Use of puberty blockers in children’s gender service to be reviewed

The Health Service Executive is to review the use of puberty blockers in children with gender dysphoria following an English decision to limit the use of the experimental treatment to clinical research.

The National Health Service (NHS) in England recently announced it was developing proposals that would see puberty blockers not being made routinely available outside of research.

A study into the impact of the treatment on children with early-onset gender dysphoria is expected to begin next year. Children currently on the treatment will not be affected.

The NHS’s Tavistock Clinic played a role until recently in the delivery of the Irish gender dysphoria service.

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Asked about the NHS’s change of policy, the HSE said it was reviewing this latest update and would establish a group this year to develop an updated model of care for the treatment of gender dysphoria. The group will be led by a clinical expert from a “relevant specialty”, a spokesman said.

“The HSE’s goal is to develop a person-centred model of care and invest in an integrated service that meets the needs of transgender people in Ireland.”

Blockers, used to pause puberty, work by suppressing the release of hormones. But one recent report into the English gender services said there were “gaps in evidence” around the drugs, while another described the quality of evidence to support their use as “very low”.

Children’s Health Ireland, which treats children and young people with gender dysphoria at Crumlin children’s hospital in Dublin, said “less than 15″ patients were on “this kind of treatment”.

Meanwhile, the age of people expressing gender dysphoria – distress arising from a mismatch between their biological sex and their gender identity – has been steadily falling, according to a large international study.

It is lower for those assigned female sex at birth than those assigned male, the findings published in General Psychiatry indicate.

The study is the biggest yet to examine the rising incidence of gender dysphoria, particularly among those assigned female sex at birth.

The US and Chinese researchers drew on information submitted to a database network by 49 healthcare organisations between 2017 and last year. This involved the medical records of about 66 million people, 80 per cent of them living in the United States.

Researchers, who said the records “likely” included a small number of Irish patients, focused on 66,000 people who were diagnosed with gender dysphoria – 155 people per 100,000 of the population.

Their average age was 26 to 27 for those assigned female sex at birth, and 30 for those assigned male sex.

The estimated prevalence of gender dysphoria rose significantly between 2017 and 2021, while the average age of those diagnosed with it fell from 31 in 2017 to 26 in 2021.

The trend of rising diagnoses before the age of 22 among those assigned female sex at birth was significantly more rapid than that of those assigned male sex at birth.

In this group, diagnoses rose sharply at the age of 11, peaked between the ages of 17 and19 and then fell below that of those assigned male sex at birth by the age of 22.

This compares with the estimated prevalence of gender dysphoria among those assigned male sex at birth, which started to increase at the age of 13, peaked at the age of 23 and then gradually decreased.

Earlier puberty among girls, leading to earlier medical help, may explain these trends, the researchers suggested, along with greater acceptance by peers of school-age masculine girls with gender dysphoria, wider availability of specialist clinics and growing acceptance of gender diversity.