11 Apr 2024

Ministry of Health 'taking the time to get it right' on puberty blockers

9:58 pm on 11 April 2024
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Photo: 123RF

The Ministry of Health's long-awaited 'evidence brief' on puberty blockers to treat gender dysphoria is expected to be released next week.

The hormone drugs, which stop the physical changes of puberty, were under increasing scrutiny internationally, with Britain's National Health Service last month banning their routine use outside of clinical trials.

An independent review of youth services in the UK - the Cass Review - published this week after a four-year investigation found vulnerable children had been let down by a system underpinned by weak research and lack of mental health support.

However, it has been criticised by transgender health professionals in New Zealand, who described it as "harmful" and out of step with other countries.

The Ministry of Health's evidence brief (a review of the current evidence) was initially due in November but will now be made public next week.

Chief medical officer Joe Bourne said the ministry had taken extra time to develop a position statement to accompany it, which would set out the next steps.

"We appreciate that many people and communities have been waiting some time for this.

"It is a complex piece of work that addresses an issue with a high level of public interest. At the centre are young people who are seeking advice and care. It is important we take the time to get it right."

The ministry would be able to comment further on the brief and the position statement once they were released, he said.

Health New Zealand Te Whatu Ora, which was responsible for clinical care and guidance, had commissioned the Professional Association of Transgender Health Aotearoa (PATHA) to update the national guidelines and referral pathways for gender-affirming healthcare.

Clinical director for primary and community care Dr Sarah Clarke said that was expected to be completed by August.

"Transgender patients frequently encounter healthcare workers with little or no knowledge of gender affirming healthcare that do not know where to look for answers.

"The guidelines will be a resource GPs can refer to answer their questions and to learn more. It will also provide tools to support GPs who want to learn to prescribe hormone therapy.

"The updated guidelines will reflect recent international guidelines and research, incorporate advice about changes in some medication and include language updates and more information about non-binary healthcare needs."

In a written statement, PATHA president Jennifer Shields said the Cass Review "ignores the consensus of major medical bodies around the world and lacks relevance in an Aotearoa context".

"The final Cass Review did not include trans or non-binary experts or clinicians experienced in providing gender affirming care in its decision-making, conclusions, or findings. Instead, a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming 'gender exploratory therapy', which is considered a conversion practice."

Shields said it was shocking to see such a significant inquiry into transgender health disregard the voices of transgender experts.

"It would be like reviewing women's health with no women, or Māori health with no Māori involved."

However, Dr Hilary Cass, who led the review, said it involved a wide range of clinicians, advocacy groups, trans people and their families.

The 388-page final report includes detailed evaluation of clinical approaches and previous research, as well as stakeholder engagement.

Youth and transgender GP Dr Rona Carroll, a member of PATHA's executive, said increased access to gender affirming care had had a big and positive impact on trans communities in New Zealand.

"Barriers to care have detrimental impacts on wellbeing, and create additional work for healthcare systems already under stress. Our holistic approach, utilising multi-disciplinary teams, works well for Aotearoa."

All clinicians working in gender-affirming care welcomed further research and the growing body of evidence about puberty blockers, she said.

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