implemented ‘without taking clinical or other scientific advice’.
Let us be clear though about the evidence base we are dealing with here and why the government seeks to maintain a ban on puberty blockers for under 18s in the first place. Guidance issued in March 2024 by NHS England concluded ‘that there is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make the treatment routinely available at this time’.
The Cass Review found that, of the more than one hundred studies examining the role of puberty blockers and hormone treatment for gender transition, only two were of passable quality. Dr Cass has since reflected it became clear in conducting the review that ‘gender medicine’ was ‘built on shaky foundations’.
The editor of the British Medical Journal has written that ‘studies in gender medicine fall woefully short in terms of methodological rigour’. The decision to prescribe life altering drugs to children was based on a ‘single Dutch study’ of just 70 children.
These are damning indictments. Is there a single area of medicine where such a low evidence base would be deemed acceptable to support such significant, life-changing medical interventions for children? We certainly cannot think of any.
Yet, despite the case being ‘closed’ from a medical perspective, the debate seems likely to loom large in the legal realm. A judgment in the High Court is expected to be heard this week.
On X/Twitter, the Health Secretary’s clarification was met with extreme indignation in some quarters. Jolyon Maugham, director of the Good Law Project (who have acted in partnership with TransActual in bringing the aforementioned judicial review), has claimed that ‘my feelings about Wes Streeting are unprintable: these measures will kill trans children’.
Ultimately however, the new Health Secretary is right to say that ‘the evidence should have been established before they [puberty blockers] were ever prescribed’ and to take action to make the last government’s emergency ban permanent before the current legislation expires in September.
Further tests of the government’s approach to gender identity across health and care are sure to come, but Streeting’s first actions in his new brief represent a promising start.
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Lara Brown is Senior Research Fellow at Policy Exchange. Sean Phillips is Head of Health and Social Care at Policy Exchange
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