Hannah Barnes at the New Statesman takes a detailed look at the puberty blocker trial:
Strange as it may sound, there is not one agreed view on what the primary purpose of puberty blockers is when used in gender medicine. Cass summarised in her interim review in 2022, that depending on who you ask, the answer to the question “what is the intended outcome of puberty suppression?” varies. Responses include: providing time/space for the young person to decide about continuing with transition; reducing or preventing worsening of distress; improving mental health, and stopping potentially irreversible pubertal changes which might later make it difficult for the young person to ‘pass’ in their intended gender role. The Labour government summarised Cass’s final review as concluding that “the rationale for early puberty suppression remains unclear”.
The team undertaking the Pathways trial told the New Statesman: “The primary function of puberty suppressing hormones is to pause pubertal progression, allowing continuing psychosocial interventions and exploration of identity without the distress of irreversible physical changes.” Yet this interpretation, which provides the foundation of the new trial, was rejected by the Cass Review. “Given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising [or] feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development,” Cass wrote.
One researcher, who is no longer part of the trial team, told me, “the early planning meetings were unlike any other clinical trial I’ve encountered. We could easily list all the potential harms to monitor and how to test for them, but we didn’t have a clear rationale for giving the drug in the first place”. Normally, they said, “you start with a strong rationale for how and why a treatment might help someone, and then think carefully about the possible downsides. It’s very unusual to start planning a trial without a well-defined outcome, especially in children.”
Very unusual – and very unethical.
These children will be receiving therapeutic support, as well as the puberty blockers. How will the study disentangle the effects of the psychological approach from the medical affects of the blockers? Answers came there none.
It’s a mess. Turns out it’s easier to get ethics approval to experiment on children than to use the results of previous experiments.
Mick Hartley 
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