Scottish health boards pause prescription of puberty blockers for young people

Scotland's only gender identity clinic for under-18s has paused the prescription of puberty blockers to young people.

NHS Greater Glasgow and Clyde (NHSGGC) - which controls the Sandyford clinic in Glasgow - said it made the decision following a landmark review of gender services for under-18s in England and Wales.

Dr Hilary Cass' review said children had been let down by a lack of research. She also reported that there was "remarkably weak" evidence on medical interventions in gender care.

NHS England confirmed it would stop prescribing puberty blockers in March.

NHS Lothian has also formally paused the prescription of puberty blockers and gender-affirming hormones for new young patients seeking gender-affirming care.

Existing patients who are currently receiving hormone suppressants or gender-affirming hormones will not be affected by this pause.

Announcing the move on Thursday, NHSGGC said it received the support of Scotland's chief medical officer Professor Sir Gregor Smith.

On clinical advice, NHSGGC and NHS Lothian deferred starting new patients on treatments in mid-March in response to the position taken by NHS England and while the publication of the Cass Review was awaited.

Patients have now been formally notified of the pause while NHSGGC works with the Scottish government to engage in research with NHS England that will generate evidence of safety and long-term impact for therapies.

Dr Emilia Crighton, NHSGGC director of public health, said: "The findings informing the Cass Review are important, and we have reviewed the impact on our clinical pathways.

"The next step from here is to work with the Scottish government and academic partners to generate evidence that enables us to deliver safe care for our patients.

"We echo the views of Dr Hilary Cass that toxicity around public debate is impacting the lives of young people seeking the care of our service and does not serve the teams working hard to care and support them.

"We understand the distress that gender incongruence can cause and, while all referrals to endocrinology are paused, we will continue to give anyone who is referred into the young people gender service the psychological support that they require while we review the pathways in line with the findings."

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Tracey Gillies, executive medical director at NHS Lothian, said patient safety "must always be our priority" so it is "right that we pause this treatment to allow more research to be carried out".

Since the publication of the Cass Review, the Scottish government has faced pressure to respond to its findings.

Meghan Gallacher, depute leader of the Scottish Tories, said the Scottish government had been "dragged kicking and screaming towards taking the necessary action to safeguard vulnerable youngsters after days of shameful silence and dithering in response to the Cass Review".

Neil Gray, Scotland's health secretary, said it is for clinicians and health boards to make decisions about clinical pathways.

He added: "This is what both health boards have done, and their position is supported by the chief medical officer.

"More broadly, the Cass Review's final report and findings are being closely considered by both the Scottish government and health boards, in the context of how such healthcare can be best delivered in Scotland.

"We agree with Dr Hilary Cass when she highlights that 'increasingly toxic, ideological and polarised public debate' does nothing to serve the young people accessing this care, their families and the NHS staff working hard to care for them.

"I remain clear that it is right that those most impacted by this change were the first to hear about these changes, sensitively and from the services caring for them. They are who should be at the centre of our thoughts when we discuss this issue."