The UK is the latest country to ban puberty blockers for trans kids. Why is Europe restricting them?
The United Kingdom has banned puberty blockers for children and adolescents under age 18, making it the latest country in Western Europe to limit access to the treatment for transgender and gender-questioning youth.
The rule extends a temporary ban issued earlier this year on the sale and supply of puberty blockers, which delay the physical changes associated with puberty, such as the growth of breasts, testicles, and body hair, and a deeper voice.
Typically used for children with precocious puberty – when puberty starts around age 7 or younger for girls, and age 8 or younger for boys – puberty blockers can also be offered to children on the cusp of normal puberty, with the goal of giving young people time to consider their gender identity.
Later, adolescents may go on hormones like oestrogen or testosterone to develop in their chosen gender, or opt for more invasive procedures like surgeries when they are older.
The UK decision means gender-questioning adolescents will no longer be able to receive puberty blockers from their doctors. But the UK isn't the only country to roll back access in recent years.
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A handful of European countries – such as Sweden, Denmark, and France – have also moved to limit their use to research settings or in exceptional circumstances, amid intense medical debate over how to care for the growing number of children who identify with a gender other than their biological sex.
“We've shifted into a direction saying if we're going to stop normal puberty in certain young people, then we need to do it with our eyes open [and] collect the data very carefully,” Dr Ashley Grossman, emeritus professor of endocrinology at the University of Oxford, told Euronews Health.
“There may be some children who are going to improve, who feel this is absolutely the right thing to do, and others for whom it's inappropriate,” he said.
What has changed?
It’s an apparent reversal from the so-called “Dutch protocol,” which for years was hailed as the gold standard for medical care for transgender children.
In the 1990s, clinics in the Netherlands began offering puberty blockers and hormonal treatments to children and teenagers, who previously had to wait until adulthood to seek gender-affirming medical care.
In a long-term study published in 2014, Dutch researchers reported that access to these treatments had improved patients’ mental health and curbed their gender dysphoria, which is when someone experiences distress because their gender identity does not match their biological sex at birth.
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This care enabled them to “develop into well-functioning young adults,” researchers said.
But in recent years, clinicians and researchers in the Netherlands and elsewhere have argued that those findings may not apply to today’s gender-questioning youth, and that the early studies didn’t track how the patients fared long enough into adulthood.
In 2015, for example, Finnish researchers found that patients who were biologically female at birth were “markedly overrepresented” at two clinics specialising in gender identity, differing from studies done elsewhere and meaning the Dutch patients may have had different backgrounds and needs than the Finnish patients.
Further, 62 per cent of the Finnish patients began questioning their gender identity around age 12 or later, and many experienced gender dysphoria alongside other psychological issues and “considerable challenges” in their development overall.
Today, the medical debate is being driven by the “increase in the numbers of people who are presenting [to gender clinics], the change in the type of people presenting, and social changes,” as well as the “demand for some data and evidence” on puberty blockers, according to Dr Joe Brierley, a critical care doctor in the UK and head of ethics at the European Academy of Paediatrics.
“But it’s kind of hard, because at the same time as wanting data, no one's funding research,” Brierley told Euronews Health.
In 2020, the UK government commissioned Dr Hilary Cass, the former president of the Royal College of Paediatrics and Child Health, to assess the evidence on gender-affirming medical care for young people and provide recommendations.
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The landmark Cass Review was published earlier this year and concluded that the evidence on how puberty blockers affect children’s gender dysphoria and mental health is weak, and that it’s still unclear how the drugs affect their cognitive and psychosexual development in the long term.
How European countries approach puberty blockers
Countries like Denmark and Finland are now prioritising counselling and supportive services over medical interventions for young people with gender dysphoria.
In Denmark, the number of referrals to the country’s sole adolescent gender clinic more than tripled between 2016 and 2022 – from 97 to 352 – but patients have become less likely to be offered hormone treatments.
That share fell from 67 per cent in 2016 to 10 per cent in 2022, according to the Copenhagen area’s health agency.
In Finland, hormonal treatments can be given to adolescents if it is clear that their identity as another gender is of a “permanent nature and causes severe dysphoria”.
In 2022, the Swedish authorities said the risks likely outweigh the benefits of puberty blockers, but said that the treatment can be offered in “exceptional” cases to adolescents with gender dysphoria.
France takes a similar approach. The French medical academy says puberty blockers are available at any age with parental consent, but encourages “the greatest reserve” in their use given the potential long-term side effects, which may include osteoporosis or fertility issues.
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Meanwhile, in Norway, puberty blockers are limited to clinical trials, and in Spain and the Netherlands, they are available through specialist care.
The debate over how to care for these children is also ongoing in Belgium and Italy.
Yet while a handful of countries have limited the use of puberty blockers while calling for more research on them, other parts of Europe are moving to restrict gender-affirming medical care overall as part of a broader pushback against LGBTQ rights.
In Georgia, for example, the parliament passed a ban on all trans-specific healthcare in a bid to preserve “family values” this year.
“Different countries in Europe are in massively different places here,” Brierley said.
Going forward
Grossman said the debate over puberty blockers and other medical care for gender-questioning youth should be less politicised and instead focus on scientific inquiry into how safe the drugs are, how well they work for kids with gender dysphoria, and any potential long-term effects.
“There's been a lot of people riding on one train or another saying this is clearly, absolutely essential for these children, [or] we should never use it at all,” Grossman said.
“You've got to have the evidence”.
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In the meantime, Brierley said medical care for gender-questioning children should be more holistic, with better collaboration between pediatricians, specialists, and mental health professionals.
That could be especially important for children and teenagers who have already started puberty blockers or other gender-affirming treatments in countries where access has been rolled back, he said.
“There’s a bit of a gap… This has now been restricted, but nothing's really been put in its place just yet,” Brierley said.
“The child has to be treated as a person, with all of their issues looked at and considered”.
