Sale and supply of puberty blockers to be banned indefinitely

Medical experts found an ‘unacceptable safety risk’ in the continued prescription of puberty blockers to children

The Department of Health and Social Care (DHSC) has decided to enforce an ‘indefinite’ ban on the sale and supply of puberty blockers via private prescriptions for the treatment of gender incongruence and/or gender dysphoria in under-18s in the UK.

This decision follows official advice from the Commission on Human Medicines (CHM), which found an "unacceptable safety risk" in the continued prescription of puberty blockers to children.

The CHM, tasked by the health secretary and Northern Ireland Minister for Health to evaluate the safety of gonadotropin-releasing hormone (GnRH) agonists for puberty suppression, issued eight recommendations.

It advised that a statutory indefinite ban be placed on the use of puberty blockers until its three recommended structures are in place to support safe UK prescribing.

Legislation to make this order indefinite will be updated today and will be reviewed in 2027.

The NHS stopped the routine prescription of puberty blocker treatments to under 18s in March 2024, following the Cass Review into gender identity services.

In May 2024, a temporary ban was introduced after the Cass Review concluded that there was insufficient evidence to prove the safety of these treatments.

Health secretary Wes Streeting justified the decision, stating, “Children’s healthcare must always be evidence-led.

“We need to act with caution and care when it comes to this vulnerable group of young people, and follow the expert advice.”

He also announced plans to work with NHS England to launch new gender identity services, providing holistic health and wellbeing support.

Additionally, a clinical trial into the use of puberty blockers will begin next year to establish a clear evidence base for the use of this medicine.

Professor Steve Cunningham, vice-chair of the Commission, noted that the indefinite ban is made in the context of a significant waiting list for gender specialist services in the UK.

“In making this decision, CHM considered the safety, actual and potential, of using GnRH agonists to suppress puberty, and also risks to children and young people associated with accessing GnRH agonists via alternative routes,” she said.

Dr Hilary Cass, the author of the independent review of gender identity services for children and young people, described puberty blockers as “powerful drugs with unproven benefits and significant risks.”

She recommended that they should “only be prescribed following a multi-disciplinary assessment and within a research protocol.”

Dr Cass supported the government’s decision to continue restrictions outside NHS protocols, where these essential safeguards are not being provided.

James Palmer, NHS medical director for specialised services, welcomed the move, saying it “closes a loophole that posed a risk to the safety of children and young people.”

He acknowledged that the decision may be difficult for affected young people and their families, and assured that targeted mental health support will be available.

The Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE) will develop new standards based on the CHM's recommendations.

A clinical trial, as suggested by the Cass Review, will be initiated by the National Institute for Health and Care Research (NIHR) in collaboration with NHS England to determine the effectiveness of puberty suppression and the safety of prolonged treatment, aiming to recruit the first patients by spring 2025.

Restrictions overview

• Continue restrictions on the dispensing of puberty blockers prescribed by private UK-registered prescribers for gender incongruence and/or gender dysphoria to under-18s not already taking them.
• Ban on sale and supply of the medicine from prescribers registered in the European Economic Area or Switzerland for any reason to those under 18.
• NHS patients already on puberty blockers for gender dysphoria or other medical purposes can continue to access them.
• Local NHS mental health services in England will offer targeted support to those whose access to puberty blockers is discontinued and who are not on the waiting list of children’s gender services.