A consultant involved in the National Gender Service (NGS) has urged a much more cautious approach to the prescribing of puberty blockers for children in Ireland, pending more clinical research.
Puberty blockers are given by way of injections and they turn off the hormones in the brain that kick-start physical changes, such as breast development or facial hair.
Consultant endocrinologist at St Vincent's University and St Columcille's Hospitals, Professor Donal O'Shea, said the widespread prescribing of puberty blockers for children with gender questions should stop.
He was responding to the decision by NHS England that children will no longer be prescribed puberty blockers at gender identity clinics and they will only be available as part of clinical research.
The UK government said it welcomed the "landmark decision", adding it would help ensure care is based on evidence and is in the "best interests of the child".
Prof O'Shea said that clinical trials are planned on when and where puberty blockers should be used and Irish consultant psychiatrist Dr Paul Moran, who also works in the NGS is involved in the design of that NHS trial.
Prof O'Shea urged people to await the evidence of best use of puberty blockers in children.
He said that puberty blockers may have a role as part of the holistic care for some children.
The HSE said there are less than ten people under the age of 16 on puberty blocker medication, following specialist review by a team.
In a statement, the campaign group, Trans Healthcare Action said that the overwhelming evidence is that puberty blockers are reversible and safe treatment for trans youth, and they have been prescribed and studied as such for decades.
It said that denying trans youth access to these lifesaving medications means that their bodies will undergo unwanted changes such as beard growth or breast development, which not only could have detrimental mental health impacts but could also force them to undergo significant surgeries to reverse these changes in future.
It added that trans healthcare has increasingly become a topic for public debate in the media, and this has made it difficult for trans people to access essential gender-affirming care.
Read more: Leading doctors report HSE to HIQA over transgender care
Historically children were referred for assessment and treatment in the Gender Identity Development Service (Gids) run by the Tavistock Clinic in the UK, which is closing at the end of March and will be replaced by new NHS services in London and Liverpool.
The closure followed an independent review in 2020 in Britain by consultant Dr Hilary Cass into gender identity services for children under 18.
Some Irish children are now being notified of the service in Antwerp in Belgium.
Recently, HSE Chief Clinical Officer Dr Colm Henry produced a report for the HSE on developing a new model of care, with the aim of having a full domestic service.
Dr Karl Neff, consultant endocrinologist and new clinical lead for transgender services in Ireland is developing a model of care for children, young people and adults.
The service will also aim to cut waiting times for assessment and care for gender dysphoria.
The HSE said that a new clinical programme for gender healthcare is being set up and an updated clinical model will be developed over the next two years.
It said that a small number of children and young people may be prescribed puberty blocking medication following multi-disciplinary specialist review and on a case-by-case basis.
The HSE said that children and young people who require specialist psychological or psychiatric assessment and support are referred to The Children and Young People Gender National Referral Support Service in the UK who will triage these referrals to one of the newly developed services.
This service will start to see patients in April.
Tavistock Clinic under repeated scrutiny
In 2021/22, there were over 5,000 referrals to Gids, compared to just under 250 a decade earlier.
In February 2022, Dr Cass published an interim report saying there was a need to move away from one unit and recommended the creation of regional services to better support youngsters.
She also pointed to a lack of long-term evidence and data collection on what happens to children and young people who are prescribed medication.
She added that Gids had not collected routine and consistent data "which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service."
Following the Tavistock's closure, two new NHS services will now open in early April, situated in London's Great Ormond Street Hospital and Alder Hey Children's Hospital in Liverpool.
The NHS has said children attending these clinics will be supported by clinical experts in neurodiversity, paediatrics and mental health, "resulting in a holistic approach to care".
The consultation on the future of services received more than 4,000 responses, including around a quarter from members of the public, 22% from patients, 21% from parents, 10% from trans adults and 5% from clinicians.
Around 250 patients are expected to be transferred to the new clinics from Gids when they open.
Some 5,000 more children and young people are currently on the waiting list for referral into the new clinics.
Fewer than 100 young people are currently on puberty blockers in the UK.
They will be able to continue their treatment and are being seen by specialist endocrine services at Leeds and University College London Hospital.
It is understood NHS England hopes to have a study into the use of puberty blockers in place by December 2024, with eligibility criteria yet to be decided.
