NI to join trial to assess use of puberty blockers

Northern Ireland is set to be part of a clinical trial to assess the risks and benefits of puberty-blocking drugs in children who question their gender.

That is according to a review of Northern Ireland's gender identity services carried out by Dr Hilary Cass.

Baroness Cass also said that children and young people should be fully and holistically assessed before being placed on any medical pathway to change their gender.

The Health Minister Mike Nesbitt had appointed Baroness Cass to review Northern Ireland's gender services.

Baroness Cass is a consultant in paediatric disability and a former president of the Royal College of Paediatrics and Child Health.

She previously carried out a review of gender services for young people for NHS England.

It found that children had been let down by a lack of research and "remarkably weak" evidence on medical interventions in gender care.

Her review also found there was not "good evidence" that puberty blockers, which pause the physical changes of puberty, were safe or effective.

But researchers from King's College London are carrying out a clinical trial involving about 220 children under the age of 16 who are going through puberty.

The trial will examine the impact of the drugs on their physical, social and emotional well-being.

However, it has proved controversial with some campaigners saying it is unethical and could harm children.

In her review of gender services in Northern Ireland, Baroness Cass said that Northern Ireland was set to be a research site within the puberty blocker trial.

She said that "would require significant staff training, changes in clinical processes, and establishment of the necessary research infrastructure".

"There will also need to be training on all relevant aspects of the research protocol, including preparatory work in the lead up to a young person being considered eligible for puberty blockers."

She also said that engagement with the Kings College London team behind the trial was "urgent".

The Belfast Health Trust runs the Brackenburn Clinic, based in south Belfast, which has a service for adults experiencing gender dysphoria and a separate service for young people called Knowing Our Identity (KOI).

There are about 150 people using the adult services, including 25 new patients monthly, while about 60-80 children and young people are referred annually to the KOI service.

In order to address a growing waiting list for gender services in Northern Ireland, it is planned to bring under-18s and adult services together under a single "Lifespan Gender Identity Service".

Baroness Cass was asked to examine whether planned changes to services for young people in Northern Ireland complied with the recommendations from her review in England.

Her review included meetings with staff and users of gender identity services in Northern Ireland.

"This is a challenging and contested area of medicine and aligning the Northern Ireland services with those in England would be beneficial," Baroness Cass wrote.

"Ensuring a safe, standardised clinical pathway from assessment to treatment is a priority."

Baroness Cass' review called for better research into the characteristics of children seeking treatment and to look at outcomes for every young person.

She said that gender identity services for young people in Northern Ireland were helped by referrals coming from Child and Adolescent Mental Health Services (CAMHS), which ensured early mental health treatment when needed.

However, some CAMHS staff expressed frustration "that there are children and young people on their caseload who are awaiting the KOI service but cannot access it".

The review said that is a comprehensive assessment of young people was "fundamental, capturing individual physical, psychosocial, mental health, neurodiversity, and educational needs, enabling tailored interventions before any medical pathway is considered."

"There was recognition that there is a very small subgroup of children whose gender incongruence persists long-term and who may require ongoing support and possible medical interventions," the review said.

"However, support for parents to keep options open and manage distress is critical to avoid premature or inappropriate social transitions."

The review contains a number of recommendations but said that clinical practice in Northern Ireland should be aligned with that in England.

Baroness Cass said, though, that the Lifespan model should enable "a much smoother 17-25 year transitional care pathway" from children's to adult services.

In a statement, Nesbitt thanked Baroness Cass and her team "for taking the time to conduct this assessment during their visit to Northern Ireland in November".

"I hope this report gives assurances that the new Lifespan Gender Service is compliant with Dr Cass' 2024 review, and that the decision to invest in new and additional psychological and psychiatric support is the right approach," he said.

In July, he had faced criticism from some unionist politicians after more than £800,000 was allocated to gender identity provision in Northern Ireland.