Pressure from the public, including activists, contributed to the Ministry of Health’s decision to remove health advice regarding puberty blockers from its website in September.

While the ministry previously told media it had made the changes because it didn’t want to provide specific clinical advice, correspondence released under the Official Information Act shows the webpage was also edited “in the hopes it creates fewer queries”.

At issue was a line stating that puberty blockers “are a safe and fully reversible medicine”. The senior advisor who asked for it to be edited said “the statement is no doubt true”, but that some people disagreed with it.

A senior advisor in the Ministry of Health’s primary care team asked for the page to be altered.

A spokesperson for the ministry said the advisor wasn’t referring solely to queries directed at the ministry but also to public queries to doctors.

The ministry spokesperson initially didn’t answer a question about whether it had bowed to public pressure, including some from anti-trans activists. After this article was published, they told Newsroom the ministry disagreed with the claim.

“The September 2022 update to the website recognised that overseas jurisdictions, including UK and Sweden, were reviewing the use of puberty blockers in their health systems particularly in younger people,” they said.

“In light of the relatively limited and thin evidence available in this area, the Ministry’s advice was changed to align better with that.”

Minister of Health Ayesha Verrall also didn’t say whether the ministry had bowed to anti-trans pressure or whether she would seek to have the information restored, in a response provided to Newsroom after this article was published.

“Puberty blockers play an important role in the treatment of transgender people and continue to be prescribed by clinicians. All prescriptions need to be discussed in terms of the needs of an individual being treated. Resources and information can be found online on the Te Whatu Ora website,” she said.

Puberty blockers were pioneered to address a condition called precocious puberty, in which children start to undergo puberty too early. Since the late 1990s, they have also been used to help children questioning their gender identity delay the onset of puberty. This gives them time to decide whether to continue transitioning – at which stage partially irreversible treatments like hormonal care may begin – or to go through puberty.

The vice president of Professional Association of Transgender Health Aotearoa (PATHA) told Stuff in September that puberty blockers are only started after careful consideration with the involvement of youth, their families and their clinical teams.

In 2021, in response to a court decision in the United Kingdom that barred transgender youth from access to puberty blockers without a court order, experts from the World Professional Association for Transgender Health penned an editorial in the International Journal of Transgender Health explaining the importance of the medicine.

“Starting with hormone blockers such as Gonadotropin Hormone Releasing agonists (GnRHa), whose effects on pubertal development are considered reversible according to the current literature, young people are provided with ample time to explore their gender. If desired, this can be followed by a reversion to their birth assigned gender role,” they wrote.

“Whereas for those who wish to continue with their physical transition and who have been carefully evaluated by qualified clinicians, partially reversible hormonal therapy, and finally irreversible surgeries are options; it is not the case that one stage invariably leads to the next.

“It is important to realise that allowing puberty to progress in adolescents who experience gender incongruence is not a neutral act and may have lifelong harmful effects for a transgender young person such as stigmatisation, personal physical discomfort, difficulty with sexual function, and difficulty with social integration.”

Treatment of transgender youth with puberty blockers is supported in New Zealand by PATHA and the Royal New Zealand College of GPs and overseas by the Royal Australian College of GPs, the Royal Australasian College of Physicians, the American Medical Association, the American Psychological Association, the American Academy of Pediatrics, the Endocrine Society and the British Medical Association, among others.

Some medical professionals and other health experts have raised concerns about puberty blockers, distinct from the anti-trans movement.

Public health researcher Dr Sarah Donovan from the University of Otago argued last year, prior to the removal of the sentence on the webpage, that the New Zealand position was “out of step” with the approach now taken in a number of internationally renowned gender medicine clinics. 

In the UK, an interim report on gender affirming care made no recommendations on the use of puberty blockers due to gaps in the evidence base, but is expected to make recommendations as research and the review process continue. Subsequently Britain’s health authority, the NHS, proposed barring use of puberty blockers outside of formal research settings.

PATHA’s guidelines acknowledge prolonged use of puberty blockers may have effects on bone density and development but offer ways to manage this risk. Side effects are common in an array of other medications that aren’t used to treat transgender people as well.

Puberty blockers have also come under attack from non-professionals, including Republican politicians in the United States who have passed legislation which would remove transgender youth from their parents’ care if they are given puberty blockers.

The use of puberty blockers is associated with lower rates of depression, anxiety and suicidality in young people between six and 18 months after starting treatment.

This is significant because transgender youth are disproportionately likely to face mental health issues, with more than half saying they had seriously thought about suicide in the past year, in a recent survey.

The Ministry of Health spokesperson didn’t say whether the ministry still believed puberty blockers were safe and fully reversible. They said the ministry had conducted an evidence brief on the issue which is due to be released in May.

“That aside, it is important to note that any medical intervention carries a balance of benefit and risk that needs to be considered in context by the person in partnership with their health professional,” the spokesperson said.

“Anyone considering gender-affirming intervention for themselves or others should seek advice and guidance from a health professional.”

In September, after the webpage’s alterations were noticed, the ministry told Stuff that it still endorsed the guidelines from PATHA, which state: “Puberty blockers are considered to be fully reversible and allow the adolescent time prior to making a decision on starting hormone therapy”.

However, the ministry told Newsroom on Tuesday that it “has not gone through any formal process to review or endorse the PATHA guidelines”. A spokesperson was unable to explain the contradiction between the two statements.

Clarification: A previous version of this article wrongly implied that Dr Sarah Donovan was part of the anti-trans movement by referring to her piece on puberty blockers, published earlier by Newsroom, in the context of discussing anti-trans opposition to puberty blockers. The wording also suggested she was a medical professional, which she is not. Newsroom acknowledges this was incorrect and has made changes to rectify that, and apologises to Dr Donovan.

The headline and some text in this article have also been updated to reflect that public pressure was a contributing factor to the decision to change the website text and to make clear that not everyone involved in the movement to have the website changed is anti-trans.  Incorrect wording in a photo caption has also been deleted, as has the highlighting of an anonymous tweet referring to earlier complaints.

Marc Daalder is a senior political reporter based in Wellington who covers climate change, health, energy and violent extremism. Twitter/Bluesky: @marcdaalder

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