Health Secretary Wes Streeting has banned puberty blockers, but not cross-sex hormones. This now looks like changing. A New Statesman report from Hannah Barnes:
It emerged last week that the Health Secretary was “actively reviewing” whether to restrict or ban the prescription of cross-sex hormones to children who want to transition to another gender. On 28 April, a group of clinical specialists was established to explore the issue, including NHS England specialist commissioners and paediatric endocrinologists, some of whom prescribed the drugs to children attending the now closed Gender Identity Development Service (Gids) at the Tavistock clinic.
The development was revealed at the High Court, where judges were deciding whether to allow a judicial review which criticised Wes Streeting’s failure to restrict the medications already. The New Statesman can exclusively reveal the contents of the expert clinical reports which persuaded the government to change direction.
Reports from two European sources, it turns out, have provided significant evidence of the harm caused by prescription of these irreversible drugs.
In one report, Professor Riittakerttu Kaltiala, chief psychiatrist at one of the two government approved paediatric gender clinics in Finland, described how the services had dramatically changed their clinical protocols over the last decade because of “growing concern about the harms of transition on vulnerable young patients”. Hormone treatment for under-18s is only considered “with extreme caution and… in rare cases”. Those who identify as non-binary – neither male nor female – would not be eligible at all, because of a lack of research.
Kaltiala, who has personally assessed more than 500 adolescents, explained that alongside a significant change in the “profile and volume of those seeking support for gender related distress”, she and her team started seeing “cases of previous patients coming back and telling us they regretted their transition” – often referred to as “detransitioners”. She is “increasingly concerned” that regret is far more widespread than suggested by older studies, which do not reflect the current patient group of largely adolescent females with multiple other difficulties. Two recent studies have suggested that between 20 and 30 per cent of those who initiated hormonal gender reassignment discontinued hormonal treatment in four to five years, Kaltiala noted.
The main focus of both reports is the health risks posed to young people by early hormone use. In the second, paediatric endocrinologist Professor Dr Jovanna Dahlgren, who established one of Sweden’s three units that assess children with gender-related distress, described how Sweden’s doctors are advised to no longer prescribe hormones to those under 18. Instead, they focus on other difficulties a young person is facing, provide psychological support, and look for other medical ways to relieve distress.
“Cross sex hormone treatment affects each of the cells of the body,” Dahlgren explained. Research showed trans women (“natal males”) have a substantially higher risk of ischemic stroke, venous thromboembolism (VTE) – which includes deep vein thrombosis and pulmonary embolism – and heart attacks. After eight years of oestrogen use, trans women had a risk of VTE nearly 17 times higher than other biological males, and 13.7 times than biological women. Studies have also suggested that females who take testosterone, have an increased risk of heart attacks.
Seemingly most relevant to Wes Streeting’s decision-making, is the outlined additional danger of starting hormone treatments while still in childhood. “If the treatment is started in young years, many years with daily treatment with cross sex hormones will increase the risk of cardiovascular disease… and stroke… [and] can decrease fertility, impair liver function and increase the risk of cancer in both genders,” hormone expert Dahlgren wrote. She also noted the lack of long-term data: “The consequences of prescribing cross sex hormones in individuals under the age of 18 years are that the body and the brain are permanently marked/changed with both known and more unforeseen consequences.”
As well as bringing about the physical changes the young person wants, testosterone use can – she says – impact on bone mineral density, the heart and “several structures of the brain”. The treatment will, “in other words influence processing, emotions, consolidation of information and spatial memory”. Female sexual function is also affected, while oestrogen use in males impairs sperm quality, and thus, fertility. “The risks of [cross-sex hormone] treatment are greater if treatment commences prior to the conclusion of puberty,” Dahlgren argued. Hormone use accelerates bone maturation, meaning that if a child hasn’t completed puberty, but takes hormones, it will “accelerate the bone age”, and contribute to a shorter adult height.
For Finland’s Riittakerttu Kaltiala, the use of cross-sex hormones, “is not safe to any minors”. The psychiatrist is explicitly critical of NHS England’s current stance (which is under review) of allowing hormones to be prescribed to 16- and 17-year-olds. “I have seen the NHS Clinical Commissioning Policy Prescribing of Gender Affirming Hormones which implies that CSH treatment has been evidenced as safe for treatment for over 16-year-olds”, writes Kaltiala. “The evidence relied upon in the policy does not support that conclusion. It is not possible to conclude that treatment with cross sex hormones is safe for under 18-year-olds, and having reached age 16 makes no difference to this,” she said.
Existing research does not verify “the assumed psychosocial and mental health benefits of cross-sex hormones initiated during developmental years” either, she argued. Gender medicine seems to be acting outside of medical norms: “No other medical field performs irreversible treatments before the age of 25 years in Sweden”, Prof Dahlgren said, adding that she is “not aware” of any condition in children that needs cross-sex hormone treatment. “However,” she also wrote, “some disorders of sex development (DSD) may need complementary sex hormone treatment.” Both expert reports were highly critical of the model provided by overseas prescribers of hormones. It was “unsafe and irresponsible”, Kaltiala said.
It could hardly be more damning. This is what "gender-affirming care" really means. Prescribing these drugs to teenage children – or younger – is a grotesque breach of everything medicine should be about. Streeting can surely not ignore this.
Last word to JKR:
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Mick Hartley 