The evidence for puberty blockers and gender-affirming hormones is of ‘low quality’

The biggest controversy in medicine at the moment is the appropriate treatment of children with gender dysphoria. Trans advocates claim that puberty blockers are important for their mental health and that they are reversible.

However, a preliminary study by the UK’s National Institute of Health and Care Excellence (NICE) has found that the science supporting this view is of low quality.

In relation to body image and psychosocial impact, says NICE, the results “are of very low certainty”. “Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance.”

Another study asked what is the clinical effectiveness of gender-affirming hormones compared with one or a combination of psychological support, social transitioning to the desired gender or no intervention.

The answer was astonishingly negative, considering the pressure from transgender supporters.

The aim of employing gender-affirming hormones is to induce the development of the physical sex characteristics congruent with the individual’s gender expression while aiming to improve mental health and quality of life outcomes.

However, the NICE study found that certainty of their impact on gender dysphoria, on depression, on anxiety, on quality of life, on suicidality and self-injury was all “very low”.

Why? All of the studies in the review of the literature were flawed. They were all uncontrolled observational studies, which are subject to bias and confounding; they had relatively short follow-up; most of them did not report comorbidities (physical or mental health); most of the studies were poorly reported and used a confusing variety of scoring tools and methods.

The study concluded that “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”

These documents will help inform an independent review into gender identity services for children and young people.

Michael Cook is editor of BioEdge

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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