The Women and Equalities Select Committee (WESC) today held a hearing entitled “Evidence base on the safety and effectiveness of puberty blockers”. Given that the Cass Review published in 2024, at the end of four years’ research including seven peer-reviewed systematic reviews – the largest study of its kind – has already concluded that there is substantial evidence of harm and very low evidence of any benefit arising from the administration of GnRH agonists (puberty blockers) to children, it is hard to see what motivated WESC to arrange this hearing.
The Cass Review ends with 32 recommendations. One of its main recommendations was to change from the “gender clinic” model to more holistic care, involving clinicians with a wide range of paediatric specialisations. The Health Secretary, Wes Streeting, has committed the Labour Government to implementing all the recommendations of the Cass Review. Those listening to today’s hearing would be forgiven for thinking neither the Cass Review nor the Health Secretary’s commitment to implementing its recommendations had taken place.
The people invited to testify to WESC were Professor Gary Butler, Professor Simona Giordano, and Professor Ashley Grossman.
Butler’s hostility to the Cass Review is a matter of record. As keynote speaker at a major conference in 2023, he stated that he saw no need for any change to the regime that had prevailed at the GIDS and even indirectly accused Lady Cass of nepotism. At today’s hearing he made many observations that are false and have indeed been disproven by evidence gathered and reported at length – among others, by Hannah Barnes in her scrupulously-researched book “Time to Think”. For instance, the cautious and lengthy procedure he repeatedly described as “routine” at GIDS is simply untrue. The suave self-confidence with which Professor Butler assured the panel that clinicians in this field have extensive information around the monitoring of young people – whereas we know that long-term follow-up is virtually non-existent – was brazen and difficult to listen to.
Professor Giordano stated at one point that there is little point in enquiring whether puberty blockers treat or improve gender dysphoria, since that is not its purpose. The purpose of puberty blockers is simply to block puberty, and in that sense they are effective. She also observed that no one has ever complained of bone density loss from GnRH analogues. This is untrue: numerous cases have been brought in the United States for loss of bone density caused by Lupron (sometimes prescribed for other conditions).
LGB Alliance was pleased to hear Professor Grossman’s acknowledgment of the influence of social media, especially on teenage lesbians. This is naturally the major concern of LGB Alliance. The evidence shows that puberty blockers set distressed gay and especially lesbian teenagers on a pathway to lifelong medicalisation that is harmful and entirely unnecessary. Professor Grossman was the only panelist who was willing to acknowledge the concerns in this area.
Clinical trial
Although the thrust of the recommendations in the Cass Review was to widen the approaches to gender dysphoria to assure more holistic care, it makes one recommendation that causes concern: for a “clinical trial.” Those who are currently fixating on this single recommendation are ignoring the provisos accompanying it: “The puberty blocker trial should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/feminising hormones.” The panellists ignored the major recommendation for holistic care, including the psychosocial interventions that should be the primary approach to young patients presenting with gender dysphoria.
Asked about these plans, Giordano objects to the name “Clinical trial”: puberty blockers are not a new form of medication. They are already authorised – but not for “transgender individuals”. (What she means is that these drugs are authorised to treat prostate cancer, endometriosis, and precocious puberty, but not to treat gender dysphoria.) This “cis/trans” language, used by all three panelists – presupposes that there is some observable and clear distinction between “cisgender” and “transgender” individuals. This language is part of what we call gender identity discourse. It completely ignores the large body of evidence that suggests, as the consultant psychiatrist Dr David Bell has said, that there is no such thing as a “trans child.” This view – so important from a child safeguarding viewpoint – was absent from today’s hearing.
We heard some extraordinary remarks about the planned trial:
- At one point, Giordano worried that it was problematic assuming that in order to research puberty blockers, you must believe that their likely benefits must outweigh harms. Otherwise, you might conclude that these drugs should not be prescribed at all. She went on to call this very logical and reasonable conclusion as “draconian”!
- As already noted, Giordano said puberty blockers are only “effective” in that they block puberty. They do not resolve gender dysphoria, and it would be inappropriate to take that as a measure of efficacy, she said.
- Butler welcomed the recommendation for funded research but agreed that arranging a trial is a challenge. It’s important to decide on the parameters to assess the success of intervention. This would be difficult, he said, since “a lot of the measures of functioning and quality of life are in some respects not very good”.
Grossman admitted that he is “a little sceptical” as to how a trial can be arranged and acknowledges the influence of public pressure.
None of the panelists mentions that puberty is a necessary phase in human development. The closest they came was to refer several times to “normal” puberty. As we know, the purpose of puberty blockers is to interrupt and prevent “normal puberty.” In the view of LGB Alliance, this cannot be called “healthcare.”
We understand why some people have concluded that the absence of high-quality evidence for the efficacy of puberty blockers means that research must be conducted to determine this efficacy. Given the demonstrable harms to young people, however – especially gay and above all lesbian teens – LGB Alliance finds this position untenable.
At the end of the day, WESC plays no role of any importance in the plans for a trial. Nonetheless, it is incomprehensible that it invited speakers as biased as Professor Butler (formerly of GIDS) and Professor Giordano (WPATH) to testify. In doing so, the Committee created the impression that it seeks to undermine the Cass Review. We consider that reprehensible and wish to restate our position that it is above all LGB teenagers who are being harmed by the prescription of GnRH analogues. We are highly sceptical that any clinical trial, research trial, or study of puberty blockers could be conducted in an ethical manner.