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Funding of nearly £11 million has just been announced for a research study on treatments at the new children’s gender hubs, including a puberty blockers trial. We have also learned that follow-up data on outcomes for children who have been through the Tavistock GIDS, which the adult gender identity clinics (GICs) refused to share, was never released to the Cass Review research team. Now the review is closed, the NHS does not have permission to request it from the GICs.

This means that a vital part of the Cass Review research, the data linkage study, has stalled due to the refusal of NHS GICs to release the required data. The longer-term outcomes of around 9,000 children passing through the GIDS remain unknown. This includes an estimated 2,000 who were prescribed puberty blockers.

Our view on a puberty blockers trial is very simple. Although we accept that trials of drugs on children with life-threatening conditions may be worth the risk of serious side-effects, in the case of puberty blockers the treatment IS the harm. It is not a negative ‘side effect’ or a ‘risk’; the treatment itself causes the damage. The purpose of the blocker is to introduce ill-health to a previously healthy body. Because arrested growth is the desired outcome it is seen as a ‘successful’ treatment by gender ideologues.

Every ‘positive’ result of blocking puberty (cessation of menses in girls, breast growth in boys etc) is physical indication of a health concern. Every physical change that is viewed by the trans lobby as a positive, effective and desired result is medical harm.  

It may be that other, psychological, outcomes are measured, but the real purpose of puberty blockers is to stop vital growth and this is the outcome that children and some parents want, even if this also causes a deterioration in mental health. When the whole point of blockers is to prevent growth, research that reveals further negative mental or physical health outcomes is irrelevant. It is also unlikely to affect demand.

There is nothing a trial can reveal that adds anything to the certainty that blockers cause the cessation of a critical growth stage. This causes immediate health problems and will inevitably lead to some as-yet unknown long-term health problems. We don’t need a trial to tell us this.

But there are further reasons why a new trial should not go ahead.

We have already had a puberty blockers trial at the Tavistock GIDS: the Early Intervention Study. We are in a position now where we can learn from previous research. Looking at the previous trial should be the starting point in any considerations about doing a new trial. What did we learn? What were the outcomes? Were mistakes made?

We also know much more now than we did at the time of the previous trial, particularly in light of the Cass Review findings; how does this knowledge inform our decision-making regarding a new trial?

From the Early Intervention Study findings, these are the three main points we learned:

1. The purpose of puberty suppression is to allow subsequent cross-sex hormone treatment without the need to surgically reverse or mask the changes in puberty that would make it more difficult to ‘pass’ as the opposite sex. It is a first step on an increasingly invasive medical pathway to cosmetically achieve the appearance of the opposite sex.
2. The vast majority of children on the new puberty blockers trial will progress to cross-sex hormones, with increased likelihood of subsequently progressing to surgery and lifelong medical dependency, damaging fertility and adult sexual function, and increasing the risk of serious health conditions such as cancers and heart disease, along with surgical and hormonal complications.
3. For the majority there will be either no improvement or a deterioration in short-term mental health outcomes. There will be short-term mental health improvements for a minority but the evidence is not good for effects on long-term mental health.

Since that trial started, the increasing number of detransitioners such as Keira Bell is indication that a proportion of participants in new trial will experience regret. The NHS has not yet set up services for this highly vulnerable group who have complex health needs as a result of their treatment and neglected mental health conditions. This group should be the priority for the NHS, not a trial that will inevitably increase the numbers needing this service.

There has been another change between then and now which nobody seems to be talking about. During the early years of the EIS, although social media was saturated with trans affirmation, it took a bit longer for the full-scale targeting of children in schools to take effect. Today you would be hard pressed to find a child who has grown up in a neutral environment, who has not learned in school that they have a ‘gender identity’ that cancels out their sex, who has not been fully ‘affirmed’ and socially transitioned by teachers, peers, therapists and in some cases parents. This is a generation that has been fully indoctrinated into a belief in ‘gender identity.’ How will a new trial account for this?

The new trial

Although the new trial design has not yet been published nor ethical approval for the trial secured, the research parameters outlined here only reinforce major concerns.

• Although other research strands will continue for longer, the puberty blockers trial is set to run for only two years, a meaningless time-frame when the data that is lacking is long-term outcomes.
• The language reveals a purely ideological, not clinical, framework. Sex is not ‘assigned’ nor ‘given at birth.’ What does it even mean to say that some people ‘want their bodies to be more like their gender identity’? It is ironic that this section is headed ‘Plain English Summary.’
• Much emphasis is placed on lived experience when these are children, who by definition have very limited life experience. They are at a life stage where their beliefs are inevitably shaped by those around them, including parents, peers, teachers, media, the internet and popular culture. The ability to think for oneself is not a skill that is highly developed in adolescents (the terms ‘young people’ and ‘young adults’ are used but as this is a service for children we assume these are euphemisms).
• The advisory groups will inevitably be made up of only the parents who want puberty blockers for their children. Parents who don’t will stay away, otherwise they will be put in a position where they may have to choose between blockers or a relationship with their child. There will be inherent bias built in unless the advisory groups are made up of parents with a range of views together with detransitioners.
• Offering blockers as a choice will inevitably steer children away from psychological support only. As Marcus Evans (former Director of Nursing, Clinical Director and Head of the Adult Dept and governor at the Tavistock & Portman NHS Trust) said in an excellent post on X:

“It’s like standing outside a drug rehabilitation service and saying Today, we’re offering psychological support over here, or you can get opium over there.”

• And finally, a study that seeks to find out if blockers affect children’s cognition and brain development is simply not ethical. There is nothing that justifies trialling an unnecessary drug on children to see if it causes brain damage.

The Tavistock GIDS Early Intervention Study

From information gathered so far, the new trial is set to be a repeat of the Tavistock GIDS Early Intervention Study (EIS) on puberty blockers which began in 2011, was rolled out to all children in 2014, with results finally published in 2021. This is what the study showed:

Impact on mental health

Despite the Tavistock’s claims that results were positive overall, a secondary analysis revealed a more worrying picture:

Data indicate that across all scales with both self-report (YSR) and parent report (CBCL), the majority of participants experience no reliable change in distress across all time points. Between 15% and 34% reliably deteriorate and between 9% and 29% reliably improve.

The results show that rates of clinically significant change are low when compared with CAMHS services which typically see around 50%. This means that puberty blockers are a comparatively ineffective treatment for what they are intended to do, or for the outcome that justifies their use, which is to improve psychological functioning and relieve gender dysphoria in the short term.

By the measure of mental health, results are poor. We can predict that the majority of children in a new trial will either not improve or see worsening mental health.

The one reliable outcome

There is one outcome of the study that can be considered reliable evidence, as it has been replicated in study after study. And that is that puberty blockers almost inevitably lead to cross sex hormones (CSH). In the case of the EIS it was 98% of the study participants.

The original 2010 research protocol submitted for ethical approval declared that one of its three aims was to ‘evaluate persistence and desistence of the gender identity disorder and the continued wish for gender reassignment.’ The results of the study clearly indicate an extremely high persistence rate for the children on the blocker.

However, the study design was later changed to say that it was not designed to investigate the implications on persistence or desistence of offering puberty suppression to a wider range of patients, it was limited to a group that had already demonstrated persistence and were actively requesting puberty blockers.

On publication of the study results the Tavistock team claimed that one child not progressing to CSH is evidence that ‘development of gender identity continues’ while on blockers, in total contradiction of the findings: it is in fact conclusive that blockers lock in a childhood ‘gender identity’ for the vast majority.

Although results of different studies (including the Dutch) were already showing this at the time of the EIS, we might be able to excuse the Tavistock GIDS then, but we certainly can’t now.

From all studies of blockers there is one dependable, reliably evidenced outcome: blockers set a child on a medical pathway they will not get off. Blockers do not buy ‘time to think.’

The vast majority of children recruited to the new puberty blockers trial will progress to cross-sex hormones, with a greater likelihood of subsequently progressing to surgery and a lifetime as a medical patient.

Short term follow up

The study recruited over a three year period from 2011. It was supposed to publish results after two years, but finally published in 2021. According to the Tavistock’s information the study concluded in February 2019: ‘when the last cohort member began the next stage of therapy (cross-sex hormones) at age 17 years.’

But the study did not follow up these children, they were lost once they progressed to adult GICs.

In 2019 the Tavistock GIDS received £1.3 million in funding from National Institute for Health Research (NIHR) for a longitudinal study into the outcomes for children referred to the service. The Longitudinal Outcomes of Gender Identity in Children (LOGIC) study was described as ‘innovative and will include both quantitative and qualitative approaches.’

Uniquely, an independent team of researchers will follow a whole group of volunteer young people who have been referred to the Gender Identity Development Service (GIDS), whether these young people and their families remain in contact with NHS services or not and no matter what path they choose. This will allow the researchers to compare and investigate outcomes for the entire cohort, including both those who go on to use physical interventions such as hormone blockers and those who do not.

Polly Carmichael acknowledged the limits of short term evidence:

While we know how children and young people are doing in our care, we have struggled in the absence of such research to understand how the care we provide affects them in the longer term and what choices they go on to make as they move into adulthood.

Carmichael also said the centre had recently been given a research grant “to follow young people who come to the service through and forward, whatever their outcomes, and that is going to be really important information”.

However, the study was only set to run for five years, with follow-up questionnaires at 12 and 24 months. It seems to have been interrupted by Covid and we can find only one published research paper, which is in regard to children on the waiting list.

Long term research is still lacking, children on the Early Intervention Study were not followed up and it is long-term outcome data we need. The Early Intervention Study is incomplete without this data. Children taking part in the new trial will add nothing to the evidence base we need.

Ethics

Working with another researcher, we looked into the process by which the GIDS finally obtained ethical approval for their Early Intervention Study.

The EIS was initially denied ethical approval by one Research Ethics Committee. Rather than amend and resubmit their proposal to the same committee (as is normal) the GIDS team resubmitted essentially the same proposal to a different committee. Several members of the second committee had connections with University College London, the institution of Russell Viner, one of the co-authors of the EIS.

We do not know if this conflict of interest was declared.

BBC Newsnight conducted their own investigation and reported on the outcome. The Health Research Authority (HRA) conducted an official review of the process and cleared the Tavistock GIDS of any wrong-doing. Michael Biggs published an analysis of the HRA review for Transgender Trend in 2019. Major concerns include the failure of the research team to submit annual reports in 2013, 2014, and 2015. This was casually dismissed by the HRA because ‘it is common for researchers not to supply annual progress reports.’

But the HRA report did give us something useful. It finally put to bed the claim that blockers are a ‘pause button’ that give a child ‘time to think.’ This statement is an admission of the real purpose of puberty blockers:

It would have reduced confusion if the purpose of the treatment had been described as being offered specifically to children demonstrating a strong and persistent gender identity dysphoria at an early stage in puberty, such that the suppression of puberty would allow subsequent cross-sex hormone treatmentwithout the need to surgically reverse or otherwise mask the unwanted physical effects of puberty in the birth gender.

In fact, the Tavistock & Portman’s announcement of the trial admitted as much:

This intervention, which is deemed reversible, is part of a step-by-step approach in the journey to harmonise the body to the person’s enduring self-perception of their gender identity.

The whole purpose of blockers is to prepare the body for cross-sex hormones. The new puberty blockers trial will be putting children’s whole futures at risk for purely cosmetic reasons.

For the majority of children taking part in the new trial, any chance of a future without medical dependency, a future without bone and brain damage, with fertility and sexual function intact, and the chance for normal adult romantic and sexual relationships, will be sacrificed so that they can look more like the opposite sex in childhood, based on an ideology that adults have taught them is fact.

Will the new puberty blockers trial be honest with children and parents that the purpose of the treatment is purely cosmetic and that the likelihood is that these children will never go through puberty to reach adulthood?

Missing data

Back to the missing long-term outcome data. We do in fact have some data, obtained by the Telegraph, that 3,490 women were referred for “masculinising chest surgery” between 2021 and 2023.

The number has risen slightly each year, from 1,089 in 2021 to 1,164 in 2022 and 1,237 in 2023.

And over three years, more than 780 women were referred for “masculinising genital gender reassignment surgery”, also known as “bottom surgery”.

Is this what has happened to the huge, unprecedented spike in teenage girls referred to the Tavistock GIDS from around 2015? Are they are now having double mastectomies and risky surgery to attach cosmetic phalluses to their bodies, on the NHS?

In conclusion

No, it wasn’t ethical to experiment on children’s healthy bodies the first time round and it is certainly not ethical to do it again. The main reason the Tavistock GIDS embarked on the first trial was not to follow normal medical standards of research, but as a response to pressure by ideological groups like Mermaids. Questions remain about the way they gained ethical approval, despite being cleared by the HRA, and this does not give us confidence in the ethical review process now. Given what we know now compared to what was known then, there is no justification to conduct this experiment again.

Last November we were co-signatories of a letter to the Health Secretary, authored by Carrie Clarke, Director of Genspect UK, expressing our concerns, which was covered in the Telegraph. We wrote to him again this week, following the revelation that the NHS has not obtained the data necessary to complete the Cass Review’s data linkage study. Our letter can be seen here.

As we commented for this article in the Telegraph:

Puberty is an essential growth stage for a child to go through to reach adulthood. The sex hormones released at puberty are vital for healthy male or female development.

It is unethical to experiment on children’s bodies in order to find out how serious and long-lasting those harms will be. A child cannot weigh the risks of an interrupted puberty which may impact their fertility, sexual function and brain and bone development. It is unclear what the purpose of the treatment is or what such a trial would achieve.

We are fully behind Keira Bell and James Esses in taking legal action if the HRA does not call off the trial.