Eight months after the comprehensive Cass report on gender affirming care was released in the United Kingdom, the Ministry of Health (MoH) has finally responded to its findings.
Their evidence brief and position statement on the use of puberty blockers for gender identity issues has been both applauded and derided by interested parties.
Optimists take heart at MoH statements such as “the evidence brief shows a lack of good quality evidence to back the effectiveness and safety of puberty blockers when used for this purpose.” They applaud the Ministry’s emphasis on a more precautionary approach for adolescents with gender identity issues.
“We’re winning,” said Jan Rivers of Genspect and Public Good while Family First head Bob McCoskrie called the report “good news.” He said it indicated New Zealand was beginning to align with jurisdictions around the world where puberty blockers have been severely restricted or even banned for young people such as in various American states, the United Kingdom, Sweden, Finland and Norway.
Act and New Zealand First welcomed what they saw as new rules restricting the use of puberty blockers for gender identity issues. New Zealand First leader Winston Peters said he was pleased to see the first steps have been taken by the ministry to restrict their use - once feedback and consultation has been completed. To date New Zealand First has been the only major political party to tackle this issue head-on.
But enthusiasts for medicating gender dysphoric children like Labour MP Shanan Halbert dismisses these claims and says the Ministry’s edict makes it clear access will be maintained. “Puberty blockers are still to be used as part of comprehensive care plans.”
Labour continues to support gender affirmation and courtesy of puberty blockers, the sterilisation of children. Halbert made the usual genuflections to “our rainbow rangitahi and their whanau” and added that “NZ First has no rainbow representation in caucus and are out of touch with the needs of the rainbow community.”
Indeed but in touch with reality. Little does Halbert realise that this lack will be regarded as a plus amongst the working people Labour used to represent. Trans activism has been a losing strategy politically everywhere. The recent Trump victory “for you” and Kamala loss “for they/them” should signal the foolishness of sticking to this unpopular ideology.
Meanwhile the first response from a medical professional, was from endocrinologist Prof Paul Hoffman, who actually said “Encouragingly the evidence published to date, while of low quality, all indicates the use of pubertal blockers is safe.” Even the Ministry of Health has removed that claim from its website.
So no change then. Suzanne Levy from Speak Up For Women (SUFW) is inclined to agree.
“We have never had the evidence to say they were safe. Puberty blockers have always been off-label, that is, not developed for the use to which they are now put. They were initially devised to suppress puberty in children showing signs of precocious puberty and also for the castration of male sex offenders.
“The Ministry’s statement changes nothing. Those who were cautious before will continue to be cautious and those who think it’s safe and effective will continue to prescribe.”
She said it is glaringly obvious that any medical profession using a drug off-label should be exercising a high level of caution anyway. In a way this new evidence brief is worse.
“They are now telling us that they (MoH) acknowledge there is not enough evidence to say puberty blockers are beneficial or safe, but they are not going beyond that. So given the drugs are off-label, it would appear that they just don't care.”
Act and New Zealand First might say there are new rules restricting the use of puberty blockers, but they are not rules, they are at best guidelines.
While the ministry intends to consult on whether further regulations are needed, such as amendments to the Medicines Act to formalise changes in prescribing expectations, they have asked for feedback from organisations affected, not individuals.
Presumably that means groups like PATHA, the Professional Association for Transgender Health, even though The Cass report gave PATHA's existing guidelines a score of 149/600, the second lowest score out of 21.
A cynic might say they have handed back the reins to gender clinicians invested in the medical pathway, especially those, who to date, have generously prescribed these off label drugs.
SUFW’s press release put it like this:
“It seems an extraordinary approach and we wonder if the same loose rules apply to other treatments unrelated to the gender identity fad - are these factors usually ignored when prescribing to children?
* Drugs that are used off label
* Drugs that are not proven to be safe or reversible
* Drugs that have little or no evidence of beneficial effects
* Drugs where there are no clinical trials or evidence of long-term side effects when taken in children beyond puberty”
It’s a point not lost on the Women’s Rights Party either. Leader Jill Ovens notes from the position statement that the Ministry has already established an external advisory group, without stating who is on that group, and that Health NZ is currently developing updated guidance to support clinicians providing “gender-affirming care”, including the use of puberty blockers.
Ms Ovens says the Women’s Rights Party has been calling for an inquiry into the contracting of PATHA given their role in promoting this unproven medical route.
It is telling too that the only medical professional to have written extensively on this topic, Emeritus Professor, doctor and epidemiologist Charlotte Paul, was not consulted by the MoH. Quoted in Bernard Lane’s substack Gender Clinic News, Paul’s response to the MoH’s evidence brief and position statement is generally positive while recognising limitations.
She applauds the Ministry for taking the first steps to evaluate the clinical bases for the use of puberty blockers in gender-related distress. As well, she is impressed they did their own review and regards their conclusions as sound,
But says Paul the review also has limitations, particularly the lack of necessary context.
“There is nothing about the changing aims of treatment, the rapid increase in numbers and the change in characteristics of those presenting with gender-related distress.”
The report does not address the disagreements about reasons for the increase and the possibility that the use of blockers locks children into a medical pathway. Nor does it raise the legitimate concerns about regret from those who have taken puberty blockers.
Nevertheless she is encouraged that the Ministry has taken this first step. It’s what happens next that concerns her. Normally health authorities would make a determination on the implications for clinical practice. Instead the Ministry appears to be deferring to the government to regulate prescribing.
“Unfortunately, this risks politicization of the issue. Nevertheless, given polarized views in the medical profession, it may be the only feasible way forward.”
While some groups might not be happy with the incremental rate of change in this debate, it is significant that the number of young people using puberty blockers for gender-related distress are declining. So even before this latest determination from the Ministry to proceed with caution, it appears that clinicians and parents are becoming more careful of their own accord, perhaps responding to the approach taken overseas.
The government has now tasked the Ministry with consulting on whether the new precautions should be backed by additional safeguards, such as regulations under the Medicines Act 1981 to strengthen changes in prescribing expectations.
Consultation is open until late January 2025.
Yvonne van Dongen is a journalist, travel writer, playwright and non-fiction author. This article was originally published by ThePlatform.kiwi and is published here with kind permission.
“We’re winning,” said Jan Rivers of Genspect and Public Good while Family First head Bob McCoskrie called the report “good news.” He said it indicated New Zealand was beginning to align with jurisdictions around the world where puberty blockers have been severely restricted or even banned for young people such as in various American states, the United Kingdom, Sweden, Finland and Norway.
Act and New Zealand First welcomed what they saw as new rules restricting the use of puberty blockers for gender identity issues. New Zealand First leader Winston Peters said he was pleased to see the first steps have been taken by the ministry to restrict their use - once feedback and consultation has been completed. To date New Zealand First has been the only major political party to tackle this issue head-on.
But enthusiasts for medicating gender dysphoric children like Labour MP Shanan Halbert dismisses these claims and says the Ministry’s edict makes it clear access will be maintained. “Puberty blockers are still to be used as part of comprehensive care plans.”
Labour continues to support gender affirmation and courtesy of puberty blockers, the sterilisation of children. Halbert made the usual genuflections to “our rainbow rangitahi and their whanau” and added that “NZ First has no rainbow representation in caucus and are out of touch with the needs of the rainbow community.”
Indeed but in touch with reality. Little does Halbert realise that this lack will be regarded as a plus amongst the working people Labour used to represent. Trans activism has been a losing strategy politically everywhere. The recent Trump victory “for you” and Kamala loss “for they/them” should signal the foolishness of sticking to this unpopular ideology.
Meanwhile the first response from a medical professional, was from endocrinologist Prof Paul Hoffman, who actually said “Encouragingly the evidence published to date, while of low quality, all indicates the use of pubertal blockers is safe.” Even the Ministry of Health has removed that claim from its website.
So no change then. Suzanne Levy from Speak Up For Women (SUFW) is inclined to agree.
“We have never had the evidence to say they were safe. Puberty blockers have always been off-label, that is, not developed for the use to which they are now put. They were initially devised to suppress puberty in children showing signs of precocious puberty and also for the castration of male sex offenders.
“The Ministry’s statement changes nothing. Those who were cautious before will continue to be cautious and those who think it’s safe and effective will continue to prescribe.”
She said it is glaringly obvious that any medical profession using a drug off-label should be exercising a high level of caution anyway. In a way this new evidence brief is worse.
“They are now telling us that they (MoH) acknowledge there is not enough evidence to say puberty blockers are beneficial or safe, but they are not going beyond that. So given the drugs are off-label, it would appear that they just don't care.”
Act and New Zealand First might say there are new rules restricting the use of puberty blockers, but they are not rules, they are at best guidelines.
While the ministry intends to consult on whether further regulations are needed, such as amendments to the Medicines Act to formalise changes in prescribing expectations, they have asked for feedback from organisations affected, not individuals.
Presumably that means groups like PATHA, the Professional Association for Transgender Health, even though The Cass report gave PATHA's existing guidelines a score of 149/600, the second lowest score out of 21.
A cynic might say they have handed back the reins to gender clinicians invested in the medical pathway, especially those, who to date, have generously prescribed these off label drugs.
SUFW’s press release put it like this:
“It seems an extraordinary approach and we wonder if the same loose rules apply to other treatments unrelated to the gender identity fad - are these factors usually ignored when prescribing to children?
* Drugs that are used off label
* Drugs that are not proven to be safe or reversible
* Drugs that have little or no evidence of beneficial effects
* Drugs where there are no clinical trials or evidence of long-term side effects when taken in children beyond puberty”
It’s a point not lost on the Women’s Rights Party either. Leader Jill Ovens notes from the position statement that the Ministry has already established an external advisory group, without stating who is on that group, and that Health NZ is currently developing updated guidance to support clinicians providing “gender-affirming care”, including the use of puberty blockers.
Ms Ovens says the Women’s Rights Party has been calling for an inquiry into the contracting of PATHA given their role in promoting this unproven medical route.
It is telling too that the only medical professional to have written extensively on this topic, Emeritus Professor, doctor and epidemiologist Charlotte Paul, was not consulted by the MoH. Quoted in Bernard Lane’s substack Gender Clinic News, Paul’s response to the MoH’s evidence brief and position statement is generally positive while recognising limitations.
She applauds the Ministry for taking the first steps to evaluate the clinical bases for the use of puberty blockers in gender-related distress. As well, she is impressed they did their own review and regards their conclusions as sound,
But says Paul the review also has limitations, particularly the lack of necessary context.
“There is nothing about the changing aims of treatment, the rapid increase in numbers and the change in characteristics of those presenting with gender-related distress.”
The report does not address the disagreements about reasons for the increase and the possibility that the use of blockers locks children into a medical pathway. Nor does it raise the legitimate concerns about regret from those who have taken puberty blockers.
Nevertheless she is encouraged that the Ministry has taken this first step. It’s what happens next that concerns her. Normally health authorities would make a determination on the implications for clinical practice. Instead the Ministry appears to be deferring to the government to regulate prescribing.
“Unfortunately, this risks politicization of the issue. Nevertheless, given polarized views in the medical profession, it may be the only feasible way forward.”
While some groups might not be happy with the incremental rate of change in this debate, it is significant that the number of young people using puberty blockers for gender-related distress are declining. So even before this latest determination from the Ministry to proceed with caution, it appears that clinicians and parents are becoming more careful of their own accord, perhaps responding to the approach taken overseas.
The government has now tasked the Ministry with consulting on whether the new precautions should be backed by additional safeguards, such as regulations under the Medicines Act 1981 to strengthen changes in prescribing expectations.
Consultation is open until late January 2025.
Yvonne van Dongen is a journalist, travel writer, playwright and non-fiction author. This article was originally published by ThePlatform.kiwi and is published here with kind permission.
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