November 28, 2023 - 7:00am

On the surface, last summer’s headlines about the Tavistock Gender Identity Development Service for children and adolescents sounded definitive, with the National Health Service ordering the clinic’s closure after it was found “not safe” for patients. That harsh verdict was supposed to be the end of an era and the start of a fresh approach to working with gender-distressed children and young people. 

It wasn’t. This weekend, the Telegraph reported that the number of children prescribed puberty-suppressing drugs has doubled since the National Health Service promised to curb the practice last summer, with at least 100 children initiating the controversial treatment between July 2022 and October 2023. 

Last summer, in the wake of a damning independent review, the NHS announced that “puberty blockers will not be made routinely available outside of research,” “except in exceptional circumstances on a case-by-case basis.” These changes would kick in when the new youth gender services opened and when researchers had developed a new clinical trial to study the effects of puberty-blocking drugs on children and adolescents with early-onset gender dysphoria. 

But the launch of the new youth gender services has been repeatedly delayed and the clinical trial the NHS outlined has not yet materialised, leaving thousands of young patients in limbo. 

Last month, Kathleen Stock reported on the struggle to reorganise youth gender services in England and Wales — and pointed out the difficulties of designing a clinical trial that would meet basic standards of medical ethics, given the serious risks and unknowns and dubious benefits. An NHS research trial manager Stock interviewed described the idea of such a trial as “completely insane.” 

Over the past few years, the evidence supporting puberty suppression has taken one hit after another. The NHS’s website now warns that “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria” and that effects on mental health, brain development, and bone density are also unknown. 

Unpromising findings — like research that found “no changes in psychological function” for youth on blockers — turned out to be worse on closer investigation. Rather than being merely ineffective, 34% saw their mental health “deteriorate” on blockers, while 29% showed signs of improvement. 

And the theory that puberty blockers bought patients “time to think” broke down, as reporter Hannah Barnes explained in an interview with WBUR: “Because… what are the chances of every single young person with their very different needs and backgrounds given time to think, and all thinking in the same way?”

As a result of these delays by the likes of the NHS, children and young people are falling into the gap between a service deemed “not safe” for patients and reforms that have yet to take shape. In the absence of meaningful change, a reckless model of care prevails. 

What’s happening — or not happening — in England and Wales is a warning for other medical systems attempting to reverse course. It’s not enough to dismantle the evidence base and condemn a treatment model that has turned the lives of distressed children and adolescents into medical experiments. These are necessary but hardly sufficient steps on the long road back from a medical scandal. 

Patients who have come to see themselves — their identities and their struggles — in these terms are not going away. They urgently need compassionate alternatives to transition that recognise the sources of their distress and the meanings they’ve attached to trans identities. The current path is no longer fit for purpose — and it is dangerous too.

Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.