England’s National Health Service has announced it is limiting the use of puberty-blocking drugs for minors and will allow them only “as part of clinical research” following an evaluation of medical practices for purported “gender transitions.”

Its interim policy, announced June 9, proposes that “puberty-suppressing hormones (GnRH analogues) are ‘not routinely commissioned’ as there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment and that they should only be accessed as part of research.”

The NHS document advises that “outside of a research setting, puberty-suppressing hormones should not be routinely commissioned for children and adolescents who have gender incongruence/dysphoria.”

Gender dysphoria is the perception that one’s birth sex does not match one’s perceived gender identity.

The NHS England policy will take effect as new clinics open to replace NHS’ Gender Identity and Development Service (GIDS). The gender identity service program, run by the Tavistock and Portman Trust, will close in March 2024 after an independent review found serious problems, including excessive demand and not enough evidence about treatment outcomes.

The review said that many children referred to GIDS have complex needs that can be overlooked. It found that about 1 in 3 referred children have autism or other neurodiverse mentalities, according to the BBC. A “significant proportion” of young people with gender-related concerns also have well-being issues related to mental health, neuro-development, and family or social concerns. 

The new clinical approach to such children aims to focus on each child as an individual with “careful therapeutic exploration,” the NHS said. The Friday announcement followed a 45-day comment period ending in December 2022 that received almost 5,200 responses.

NHS England’s new Children and Young People’s Gender Dysphoria Research Oversight Board has approved the development of a study into how puberty blockers affect both gender dysphoria in children and young people with early-onset gender dysphoria.

Advocates of “gender-affirming care” have presented puberty-blocking drugs, cross-sex hormones and purported sex change operations as treatments that helps those who identify as transgender.

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Use of the drugs is usually presented as a safe, reversible option and seems to help some people who suffer from gender dysphoria. However, as the New York Times reported in November, some experts are concerned about the evidence for these claims.

The best-known puberty-blocker drug is Lupron. It and similar drugs act by suppressing estrogen and testosterone, which can affect the bones, brain, and other body parts of young people. 

The drugs are not FDA-approved for use on transgender-identifying children and teens, and there is evidence of potential harm.

Some researchers and doctors voiced concern that puberty blockers’ interference with hormonal development could disrupt mental growth and brain development in areas such as critical thinking, sophisticated self-reflection, social skills, and problem-solving skills. There are also concerns about how the drugs affect bone growth and resilience.