Britain’s Pyrrhic Victory on Puberty Blockers: Part I

Following a bitter battle by lawyers, whistleblowers, politicians, and women’s safety advocates, the prescription of puberty blockers for adolescent gender dysphoria has been officially banned in Britain. After the High Court upheld former Health Secretary Victoria Atkins’ ban in July, sitting Health Secretary, and former head of education at Stonewall, Wes Streeting, extended the ban indefinitely. The Commission on Human Medicines advised  that “there is currently an unacceptable safety risk in the continued prescription of puberty blockers to children.” But before celebrations begin: things are not as they seem. Children given blockers for gender dysphoria prior to the ban will continue being prescribed them, despite the admitted damages to their mental and physical health. The number of children prescribed puberty blockers also doubled between July 2022 – 2023 — with over a hundred children given the irreversible drugs before the ban took effect. 

Last month, the NHS announced plans to spend £10,694,902 in taxpayer funds on a “clinical trial” of puberty blockers, experimenting on gender-confused children until 2031. However, the ban will be reviewed at the trial’s interim stage, in 2027 — and potentially repealed before the study concludes. The study, pending ethical approval, is expected to start this year in King’s College London, with the approval of the National Institute for Health and Care Research (NIHR). The trial summary fails to specify the age of participants. NHS clinics have no minimum age for referrals.

Baroness Hillary Cass, whose interim and final reports led to the closure of the Gender Identity Development Service (GIDS) at the infamous Tavistock and Portman NHS Foundation Trust and national ban, supports the trial, in its “aims to fill some of the gaps in our knowledge about the outcomes of different interventions and address some of the uncertainty about the impacts and efficacy of puberty-suppressing hormones”. A Department for Health and Social Care spokesman told The Telegraph:

“For years puberty blockers were given to vulnerable young children, without proof that they were safe or effective. This is shameful.

We are putting children’s safety first with an evidence-based approach to the puberty blockers ban which is in line with recommendations of both the Cass Review and the independent Commission on Human Medicines.

NHS England is working to establish a carefully controlled trial into puberty blockers. Clinical trials provide vital evidence on the effects of medicines and are conducted to the highest scientific and ethical standards.”

The trial has been criticized by Dr Louise Irvine, co-chairwoman of the clinical advisory network on sex and gender, who told The Times:

“A two-year follow-up will tell us nothing at all about risks or benefits of puberty blockers. I am shocked they are putting children through the known risks of puberty blockers for no gain in knowledge and I consider it totally unethical.”

But this bureaucratic exchange about a need for more “evidence” obscures the fact that we already know the effect that these castrative drugs have on children, and that they are prescribed under false pretenses. In fact, clinicians at Tavistock’s GIDS clinic knew of these effects before they adopted puberty blockers as best practice in the first place. This new clinical trial is a Trojan Horse for trans activists, who will insist that the best way to treat abused, gender-confused kids is to sterilize them with irreversible drugs, based on the false premise that human beings can change sex.

Puberty blockers were introduced to the GIDS clinic following the publication of the Dutch protocol in 2000, by the Utrecht University Medical Center in the Netherlands. In 1998, an adolescent female (“B”) was presented as a model case for medical interventions for adolescent gender dysphoria. B had her puberty blocked at 13, requested sex-reassignment surgery at 16, postponed cross-sex hormones until 18, and had a double mastectomy and ovariectomy soon after. A year later, she reported “no gender dysphoria at all” and having “never felt any regrets about his [sic] decision”. When the paper was published, B also had a metoidioplasty. In 2000, the “Dutch protocol” was introduced: allowing children to be prescribed puberty blockers at age 12, followed by cross-sex hormones aged 16, and surgery aged 18. A single, experimental case was used to set precedent for thousands of gender-confused children.

A study began in 2006, funded by Ferring pharmaceuticals: who produce the puberty blocker Triptorelin. Triptolerin became the primary drug prescribed by pediatric endocrinologists at GIDS. Originally a gonadotropin-releasing hormone agonists (GnRHas) drug licensed to treat prostate cancer in men, Triptorelin has also been used in the chemical castration of male sex offenders. Ferring sponsored the subsequent conferences where the Dutch experimenters presented findings to gender clinicians in Belgium and the United States, and also donated to the pro-trans political party, the Liberal Democrats. 

The Dutch study followed 70 children prescribed puberty blockers, and then cross-sex hormones, to monitor the effectiveness of the drugs in alleviating gender dysphoria. Interim results were published in 2011, and final findings in 2014. Between the two publications, before long-term results were known, the protocol authors were consistently pushing for the universal adoption of puberty blockers, writing in 2012 that:

“withholding physical medical interventions in these cases seems more harmful to wellbeing in both adolescence and adulthood when compared to cases where physical medical interventions were provided.”

In 2010, interim results reported that use of puberty blockers had decreased depressive symptoms, but not alleviated gender dysphoria. All 70 participants (37 females and 33 males) prescribed blockers went on to take cross-sex hormones — nullifying the prospect of blockers being “reversible” in practice. In the final 2014 publication, authors concluded that “gender dysphoria had resolved, psychological functioning had steadily improved, and well-being was comparable to same-age peers” following cross-sex hormones and genital surgeries. Between 2010 and 2014, the sample size shrunk from 70 to 55 — losing more than 20% of participants. Complete data was only published for 40 participants, meaning 43% of the starting sample dropped out to some degree. In both results, the authors admit to neglecting the evaluation of “physical side effects of treatment” — monitoring only self-reported mental wellbeing of participants. However, the questionnaires to record the reported improvements in wellbeing after the course of blockers and cross-sex hormones were poorly constructed: providing questions pertaining to birth-sex before the blockers, and questions concerning assumed gender identity after the blockers. This biased results: with responses demonstrating the expected incongruence between biological sex and gender identity before blockers, and strong identification with gender identity after blockers. Persistent gender dysphoria itself was not measured — only how effective the blockers had been in entrenching trans identity in the study participants. Moreover, it confirmed in both 2010 and 2014 that gender dysphoria got worse for girls while taking puberty blockers.

When the findings were published, one participants’ fate was omitted from the findings. This 18-year-old male underwent a vaginoplasty after having puberty blocked by the Dutch researchers at a young age. With his underdeveloped genitals providing insufficient tissue to construct a “neo-vagina,” surgeons grafted sections of his bowel and colon to form the orifice instead. This resulted in necrotizing fasciitis, caused by a strain of E-Coli from his intestines, and the patient died from multiple organ failure. This significant mortality rate of 1 in 70 was not reported in the final Dutch study, despite his death being a direct consequence of surgical complications caused by the effect of puberty blockers. The Dutch Protocol then became the international standard of best practice for treating gender dysphoria in children and adolescents.

In 2005, responding to the Dutch Protocol, the British Society of Paediatric Endocrinology and Diabetes (BSPED) issued guidance stating that should complete puberty before being administered any androgynising drugs, and given psychological interventions to help manage the changes caused by puberty “rather than to necessarily regard them as undesirable”. Puberty is the “the most likely time for change and reversibility of the Gender Dysphoria”. Blockers, they acknowledged, were not “fully reversible”, but rather cause the “delay or interruption of endogenous sex hormone production [which] can have irreversible consequences”. The irreversibility of puberty blockers, and effectiveness of the “watchful waiting” method of resolving gender dysphoria without affirming the incongruous gender identity, was known to British clinicians as early as 2005. So why were blockers adopted?

Unhappy with BSPED, the Gender Identity Research and Education Society (GIRES) and trans-activist charity Mermaids convened a conference to develop parallel “guidelines for endocrinological intervention”. They invited the authors of the Dutch protocol to meet with GIDS’ founding director Dr. Domenico Di Ceglie and his eventual successor Dr. Polly Carmichael. Harvard clinician Norman Spack also attended, who provided transgender-affirming medicine to the son of Susie Green, then-chief executive of Mermaids. In 2009, Green took her son to Thailand for his sixteenth birthday to have his genitals removed. That same year, Carmichael succeeded Di Ceglie as GIDS director. 

As revealed by The Telegraph, Carmichael kept correspondence with Green (who has no medical qualifications) for years, consulting her on best practice at GIDS. Tavistock had previously denied possessing emails or minutes of meetings with Green — before producing 322 pages of communications between 2014 and 2018, after the information regulator threatened legal action. Green referred children who were refused by GPs to GIDS via Carmichael; with one exchange in 2016 featuring Green demanding, “If you do NOT accept referrals from Mermaids due to the fact that I am not a professional I would like to know the reasoning behind this?” Green also reviewed GIDS’ service specification, and recommended exploring how “hormone blockers will now be considered for any children under 12”. The justification for this? 

“Age alone does not determine capacity to give consent. If it is concluded that a client has sufficient autonomy and understanding of what is to be offered, plus other key eligibility and readiness criteria have been met, they can consent to treatment.”

Whistleblower Sue Evans told investigative journalist Hannah Barnes that Di Ceglie and Carmichael would “regularly attend meetings of Mermaids … and upon their return encourage staff to change practice” — such as no longer including birth names on clinical letters. In 2019, it was revealed that Carmichael and Green were coordinating via line manager Sally Hodges to ensure the content of GIDS’ website matched Mermaids. Andrea Walker, a former GIDS social worker, said “We were answering to Mermaids.” 

In October 2024, the Charity Commission published the findings of its inquiry into Mermaids’ alleged misconduct. It concluded “there has been mismanagement in the administration of the charity by the trustees in post at the relevant times.” Between 2017 and 26 September 2022, Mermaids mailed chest-binders to adolescent girls experiencing gender distress, without requiring parental consent. One 2016 study found 97% of participants reported at least one negative health outcome that they attributed to binding — including fifty who suffered rib fractures. Mermaids’ binder delivery service provided 15 binders to 13-to-16-year-olds and 9 binders to 16-to-19-year-olds between January 2021 and September 2022, before it was suspended in October 2022, and formally terminated October 2023. As a result of the inquiry, the Commission also stated that “references to puberty blockers and reversibility have been removed from the charity’s website.”

However, the BBC reported that the Commission 

“found no evidence that Mermaids: provided medical advice, which would have been outside its charitable purposes; made medical referrals for young people without the approval of a parent or carer; held inappropriate influence or ties to GIDS at the Tavistock and Portman NHS Foundation Trust or to private medical practices; failed to have appropriate safeguarding policies in place.”

This is astounding, given Mermaids convened the conference which encouraged GIDS clinicians to adopt the Dutch protocol, and persistently pushed for lowering age barriers and removing consent safeguards for puberty blockers. How can Mermaids be considered anything less than a trans-activist accelerant for subjecting gender-confused children to medical experiments, in contravention to the guidance set forward by medical professionals?

The second and final part of this series is being published tomorrow. Supporting members will receive early access – you can become one of our supporting members below: