Genspect’s Final Submission to the UK Commission on Human Medicines Puberty Blocker Consultation

Genspect fully supports the Government’s ban on puberty blockers for gender distressed children and young people. We believe the prescription of puberty blocking medication to youth experiencing distress about their gender represents a largely unregulated experiment, carried out for over fifteen years on a cohort of young people who are disproportionately likely to have experienced mental health difficulties, conditions like ADHD and autism and childhood trauma (Cass Review. 2024, p.26). In the wake of the landmark Cass Review, which found no evidence to support the prescription of puberty blockers to gender distressed youth, we believe it is time to stop the puberty blocker experiment.

The Commission on Human Medicines will already be familiar with Dr Cass’s factual findings in relation to puberty blockers. At the end of this submission, you will find a brief summary of the alarmingly poor evidence base underpinning the prescription of puberty blockers to gender distressed youth. But in this final submission, we would like to bring to the fore Genspect’s psychological insights and the lived experiences of the many trans identified people and detransitioners who have contacted us to share their experiences of taking puberty blockers.

Adolescent Development and the Sexual Awakening

“I think it’s a human rights violation to take that from a child because, like I said, I had no sexual experience before I went on blockers at 16.”

Jett, a detransitioned lesbian woman.

Listen to Jett’s full interview here.

Adolescence is a critical period of development, not just physically but socially, psychologically and sexually. As adolescents move towards adulthood, they come to understand themselves in relation to others, as the desire to be accepted by their peers and seek a romantic partner moves them away from the individualistic mindset of childhood towards the relational mindset of adulthood. Sexual and romantic awakening is a crucial part of this process and may eventually lead some young people distressed by pubertal changes to a renewed sense of self-acceptance. Early research showed that childhood feelings of gender distress resolved after adolescence for some 85% of patients who did not undergo medical intervention, suggesting that weathering the storms of puberty may be crucial to developing self-acceptance and becoming comfortable in our bodies (Bradley and Singh et al. 2021). Blocking puberty may interfere with this process, unnecessarily altering the trajectory of a young person’s identity development towards further medicalisation and all the risks that entails.

Jett, a detransitioned lesbian from the Netherlands who took puberty blockers from the age of 16, has described how her intimate and sexual development was derailed by puberty blocking treatment:

I had never really had a crush on anyone before I went on puberty blockers. I never met any gay person before I went on puberty blockers, never met a lesbian. And then…while I was on puberty blockers I met a lesbian girl and I knew I liked her but I just…I didn’t have any feelings for her, like I didn’t want to kiss her, I didn’t have any sexual feelings because I was on blockers. I knew I liked her, and it just wasn’t making any sense…I didn’t have my own sexuality and so I knew I was in love with this girl, but I wasn’t experiencing actual attraction to her. And like, you do need that sexual attraction when you’re crushing on someone. It’s important also in the context of love.

Jett experienced physical side effects from taking puberty blockers including pain in her genitals and at orgasm. These effects further alienated her from her body and made sexual intimacy appear painful and scary:

I had no experience with my body, none whatsoever. Only at the age of 22 have I experienced healthy genitals, and non-painful orgasms and that sexuality is actually nice. While for those six years between age 16 and 22 I thought sexuality was gross, I thought my body was gross. My genitals hurt; orgasms hurt. I didn’t want to be with anyone. I was ashamed of my body and like I said I wasn’t actually crushing on anyone in a normal way. Nothing made any sense.

Jett is quoted at the beginning of this section describing puberty blocker treatments as a human rights violation. Genspect tends to agree with her. The puberty blocker ban upholds the right of children to an open future, by preventing irreversible harms to young people during the crucial and turbulent period of adolescent development.

Puberty Anxiety

“Well, maybe it would be ok for me to try and like, give it up to mother nature for a while. Instead of constantly fighting like I’ve felt like I have to be doing. Maybe I just need to try surrendering for once…People think medicine improves everything but sometimes it’s best to just like, relax and let nature do its thing.”

Johnny (also known as ‘Scarlett’), a detransitioned gay man.

Listen to Scarlett, who has detransitioned and is now known as Johnny, in full here.

Many adolescents, including those who do not have gender dysphoria, experience distress around pubertal changes like periods, the growth of pubic hair and other physical changes. It’s also normal for young people to feel squeamish, ashamed, uncertain or overwhelmed by their developing sexuality. Blocking adolescent development may temporarily relieve these feelings of puberty anxiety but it also enables young people to engage in avoidance, running away from the source of their distress rather than building resilience by confronting developmental fears in a supportive environment.

Johnny, a male detransitioner who has shared his story with Genspect, started taking puberty blockers when he was 13. Johnny was diagnosed with high functioning autism in childhood and realised early on that he was attracted to other boys. But same sex attraction was stigmatised in his fundamentalist Christian community and Johnny, already struggling with body image issues, was disgusted by the overtly sexual messages he received from older men online. He has described seeking puberty blockers not because he positively wanted to be a woman, but because he was disgusted by the thought of developing into a man, which he associated with aggression, shame and sexualisation.

Johnny initially felt relieved when he began taking puberty blockers. It felt like his fears about development had been put on pause. But then he began experiencing debilitating hot flashes and repeated urinary infections. Genital atrophy caused knife like stabbing pains and Johnny suffered with painful full body muscle spasms. After two years on the blockers Johnny had to stop, saying: “It literally felt like my body was breaking down.”

Johnny was prescribed oestrogen which he continued to take after stopping the blocker. Since detransitioning, he has shared that his unusual body type can make his intimate relationships difficult, saying: “The public doesn’t know how to react to me.” He has spoken movingly about his youthful to desire to “meet Prince Charming” and his disappointment on discovering that his feminised male body limits his dating pool, drawing unwanted attention from fetishistic older males seeking sexual novelty rather than meaningful connection. When the blockers were first prescribed to him at the age of 13, he simply didn’t have the life experience to anticipate or understand these consequences of radically altering his natural development.

Johnny’s story shows how powerful and profound the urge to hide from developmental fears can be and the way in which puberty blockers offer only illusory relief from such fears. As he states in the quote at the beginning of this section, “People think medicine improves everything.” Medicalising developmental anxiety fails to resolve underlying feelings of distress while causing irreversible changes to the body. Genspect believes the puberty blocker ban sends a strong message against over medicalisation and towards more holistic acceptance and understanding of the complexity of human distress.

Brief Summary of the Evidence

The Cass Review’s systematic review found only one high quality study on the use of puberty blockers to treat gender distress in young people. Fully 48% of the identified papers were of such low quality that they could not be included in the analysis (Cass Review. 2024, p.175). In light of this very poor evidence base, the ban is an entirely appropriate measure to protect public health.

Some of the risks associated with use of puberty blockers include:

• Physically, deleterious effects of puberty blockade include bone, brain and cardiovascular health issues (Cass Review. 2024, p.178-179). We have no idea whether these effects are reversed when a young person moves straight from puberty blockers to an artificial puberty induced by cross sex hormones, but up to 98% of people treated with puberty blockers will do just this (Carmichael et al. 2021).
• President of the discredited World Professional Association of Transgender Health (WPATH) Dr Marci Bowers has admitted that blocking puberty at Tanner Stage 2 appears to cause permanent anorgasmia (Barnes. 2024). Children prescribed puberty blockers may therefore never experience sexual pleasure or intimacy as adults.
• Cognitive development, executive function and IQ all appear to decline following treatment with puberty blockers. One case report found a 10-point drop in global IQ following treatment with puberty blockers for gender distress (Cited in Athéa and Jorgensen et al. 2024), but evidence from studies examining puberty suppression in the treatment of precocious puberty also point to declines in cognitive functioning. Animal studies suggest these effects may be permanent, and do not recover when puberty blockers are stopped. Blocking puberty in young people is therefore associated with a strong chance of impaired cognitive development (Cass Review. 2024, p.178).

The Cass Review further found that there was profound disagreement in the medical community over the rationale for prescribing puberty blockers (Cass Review. 2024, p.173-174) and their intended effect (Ibid. 2024, p.176-177). While this lack of professional consensus persists, the ban will protect vulnerable young people from inappropriate medicalisation:

• Time to think: The traditional rationale, that puberty blockade provided gender distressed youth “time to think”, has been comprehensively disproven: the UK’s early intervention study shows that 98% of youth who take puberty blockers proceed to cross sex hormones (Carmichael et al. 2021). Puberty blockers are not a neutral intervention and instead appear to place gender distressed youth on a conveyor belt towards further medicalisation.
• Cosmetic outcomes and ‘passing’ in adulthood: This rationale was first put forward by Dr Peggy Cohen-Kettenis, who argued that blocking puberty would help gender distressed young people to ‘pass’ better as the opposite sex in adulthood. In fact, blocking male puberty stunts penile growth, making conventional vaginoplasty difficult or impossible. Puberty blocked boys seeking vaginoplasty must use a graft taken from their intestine, massively increasing the risk of infection and surgical complication (Cass Review. 2024, p.178). For girls, the effects of testosterone on the body are so powerful that full masculinisation occurs rapidly following commencement of cross sex hormones, regardless of whether the patient has been through female puberty (Cass Review. 2024, p.180). Blocking the puberty of girls therefore appears to be pointless, while blocking the puberty of boys may actually make it more difficult for them to ‘pass’ in adulthood. Whether or not a young person persists in a trans identity and wishes to pursue medical transition, puberty blockers carry many risks and few benefits.
• Reducing gender distress and improving body image: No evidence has shown that puberty suppression improves either feelings of gender distress or body satisfaction (Cass Review. 2024, p.176).
• Improving mental health: No randomised control trials have been conducted on the impact of puberty suppression on mental health, but findings from non-randomised trials have shown only “modest and inconsistent” results (Cass Review. 2024, p.177). Given the serious risks and unknowns associated with puberty blockade, other non-invasive, evidence-based approaches to improving mental health should be the first line of treatment.
• Suicide Prevention: A pervasive myth has sprung up that withholding puberty blockers from gender distressed youth will cause them to commit suicide. The Cass Review found no evidence to support this view, observing that young people in the gender distressed patient cohort are no more likely to commit suicide than other young people with mental health conditions (Cass Review. 2024, p.179). Professor Louis Appleby (2024), a UK government adviser on suicide prevention and mental health, has confirmed that the claim of increased suicides among gender distressed youth “is not based on evidence” and condemned the perpetuation of this myth.