Puberty Blocker Evidence Brief Affirms Aotearoa’s Approach

The Professional Association for Transgender Health Aotearoa (PATHA) welcomes Manatū Hauora’s (the Ministry of Health’s) evidence brief and position statement into the use of puberty blockers in gender affirming care, released today. Today’s position statement makes it clear that puberty blockers can continue to be used as part of a comprehensive care plan for trans and gender diverse young people where needed. PATHA will continue to work to ensure access to this important care is maintained.

PATHA is an interdisciplinary professional organisation working to promote the health, wellbeing and rights of transgender people. Our members work professionally for transgender health in clinical, academic, community, legal, and other settings. Our vision is that all transgender people have equitable access to the healthcare they need, and that all healthcare providers have access to information and resources which enable them to provide safe and informed healthcare.

“It’s reassuring to see Manatū Hauora recognise the best-practice approach Aotearoa is already taking, making it clear that trans and gender diverse children and young people will still be able to access puberty blockers, and that there is a need for more long-term, Aotearoa-based research into the clinical, mental health, and wellbeing impacts of this care,” PATHA President Jennifer Shields said. “The Ministry has been clear - puberty blockers can continue to be used as part of a comprehensive care plan. The statement is not a new set of rules, but instead guidance that acknowledges the approach experts already use.”

Manatū Hauora’s evidence brief has found limitations in the quality of evidence for the benefits and risks of using puberty blockers, reflecting the methodological and ethical limitations of running randomised-controlled trials for gender affirming care. While the brief found some evidence that puberty blockers can slow the rate of bone density increase, it found no impact on renal or liver function, the onset of diabetes, or fertility, while finding benefits for mental health outcomes such as depression, anxiety, and suicidal ideation.

Manatū Hauora’s position statement is in line with current practice in Aotearoa, where healthcare professionals providing puberty blockers are experienced in providing gender affirming healthcare and are doing so with the support of interprofessional teams, and the young people accessing this care have access to social and mental health support.

“Manatū Hauora recognises the importance of access to high quality health care which meets people's needs” said Dr Rona Carroll, a GP working in gender affirming care and Vice President of PATHA. “As a clinician, an important aspect of providing equitable and holistic care is to give trans and gender diverse youth the time and space to explore their identity, free from prejudice. Puberty is a critical time of change and development and for some trans and gender diverse youth, puberty blockers provide much needed breathing space. We have decades of experience in using these medications in other medical contexts.”

Manatū Hauora has opened consultation on the possibility of further restrictions or regulations on prescribing puberty blockers for gender affirming care. PATHA is concerned about the appropriateness of opening this consultation on a medical matter to the wider public, particularly when the matter of gender affirming care has become highly politicised and subject to disinformation. The approach to providing this care outlined by Manatū Hauora’s position statement is in line with best practice. PATHA cautions against further restrictions, and would encourage Manatū Hauora to approach this care the same way they would any other health intervention.

“It’s important that Manatū Hauora continue to centre the young people seeking gender affirming care as they move forward,” Shields said. “Our rangatahi deserve the same access to healthcare as any other young person. Exploring any additional criteria or conditions should prioritise improving support for prescribing clinicians and ensuring equitable access to this vital care. There are likely to be human rights implications if any additional standards or barriers were introduced for trans and gender diverse young people, when none exist for cisgender young people accessing the same medication.”

PATHA welcomes the proposal for more Aotearoa-based research into the benefits of puberty blockers and the wellbeing of trans and gender diverse young people. During this process, the involvement of transgender community experts is critical. Research into the effects and impacts of blockers will need to include qualitative analysis with young people and their families to understand the experiences of those undergoing this care.

PATHA looks forward to reviewing the evidence brief in further detail, and to the opportunity for its members - and other clinicians and transgender community experts around the country - to provide expert advice as Manatū Hauora explores its next steps. These next steps will require input from clinicians, whānau, and trans and gender diverse people to ensure the best possible outcomes for the health and wellbeing of trans and gender diverse young people throughout Aotearoa.

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