NZ is consulting the public on regulations for puberty blockers – this should be a medical decision not a political one

The growing politicisation and rise in misinformation about the use of puberty blockers for gender-affirming healthcare has resulted in bans and restrictions internationally.

New Zealand’s government has tasked the Ministry of Health with consulting the public on whether additional safety measures or regulations should be put in place for puberty blockers.

I argue it is inappropriate to open a public consultation on a healthcare issue when disinformation about transgender people has been well documented, especially as there appear to be no measures to prevent malicious or misleading survey responses.

Medical decisions should be guided by scientific or clinical concerns and remain free from political interference. Banning or restricting access to puberty blockers would go against best-practice recommendations from major medical bodies – including the Endocrine Society, the Royal Australasian College of Physicians, the American Psychiatric Association and the American Psychological Association – and likely cause harm to young people.

How puberty blockers work

Puberty blockers are medications which can be used to delay the onset of puberty. In gender-affirming healthcare, they may be prescribed when a young person experiences gender incongruence and accompanying distress with their body. Gender incongruence is when a person’s gender and their assigned sex do not match.

By pausing the physical changes of puberty, a young person with gender incongruence can get on with their adolescence. They can be free from the fear of potentially unwanted irreversible changes occurring to their body.

When they are older, they may decide to stop the puberty blocker and let puberty resume as it would have done. The age range for the start of puberty is wide and people who have used puberty blockers will recommence puberty within this range.

Some may choose to take hormone therapy to develop physical changes which match their experienced gender. This step is a separate decision with different healthcare input and consent.

The same medications are used for other health issues including precocious (early) puberty, menstrual disorders and prostate cancer. This has given health professionals decades of experience in using these medications. There are no concerns around the reversibility or safety of these medications when they are used in these other situations.

Ethics of clinical trials

The Ministry of Health published an evidence brief last month which found a low risk of physical harm from using puberty blockers. It also highlighted the limitations in the quality of the evidence of benefits.

The highest quality of evidence is a randomised controlled trial, where one group is given an intervention while the other is not. In these trials neither the researchers nor the participants know who is in which group. But puberty blockers result in obvious differences, meaning this is not a feasible research option.

There are other ethical considerations and methodological limitations with designing randomised trials in this context. There is a need for further research, but restricting access to this care to those enrolled in clinical trials would be coercive and unethical. No other area of paediatric medicine is held to this standard.

However, the evidence brief did not consider the harm of not using puberty blockers, the lack of evidence for any alternative treatments or the lack of harm when using these medications in other medical contexts.

Puberty blockers can prevent future distress

Puberty blockers delay the onset of puberty, but don’t necessarily result in a measurable effect at the time they are taken. The main impact is seen when people are older. The physical effects of a puberty that does not match a person’s gender can have serious negative consequences for transgender adults.

In my role as a GP, I regularly hear from transgender adults (who have not had puberty blockers) struggling with distress related to bodily changes which occurred during puberty.

I have met people who don’t speak because their deep voice causes others to make incorrect assumptions about their gender. Some harm themselves or avoid leaving the house because of the distress caused by their breasts. Others seek costly surgical treatments.

This is when the benefits of maintaining equitable access to puberty blockers for those who need them become obvious. People are seeking hormones, surgery and mental health support for changes which could have been prevented by using puberty blockers when they were younger.

The ministry’s position statement recommends that puberty blockers are prescribed by health professionals who have expertise in this area, with input from interdisciplinary colleagues.

In my experience this describes how puberty blockers are currently being prescribed in New Zealand. Clinicians are already cautious in their prescribing. They work with multidisciplinary input to best support the young person and their family. They recognise the importance of mental health and family support for young people.

However, access to this best-practice care varies throughout the country. This should be properly resourced to ensure access to quality care wherever young people live.

We have seen the distress caused by banning gender affirming care overseas. A recent study estimated that anti-transgender laws in the US were linked to an increase in suicide attempts among transgender young people.

The New Zealand government’s intention to explore regulations of puberty blocker prescriptions has not been seen in any other area of healthcare.

Restrictions leading to inequitable access to this care would go against best-practice recommendations. The people who would suffer are young people and their families.