Britain’s Pyrrhic Victory on Puberty Blockers: Part II

In 2011, after receiving preliminary results from only 30 participants by the Dutch team, before the interim findings were published, GIDS and endocrinologists at University College London Hospitals NHS Foundation Trust (UCLH) began a study which administered puberty blockers to gender-distressed children aged 12 and over. This was not unlike the clinical trial that the NHS is about to spend over £10 million on after puberty blockers have been banned. This “Early Intervention Study” was a second attempt, after an initial study at GIDS was rejected in September 2010 on methodological grounds. Fifteen participants per year, for six years, were given puberty blockers at GIDS. An interim and final report were produced at the three and six year marks respectively. This provides us with a model to set our expectations for the upcoming NHS clinical trials.

Going into the study, GIDS and UCLH “assumed that early suppression [of puberty] … is associated with improved physical and psychological adaptation and well-being during adolescence and adulthood”, has “a positive impact on any sex reassignment surgery in adulthood”, “does not have an adverse effect on either physical or psychological development”, and is reversible. All these assumptions were based on the incomplete interim Dutch study results. However, they also acknowledged that:

“It is not clear what the long-term effects of early suppression may be on bone development, height, sex organ development, and body shape and their reversibility if treatment is stopped during pubertal development”,

and that puberty blockers 

“may affect brain functioning and gender identity development by influencing the persistence of the GID [gender identity disorder] and fixing transgender beliefs”.

There were also concerns that puberty blockers may cause infertility. Despite all of this, the trial went ahead. 

After only the three year interim report, in 2014, GIDS began prescribing puberty blockers, and moved from an “age” to “stage” approach: allowing children to be prescribed blockers at Tanner Stage 2, the initial onset of puberty. Carmichael confirmed in an interview with the Mail on Sunday in 2014 that “We’re talking about stopping puberty in the normal range of puberty, so I guess the younger age might be ten or nine.”

“Now we’ve done the study  and the results thus far have been positive we’ve decided to continue with it. So we’ve decided to do “stage not age” [as the criterion] because it’s obviously fairer. Twelve is an arbitrary age.

“If they started puberty aged nine or ten instead of 12, as long as they’re monitored and the bone density doesn’t suffer, then it is right that the aim is to stop the development of secondary sex characteristics.”

Before the interim report was even published, while only 23 children were part of the study, Carmichael told the Sunday Times in 2013 that she “planned to continue the program indefinitely.” NHS England never conducted a formal evaluation of the evidence for, or efficacy of, the change in protocol. Former Tavistock & Portman Trust medical director, Dr. David Taylor said “endocrinologists felt they were just being used as prescribing devices.” Cass Report contributor and Tavistock whistleblower, Dr. Anna Hutchinson explained “the recommendation was to refer the patient for puberty blockers, usually after just four sessions.” Director Sarah Davidson referred patients after only one or two appointments. Hutchinson notes one case where, within 20 minutes of the first appointment, her colleague offered the adolescent a referral to UCLH for puberty blockers. 

Further safeguards were de facto removed, when pushy parents objected to “intrusive questions” during the sessions — saying that inquiries about “past trauma … pathologised trans children.” Whistleblower Dr. Matt Bristow recalls one patient who was sent gifts by a trans-identifying male living abroad, encouraging the adolescent to move in with them. Bristow’s recommendation that the patient not be referred was overruled by a colleague. Another whistleblower, Anastassis Spiliadis saw a child from a family with a history of domestic and sexual abuse, who said “my mum wants the blocker more than I do.” Despite raising safeguarding concerns, Carmichael suggested that the  child be referred for puberty blockers. At GIDS, ideology, not evidence, set policy. 

When the interim results of the Early Intervention study were presented to the Tavistock board in 2015, one year after puberty blockers had already been adopted as best practice at the clinic, findings for only 30 of the 44 participants (16 females and 14 males) were presented. Like the Dutch study, almost half the Early Intervention cohort was lost before follow-up. The study also did not use a control group to contrast the findings from the cohort given puberty blockers. The findings were not published as publicly-scrutable reports, but rather presented internally to GIDS staff after Carmichael had authorized the unlicensed use of Triptorelin for prescription to patients, citing the ongoing study as the justification. Furthermore, the NHS acknowledge that

“It is important to note that the treatment was not intended of itself to prevent gender dysphoria. The purpose of puberty suppression was to prevent further development of puberty in the natal gender. If during that period of puberty suppression the dysphoria had abated then the patient could choose to stop treatment, and puberty in the birth gender would then progress. If the dysphoria continued or got worse, then cross-sex hormones could be implemented after the age of 16, in accordance with existing international guidelines. Worsening behavioural and emotional symptoms of dysphoria in the study participants would therefore not in itself be unexpected or warrant a safety report to the REC.”

Just like the Dutch study, the only thing being measured was how effective puberty blockers were in blocking puberty, with the presumption that this would alleviate gender dysphoria. In this formulation, the natural process of puberty is treated as a disease to be treated, or unjust imposition inhibiting a child’s true identity. If they had not prevented gender-related distress, then this only served to manufacture consent for putting the adolescents onto cross-sex hormones at age 18. Despite this, the NHS found “no cause for concern”.

After one year of puberty blockers, researchers reported a statistically significant increase in children agreeing with the statement “I deliberately try to hurt or kill myself” and worsening mental health across the board for adolescent girls. By mid 2016, all but one of the children in the Early Intervention study had progressed to taking cross-sex hormones. The full results of the final study were provided in December 2020 — after Tavistock had failed to procure them when asked in October, and the day following three High Court judges ruling that under-16s could not give informed consent to puberty blockers. They showed that 98% of children prescribed puberty blockers at the clinic as a whole went on to take cross-sex hormones, which all acknowledged were irreversible. Tavistock argued that because one of the 44 participants did not take cross-sex hormones, it proves they are not an inevitable consequence of taking puberty blockers. 

At an international conference in 2016, Carmichael explained that children’s gender dysphoria and general mental health had either plateaued or worsened while taking blockers. There was “no change in self-harming thoughts or behaviours … gender identity or gender dysphoric feelings … [or] perception on primary or secondary bodily characteristics”. Carmichael said: “our results have been different to the Dutch … we haven’t seen any change in terms of psychological well-being.” However, just like in the Dutch study, adolescent girls’ mental health had deteriorated due to the blockers. GIDS staff knew the damage that puberty blockers were doing to children at the time, and continued to prescribe them anyway. Therefore, we should expect that, by 2027, the current ban on puberty blockers could be repealed based on new, methodologically questionable findings. If we are complacent, the mass medical experimentation on confused, abused children will begin all over again.

Keira Bell, a detransitioner who sued the Tavistock trust to ban puberty blockers in 2020, has joined forces with psychotherapist James Esses to bring legal action against the Health Research Authority (HRA) unless the trial is cancelled. We can only hope their lawsuit is successful. No child should be experimented on, sterilised, and lied to under the false premises that drugs and surgeries can change their sex. There is no new data or clinical trial that can change that fact. As Dr. David Bell, whose report on Tavistock’s failings in 2018 was quashed by Carmichael, has advised, the only study necessary is to monitor the long-term mental and physical health complications of children who have already been subjected to these cruel experiments.  

We cannot afford to be complacent about this ban, because trans activists are already plotting to bring puberty blockers back. For the sake of these children, this clinical trial must not go ahead.