Carys Moseley comments on the new clinical trial on puberty blockers for children and teenagers
Dame Hilary Cass has welcomed a new clinical trial on puberty blockers for children and teenagers. King’s College London will be running the trial on more than 200 children, some as young as eight. This has sparked outrage and concern across the board, but the truth is that it was to be expected. I warned that the Cass Review was commissioning more research into puberty blockers as far back as 2022.
Dissenting psychotherapists plead for trial to be stopped
Two psychotherapists who used to work at the Tavistock clinic, Marcus and Susan Evans, have written a letter to Wes Streeting pleading for this clinical trial to be stopped before starting. They called it a ‘shallow, harmful medical trial’, and warned that lessons needed to be learnt from ‘recent medical failures’.
Follow-up of children limited to two years
The psychotherapists warn that the trial will only allow follow-up on the children involved for up to two years afterwards. They warn that this is too short a time period, because only once they are adults would it be possible to assess the effects of puberty blockers. These include ‘sterility, impaired sexual function, lifelong dependence on medical care, and the psychological impact of irreversible physical changes.’
Undermining the ability to start a natural family
The psychotherapists warn that these young people subjected to puberty blockers may not be able to start a family naturally.
“As they age, their peers might be building families, and the reality of permanent losses and potential sterility becomes undeniable.”
In other words, those who were subjected to puberty blockers may become infertile and live a life marked by avoidable loss.
Undermining psychological treatment
At the same time, the psychotherapists warn that the clinical trial and short-term follow-up will create another problem.
“The question of whether they would have learned to accept their bodies through psychological support becomes unanswerable.”
As an alternative, they call for study into psychological treatment for children with gender dysphoria to be restarted immediately.
The social harm of a clinical trial of puberty blockers
The two psychotherapists delve into the deep social harm caused to children and teenagers by this proposed clinical trial. This is important because a lot of the coverage of the issue has been dominated by warning of the physical harms. They emphasize that the trial is flawed because it only intends to find certain things out.
“The trial overlooks how the very prospect of medical intervention affects their mental state during assessment, and it fails to consider what this communicates: that their distress is unbearable instead of something they might be supported to work through.”
In other words, the whole aim of puberty blockers is to stop the distress associated with being unhappy as a member of one’s sex.
The psychotherapists go on to warm that the clinical trial would actually leave these young people behind their peers developmentally, intensifying their confusion and isolation.
“While their friends face the social and psychological challenges of puberty, forming new relationships and shaping their adult identities, these young people remain frozen at an earlier stage. This divergence from their peers may worsen their difficulties rather than help, reinforcing their feeling they cannot manage what their peers are handling, at the very moment when connecting with peers matters most.”
Using Cass to undermine Cass
It is significant that in their nine-page letter to the government, these psychotherapists deploy the tactic of quoting the Cass Review to undermine the clinical trial. This is despite the fact that it is Dame Hilary Cass who recommended the clinical trial in her review.
Commenting on the inadequate design of the clinical trial, they say this:
“This is not the ‘careful, clinical research’ Dr Cass called for; it is research aimed at answering the wrong question at the wrong time. Any reported ‘improvement’ will be because the child has been enabled to avoid the physical and psychological conflicts of adolescence and ordinary human development, but where will this leave them?”
Back in April 2022 I warned that the Cass Review’s Interim Report barely paid attention to the role of psychotherapists on gender-confused children. It promised a literature review when in reality such a review of the historical literature on psychotherapy with gender-confused children should have been the first piece of work completed.
Two years later in May 2024 I warned that the completed Cass Review actually recommended no lower age limit for children’s ‘options’. In the last section on the Service Model, Cass said some children ‘may benefit from puberty blockers’, and recommended a clinical research trial for young children to assess this.
It is pointless for opponents of the clinical trial to try to quote the Cass Review to undermine what it in fact recommended, namely a trial of puberty blockers. We are long past the point where it is acceptable to continue with such compromise tactics.
Clinical trial designed without consultation with whistleblowers
The psychotherapists appeal to Cass’ documentation of the ‘systematic silencing of the debate’ in the mental health field. They are aggrieved that the new clinical trial ‘has now been designed without consultation with the clinicians who initially raised the alarm.’
Is anybody surprised by this? They shouldn’t be. Dame Hilary Cass is not a psychotherapist or psychiatrist; she is a paediatrician who accepts puberty blockers ‘may’ be suitable for some children, not someone who objects to them due to seeing gender dysphoria as the sole province of mental healthcare.
The letter ends with a plea to Wes Streeting to be aware of how few mental health professionals ‘with this level of knowledge and experience have been asked to contribute or comment’. Sadly, this is unsurprising. For the reality is that only a brave minority of clinicians at the Tavistock Clinic blew the whistle and resigned over puberty blockers. There can be little doubt that their more compliant colleagues will mostly be only too happy to support the clinical trial and the new gender hubs in NHS England.
Lessons to be learned?
The Cass Review is morally unreliable in two respects. First, in that it did not initially start with considering the history of psychotherapy with gender-distressed children and teenagers. Second, it left the door open for puberty blockers and proposed a clinical trial, and for ‘social transition’ for children. All this is echoed by the discrepancy between Wes Streeting’s public and private or secret comments on the topic which I highlighted in September. In private he lamented the ban on puberty blockers, while in public he claims to support the ban. He gets away with this because only a minority of psychotherapists involved in this field, at least at the NHS level, have objected to puberty blockers.
There simply is no point in trying to inhabit a putative middle ground on this issue. Puberty blockers are very likely to make things worse for the children and teenagers who receive them. The government has not really listened thus far, it has only pretended to listen. The Cass Review seems clearly intended to preserve the status quo one way or another. This is what we would expect in a post-Christian society which rebels against the created givenness of our biological nature as male and female. There is only one way forward here: campaign to scrap the clinical trial by standing apart from the compromised Cass Review’s overall philosophy.
