National Health Service (NHS) England has announced that it will stop prescribing puberty blockers in its clinics for children who wish to change their sex.

The so-called puberty blockers, which stop the appearance of the characteristic physiological changes in the adolescent phase, will from now on only be prescribed in clinical research trials.

The British Government is committed to ensuring that patient care is evidence-based and in the best interests of the child. In line with this promise, it must be remembered that Dr Hilary Cass revealed in February 2022 serious deficiencies in the Gender Identity Development Service of the Tavistock clinic in London, after several complaints from those affected and employees.

The NHS commissioned the report from Cass in September 2020, after detecting “a significant and sharp rise in referrals” of patients sent by GPs, which rose from 250 in 2011-2012 to more than 5,000 in 2021-2022, causing long waiting lists.

As a consequence, this clinic dedicated to caring for minors with alleged gender dysphoria will close at the end of March. After the closure of Tavistock, the NHS will open next April in London and Liverpool two new services for children to treat them with experts in neurodiversity, pediatrics and mental health, so that children receive treatment in accordance with scientific evidence and based on expert clinical opinion.

According to the national director of this area, John Stewart, about 200 patients will be transferred to the two new clinics, while more than 5,000 minors and young people are on the waiting list.

In Great Britain, procedures are being modified due to the lack of scientific evidence on their safety and efficacy, mainly in children and adolescents. Other pioneering countries in the promotion of gender transition processes are Finland, the Netherlands and Sweden.

Scottish law

Just a year ago, in March 2023, the British government announced that it would veto the Scottish gender law that facilitated gender transition at the age of 16. This law lowered the minimum age for gender reassignment from 18 to 16 and eliminated the need to present a medical report together with evidence of having lived at least 2 years with that intention. Given this approval, the British Government considered that the Scottish Parliament had exceeded its constitutional powers.

The Executive then used, for the first time, section 35 of the Act that established the autonomy of the Scottish Parliament in 1998. That section allows London to veto legislation that it considers to affect “matters reserved” to central Government.

Bioethical assessment

The adoption of arbitrary measures has had the connivance of many doctors who have been applying them uncritically until today, which results in a devastating scenario. These measures are not supported by the required scientific evidence and are promoted by sectors in favor of gender transition processes.

The evidence on the limited effectiveness of these measures to resolve dysphoria has shown that the adoption of therapeutic measures has been driven not by rigorous clinical criteria, but by ideological pressures without a scientific basis.

The use of puberty blockers is not included as an authorized treatment in cases of gender transition by any legislation and their use for this purpose is considered “off label”.

The silence of many clinicians in the face of this grievance has contributed to its expansion, now causing the countries that were earliest in its implementation to be rectifying the diagnostic and therapeutic approach to cases of gender dysphoria.

The lack of scientific rigor in medicine almost always leads to maleficent acts on patients. The proposal of some countries to prioritize psychological treatments instead of pharmacological or surgical ones, contrasts with what is established by Spanish law, which strictly prohibits them, even when it is the patient himself who demands it.

Cases of regret occur with increasing frequency, often resulting in irreversible situations and damage.

Well-founded ethical criteria are essential in the practice of medicine to ensure levels of efficacy and safety consistent with the need to respect the dignity of patients.

Julio Tudela and Cristina Castillo

Bioethics Observatory – Institute of Life Sciences

Catholic Univesity of Valencia

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