Scotland Pauses Puberty Blockers for Teens

AP Photo/Rick Bowmer

The Cass Review of pediatric transgender care in the UK was released earlier this month. The gist of the report was a criticism of the current approach to "gender-affirming care." Rather than rush teens onto puberty blockers and hormones, the Cass Review suggests therapists should take a more holistic approach and hold off on life-changing drugs for kids.


In keeping with the Cass Review's findings, England and Wales put a stop to the prescription of puberty blockers in all but a few cases. But Scotland has its own National Health Service and its own gender clinic which was not bound by the decisions made in England. The SNP government led by First Minister Humza Yousaf seemed to be dragging its feet in response to the review. 

Today the SNP seems to have reversed course. Scotland's NHS announced that it would be following the advice of the Cass Review and no longer prescribing puberty blockers and hormones.

The Sandyford Clinic in Glasgow said that it would also no longer prescribe “gender-affirming hormones” to under 18s.

The move follows intense scrutiny of methods at the Sandyford, which has been branded the “tartan Tavistock”, following the publication of the review by Hilary Cass, the esteemed paediatrician.

The SNP had previously said the Scottish NHS would take time to review her findings, suggesting many parts of the damning Cass report for NHS England did not apply to Scotland.

As recently as Monday, ministers insisted there would be no “snap judgments” over whether to follow Cass and they backed clinicians prescribing the drugs, saying they followed “very high standards”...

The youngest known patient to be prescribed puberty blockers after being seen at the Sandyford was just nine years old.

This means that more than 1,100 patients currently on a waiting list at Sandyford will not be able to get puberty blockers or hormones until they turn 18.


Figures released to BBC Scotland News under a freedom of information request, showed that at the end of 2023, 1,100 patients were on the waiting list...

The decision to pause both these treatments for new patients goes further than the changes announced by NHS England.

Hormones now cannot be accessed in Scotland until a patient is 18 while in England they can be prescribed "around the patient's 16th birthday".

The Cass Review is also having an impact in other European countries:

Belgium and the Netherlands have become the latest countries to question the use of puberty blockers on children after the Cass Review warned of a lack of research on the gender treatment’s long-term effects...

“In our opinion, Belgium must reform gender care in children and adolescents following the example of Sweden and Finland, where hormones are regarded as the last resort,” the report by three paediatricians and psychiatrists in Leuven said.

Figures from the Netherlands and the United Kingdom show that more than 95 per cent of individuals who initiated puberty inhibition continue with gender-affirming treatments,” the report by P Vankrunkelsven P, K Casteels K and J De Vleminck said.

“However, when young people with gender dysphoria go through their natural puberty, these feelings will only persist in about 15 per cent.”

Where the Cass Review does not seem to be having much impact so far is in North America.

Though the review's findings are being used to restrict access to puberty blockers in the U.K., no Canadian medical organization that responded to CBC News said it would change advice here.

"As with all areas of medicine, new and emerging evidence is evaluated as it becomes available," said the Canadian Pediatric Society in a statement. 

"Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient's mental and psychosocial health."

Children's Healthcare Canada, which represents children's hospitals, referred to its previous statement in support of evidence-based gender-affirming care for youth, saying: "Our position remains unchanged on the topic."


In the US the Cass Review seems to have only barely made an impact in the media. Today the Washington Post published an opinion piece by the board president of a group called Therapy First about the Review and why more people aren't talking about it.

Usually in psychotherapy, treatment approaches are refined and improved by vigorous discussion, research and dissemination of new information. When it comes to youth gender treatments, though, professionals who raise concerns have been censored and subjected to reputational damage, threats to their license and doxing. As a result, countless gender nonconforming young people have been badly served...

What I’ve learned is that therapists who cite the poor quality of evidence in support of medical interventions for youth gender dysphoria, or who advocate traditional principles of psychotherapy in this area, are likely to be vilified — sometimes by fellow clinicians. Last week alone, eight complaints were filed against one of our members’ licenses by other therapists for simply posting, on a professional Listserv, the link to one of our organization’s webinars, on trauma-informed mind-body practices...

It isn’t right that professionals must risk their livelihood and reputation to help young people struggling with gender dysphoria. If the culture of bullying persists, I fear that fewer clinicians with a developmental approach will be inclined to keep working with this population. These young people will be left with clinicians who aren’t following the science, many with good intentions, but others who might behave more like activists than mental health professionals.


In the US, the activists are still in control of the debate and anyone who runs afoul of them is at risk of paying a steep price. So for now only the bravest souls are willing to admit that the Cass Review really ought to change the approach taken here in the US as well.

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