For many years we have been using puberty blockers in young children who are going into early puberty to delay puberty to a normal time – this has been very successful with much detailed evidence.

This is a different situation – this set of reviews is looking at using these drugs to delay normal puberty.  This very detailed set of analyses now suggests that there are not enough good data showing the long-term effects in children with gender dysphoria.  Indeed there are some recent early data (although not yet peer-reviewed or published) suggesting some of their effects on testes and sperm may not be reversible.

One must realise that coming to terms that one may be trans-gender can be extremely distressing, and we certainly need more facilities to assist such individuals, and as adults treat them as rapidly as possible within specialist centres.  However, for children with gender dysphoria, these studies have shown that there is no good evidence for the routine use of puberty blockers, although that is not to discount that in occasional children and young adults they could be helpful.  What it does emphasise is that children in this category, who seem to be of greatly increased numbers, need very careful counselling, assistance and help through this difficult time.  It may be that a small number of these children should in the long term transition to a different sex, but routine puberty blocking treatment for this use has not yet been adequately studied, and many of these children may have other problems for which they need help.  More carefully run clinical trials are needed so that we can understand how and when such agents are justified and of benefit.

We would urge the public to interpret the findings of these reviews with some caution – many people will assume that this research suggests that puberty blockers and hormone treatments should never be offered, which would be mistaken.

The authors ultimately conclude that: ‘No conclusions can be drawn [about the effect of puberty blockers].’ This research highlights that we currently do not know how effective these treatments are, or who they are most effective with, but there are many reports of benefit from the people who use them and clinicians who provide them. What research we do have, albeit of limited quality at present, appears to suggest there may be benefits overall- however, we do not currently know who specifically is likely to benefit.

“With regard to hormone treatments, the authors do conclude that ‘There is suggestive evidence from mainly pre–post studies that hormone treatment may improve psychological health.’ However, again, they clearly state that ‘robust research with long-term follow-up is needed.’

What the public may not be aware of, is that it is relatively common for treatments to be offered in health and mental health, where the research evidence is still emerging and/or limited. The choice for clinicians is frequently whether to offer nothing – which is unlikely to be helpful – or offer something that we agree can be helpful for some people. In doing so, we recommend that the person undergoing these treatments gets the best possible information on what we know about their risks and benefits. For this reason, we very much welcome research studies, such as those released today, which help us fully understand what they may be.