A win or just spin?
Ministry of Health indecisive about puberty blockers
According to commentary from the media, NZ First, and ACT, the government has finally done something decisive about puberty blockers. But a close inspection of the Ministry of Health (MOH) Position Statement released on 21 November reveals very little change from previous policies, and certainly not any “new rules”that restrict their use.
(All quotations are from the MOH Position Statement or its Media Release.)
The MOH now accepts that “there is insufficient basis to say that puberty blockers are safe or reversible (or not) for use as an intervention for gender dysphoria in adolescents”, but instead of putting restrictions in place immediately, it has opened up to public consultation the question of whether regulations are needed.
In November 2023, the Ministry’s advice was, “Puberty blockers continue to be available through prescribing clinicians for those who need them. Decisions on the use of puberty blockers are best made by patients and their families in consultation with appropriate clinicians.”
The supposedly “new precautionary approach” differs only in the suggestion to clinicians that they “exercise caution in prescribing” and that puberty blockers “should only be initiated by clinicians who are experienced in providing gender-affirming care and are part of an interprofessional team”.
We are advised that this recommendation carries no real weight because it is ‘guidance’, not a directive. Doctors who have not been prescribing puberty blockers will continue to refer patients to specialist services as they did before, while for those who consider themselves to be “experienced in providing gender-affirming care”, it will be ‘business as usual’.
The MOH ‘spin’ on this story - misrepresenting the Position Statement as a major change in policy - shows the Ministry is either too cowardly or too captured to act as it should. The MOH admits there is no good evidence for the use of puberty blockers for gender dysphoria but still recommends their continued use while it collects further evidence, as if New Zealand children are somehow different.
No medical intervention is entirely without risk. Clinicians will continue to provide careful guidance to and follow-up for people and families considering gender-affirming care.
Given the limitations in the quality of the current evidence, there is a need for high-quality, longitudinal data and research to understand the benefits and risks of puberty blockers when used for treatment of gender-incongruent and gender-dysphoric young people in New Zealand.
The Ministry of Health will also commission research to determine the long-term clinical and mental health and wellbeing impacts of puberty blockers.
Why do we have to take baby steps towards policies that properly protect our children when other countries have acted correctly on the evidence from as long ago as 2020? See a “Roundup of the Rational” in our March 2024 Substack
Whether the Ministry announcement is a win or just spin is under debate
For years, the Ministry and doctors who prescribe puberty blockers have been assuring the public that they are “safe and reversible” and are only used after very careful and lengthy individual assessment. The Ministry’s supposed “new precautionary approach” puts the lie to that claim.
Only now has the Ministry clearly expressed an expectation that “the starting point for treatment is a holistic assessment determining the full spectrum [of] needs of a young person”.
The use of puberty blockers in gender-affirming care remains a relatively new area of medicine. Available evidence is predominantly based on clinical experience and patient values and preferences, rather than clinical trials. The Ministry of Health expects healthcare professionals to ensure that clinical conversations about puberty blockers reflect the paucity of high-quality research evidence about the benefits and risks of using these medicines.
Only now has the Ministry confirmed that there is no good evidence for either the safety or efficacy of these powerful hormonal interventions.
These tighter controls reflect a level of concern both here and overseas about the increasing use of these medicines for the treatment of gender identity issues without sufficient evidence to support their safety and effectiveness both now and in the longer-term.
Only now has the Ministry decided that better record-keeping might be a good idea.
Other steps already underway include updated clinical guidelines on puberty blockers being commissioned by Health NZ and expected in coming months, better monitoring of usage in New Zealand and developing New Zealand’s own knowledge in this area to guide any further advice or safeguards.
The Ministry’s Position Statement continues to misinform the public by not mentioning that the current NZ ‘best practice’ Guide for “gender-affirming care” is the very one that the Cass Review rated as second to lowest in quality in its assessment of international guidelines. Nor that the people who have been commissioned to update this Guide are members of PATHA (Professional Association for Transgender Health Aotearoa), an affiliate of the discredited WPATH (World Professional Association…)
Health New Zealand is currently developing an updated set of guidance to support clinicians providing gender-affirming care, including the use of puberty blockers. The evidence brief will be available to inform those guidelines.
For those who have been waiting two years for good evidence and good sense to prevail at the MOH, it’s fair to say that the Ministry’s November announcement is a disconcerting anticlimax. Even the definitive evidence in the Cass Review has not been enough to convince the MOH to immediately stop interfering with the normal development of some of our most vulnerable teenagers.
There is a chink of light at the end of the tunnel provided by the opportunity for public consultation on the question of whether there should be stronger safeguards for the use of puberty blockers, such as regulations under the Medicines Act. Though what new information the MOH thinks it will receive is a mystery since it already “acknowledges that there are strong and varied views relating to the area of gender-affirming healthcare. In relation to the use of puberty blockers, the Ministry is also aware of a range of experiences and views among young people who have lived experience of gender incongruence or gender dysphoria.”
The consultation is open from now until 20 January 2025 and can be completed either via online survey here or by submitting an email to pbconsultation@health.govt.nz
Even this attempt to gather evidence is skewed by an attitude that only people with “lived experience” have valid contributions to make.
In particular, the Ministry seeks input from organisations that represent people who may be affected by safety measures or that may be involved in how safety measures are used in practice.
The consultation survey is anonymous and short. The first question appears to be intended to sift out those with the preferred “lived experience” from those with pesky contrary views. The whole survey is little more than a poll asking whether or not puberty blockers should be regulated, who should be permitted to prescribe them, and what effect any changes might have on people with diagnosed gender dysphoria.
We recommend that if you want to contribute more than ticks in a poll you send your submission via email.
Those who champion the use of puberty blockers have been quick to condemn the Ministry’s call for public consultation. PATHA president Jennifer Shields says:
"To even have questions about your identity and whether the body you have is the right one for you and to be experiencing potential permanent changes to your body that you have no control over, knowing that there is an intervention out there that can give you the time to make a decision without those permanent changes looming over you and then to have that option taken away is really traumatic for a lot of people."
And that is the whole problem in a nutshell!
No child should ever be taught that their body is not the right one for them.
No child should be encouraged to think of puberty as a negative and avoidable experience.
The experimental “intervention” of puberty blockers should not ever have been offered to children in the first place.
Period! Case closed.